Plastic Surgery / Chirurgie Plastique

Introduction: Trends within the Canadian plastic surgery workforce demonstrated that most work in academic or medium-large community practice. Recent studies observed more plastic surgeons are incorporating aesthetics into their practice. This study aims to identify factors influencing how plastic surgery residents and early-career plastic surgeons in Canada choose their eventual practice with respect to practice type and practice location. Methods: A REDCap survey was distributed to plastic surgery residents and early-career plastic surgeons across Canada between February and May 2024. Demographics, training information, career information, and Likert-scale questions for factors involved in decision-making were surveyed. Data analysis included descriptive statistics and Fisher exact tests. Results: There were 45 residents and 30 early-career plastic surgeon respondents. Mixed practices that included aesthetics were the most popular practice types among residents (73%) and early-career surgeons (77%). Half (53%) of early-career surgeons were working in urban settings with more than 1 million people, and 44% of residents desired these locations. Hometown factors heavily influenced practice type and location (P < .0001), more than training experiences. Positive interactions (94%), operating time (90%), partner opinion (87%), and hospital resources (86%) were ranked as the most important factors involved in practice decisions. Conclusion: Mixed practices that include aesthetics were the most popular among our up-and-coming Canadian workforce, especially in urban settings. These changing practice trends may impact our ability as a specialty to adequately meet the needs of the Canadian population. Recruitment efforts should focus on promoting a supportive workplace and local environment, with adequate operating time and resources.

Background: Patients undergoing mastectomy for breast cancer treatment can have three-dimensional nipple areola complex (NAC) tattoos as part of their reconstructive journey. The generally accepted size and position of the NAC is noted in the literature, however, patients may have different preferences. Methods: All patients undergoing NAC tattoos were given the option to pick the size of the tattoo and location on their chest. Post-procedure measurements were obtained as well as BREAST-Q surveys to examine patient satisfaction. Results: In 104 patients, average NAC tattoo diameter was 3.62 cm (±0.45), average sternal notch to nipple was 19.53 cm (±2.66) and average nipple to inframammary fold was 8.59 cm (±2.64). On multivariable analysis, areola tattoo diameter was found to be significantly larger in patients with larger size implants (P = .02), and Asian women (P = .04). On multivariable analysis, sternal notch to nipple was significantly greater in patients with higher BMI (P = .04). In patients with pre-operative photos for comparison, post-tattoo size and position of the NAC reconstruction, was significantly smaller and higher on the chest compared to their pre-operative values with an average NAC diameter of 3.60 cm (±0.46) (P < .001), sternal notch to nipple of 19.45 cm (±2.87) (P < .001), and nipple to inframammary fold of 8.89 cm (±2.80) (P < .001). Sexual well-being significantly improved with an average score of 53 (±25) after micropigmentation. Conclusions: This study shows women prefer small areola size with a higher position compared to classic values, and these values may be influenced by race, BMI and implant size. Additionally, sexual well-being is improved after NAC reconstruction.

Introduction: Breast cancer care requires both oncologists and plastic surgeons. Coordinating these specialists and combining extirpative and reconstructive procedures before adjunctive therapies can cause delays in care. For patients with less advanced disease, surgery is performed before adjunctive therapies, requiring early specialist coordination and the possibility of surgical complications. We compare these patients to those with more advanced disease requiring adjunctive therapies before surgery. Methods: A retrospective chart review identified 337 post-mastectomy + immediate breast reconstruction (IBR) patients. Patients were divided into surgery first (SF) and neoadjuvant chemotherapy (NC) first groups with reconstructive subgroups. Wait times between care pathway milestones were compiled and compared to national standards. Results: SF experienced longer wait times from consultation to treatment initiation (47 ± 51.5 vs 22 ± 22, P<.001) and from first to second treatment modality (62 ± 35 vs 39 ± 17, P<.001). Furthermore, only 29% of SF met the standard of receiving treatment within 4 weeks from consultation compared to 63% of NC (P<.001). Within subgroups, SF alloplastic reconstructions had shorter wait times compared to SF autologous reconstructions. For SF, only 31% of alloplastic and 24% of autologous reconstruction initiated treatment within 4 weeks of consultation. Conclusion: In this cohort of Canadian breast cancer patients, those receiving surgery first experienced prolonged wait times to treatment, particularly with autologous reconstruction. Patients should be informed of the potential impact on adjunctive therapies when considering reconstructive modality.

Background: Artificial intelligence (AI) has significantly influenced various sectors, including healthcare, by enhancing machine capabilities in assisting with human tasks. In surgical fields, where precision and timely decision-making are crucial, AI's integration could revolutionize clinical quality and health resource optimization. This study explores the current and future applications of AI technologies in reconstructive breast surgery, aiming for broader implementation. Methods: We conducted systematic reviews through PubMed, Web of Science, and Google Scholar using relevant keywords and MeSH terms. The focus was on the main AI subdisciplines: machine learning, computer vision, natural language processing, and robotics. This review includes studies discussing AI applications across preoperative, intraoperative, postoperative, and academic settings in breast plastic surgery. Results: AI is currently utilized preoperatively to predict surgical risks and outcomes, enhancing patient counseling and informed consent processes. During surgery, AI supports the identification of anatomical landmarks and dissection strategies and provides 3-dimensional visualizations. Robotic applications are promising for procedures like microsurgical anastomoses, flap harvesting, and dermal matrix anchoring. Postoperatively, AI predicts discharge times and customizes follow-up schedules, which improves resource allocation and patient management at home. Academically, AI offers personalized training feedback to surgical trainees and aids research in breast reconstruction. Despite these advancements, concerns regarding privacy, costs, and operational efficacy persist and are critically examined in this review. Conclusions: The application of AI in breast plastic and reconstructive surgery presents substantial benefits and diverse potentials. However, much remains to be explored and developed. This study aims to consolidate knowledge and encourage ongoing research and development within the field, thereby empowering the plastic surgery community to leverage AI technologies effectively and responsibly for advancing breast reconstruction surgery.

Introduction: The concept of failure in breast reconstruction can occur when negative outcomes dominate the patient experience. The primary objective of this review was to identify experiences of failure in breast reconstruction from the patient's perspective in the qualitative literature. Methods: MEDLINE, Embase, Psychinfo, Emcare, and CINAHL were searched on July 31, 2023 using terms related to breast reconstruction and qualitative research. Thematic analysis was performed on direct quotations from included studies. Confidence in the Evidence from Reviews of Qualitative (CERQual) Research was used to assess confidence of the final findings. Results: Forty-two studies were identified. The following themes were identified in breast reconstruction failure: (1) failure occurs when expectations of restoring the original breast are not met with reconstruction, (2) failure occurs when unexpected outcomes were associated with the reconstruction, and (3) healthcare providers negatively impact the experience of breast reconstruction failure through lack of transparency when educating patients on expected results and poor relational support in the post-operative period. The evidence supporting themes 1-3 scored high confidence with CERQual. Conclusion: Breast reconstruction failure from the patient perspective arises from the limitations and adverse outcomes of the surgery. They may also arise even when the procedure was deemed “successful” from the surgeon's perspective. Dissatisfaction with result is increased by procedural complications. Healthcare providers can aggravate the perception of failure through inadequate patient education. Incorporating these perceptions of failure into discussions with patients can aid in their decision making.

Introduction: The scaphoid bone is essential for wrist stability and movement. While fractures commonly occur at the scaphoid's waist, those at the proximal pole, though rarer, tend to result in nonunion, potentially linked to variations in bone mineral density (BMD). Previous studies have shown an increase in BMD at the proximal pole in fractured scaphoids, but BMD distribution in intact scaphoids has not been well studied. This study aims to map the BMD distribution of the intact scaphoid to better understand the etiology of fractures and optimize treatment approaches. Methods: Conducted under ethical approval, this study included 100 individuals, using computed tomography to assess the BMD in distal, middle, and proximal thirds of the scaphoid. Measurements were performed in the defined regions and analyzed using SPSS software, with significance accepted at P < .05. Results: The study comprised 34 females and 66 males, with no significant BMD difference between the right and left wrists. The proximal third exhibited significantly higher BMD (542.2 HU) compared to the middle (293.1 HU) and distal thirds (298.4 HU). A statistically significant higher BMD was observed in males, particularly in the proximal and distal thirds. A weak negative correlation between age and BMD was noted across all sections. Conclusion: The proximal scaphoid shows significantly higher BMD, potentially explaining its lower fracture incidence but higher nonunion rate. This insight into the BMD distribution within an intact scaphoid may guide the clinical management of scaphoid fractures, highlighting the need for targeted treatment strategies based on BMD variations.

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Background: Wide-awake local anesthesia no tourniquet (WALANT) surgery has demonstrated its value in hand surgery allowing surgeons to safely operate patients in different settings outside of a formal operating room (OR). Flexor tendon lacerations have historically been repaired in the controlled setting of an OR. Plastic surgeons at our university-affiliated center have increasingly been performing flexor repairs in clinic-based procedure rooms (PRs). This study set out to evaluate the safety and complication rates of primary flexor tendon repair performed in PRs compared to those performed in the OR. Method: A unicentric retrospective study was conducted with patients who underwent primary flexor tendon repair between 2019 and 2023 in both clinic-based PRs and the OR. Primary outcomes included presence of tendon rupture and secondary outcomes included infection, adhesion, reintervention, and presence of any complication. Results are reported using odds ratios with 95% confidence intervals. Results: One hundred seventy-four patients underwent flexor tendon repair. There was no association between rupture rate and surgical setting (OR 1.05 95% CI [0.30-3.78]; P = .94). Surgeries performed in clinic-based PRs showed a reduction in the odds of observing at least one complication (OR = 0.49 [0.24-0.97]; P = .041). A subanalysis of single digit cases showed a similar association between the rate of complications and surgical setting (OR = 0.39 [0.16-0.96]; P = .039). Conclusions: This study confirms the safety of performing flexor repair in clinic-based PRs. Such settings also offer the advantage of reduced cost of surgery and minimized delay between diagnosis and surgery.

Purpose: The purpose of this study was to determine the necessity and cost-effectiveness of radiologists’ interpretation of plain hand radiographs for diagnosing and managing different hand pathologies in the plastic surgery outpatient clinic setting. Methods: Through a retrospective cohort study, we identified new patient encounters from January 2021 to December 2022 in an outpatient hand clinic. We included patients with radiology reports that were submitted subsequent to the surgeon's consult note in clinic. Plastic surgeons’ interpretations were compared with radiology reports, and findings were categorized as concordant, discrepant (different with no impact on management), or discordant (different with an impact on management). Analysis included radiograph type, underlying mechanism, site of pathology, and hand fellowship training for surgeons. Direct cost was calculated using billing code fees. Results: A total of 241 cases were included in the study: 187 were concordant (77.6%), 53 were discrepant (22%) and only one was discordant (0.4%). Trauma was the predominant reported mechanism (90.5%). Most pathologies were in the phalanges (53.5%), followed by metacarpals (30.7%) and carpals (15.8%). Univariate analysis demonstrated no significant association between radiograph type (P = .829), underlying mechanism (P = .172), site of pathology (P = .482), surgeon's training (P = .551) and concordance with radiology reports. Total direct cost of radiographs reporting in this study was 8477 CAD. Conclusion: The study identified high concordance rates of hand radiograph findings between plastic surgeons and radiologists, with radiology reports rarely impacting patient management. Given the significant patient volume in plastic surgery hand clinics, these findings prompt further considerations in optimizing cost-effective diagnostic practices.

Introduction: Panniculectomy is recognized to have a high complication rate with up to 56% of patients having postoperative wound healing problems. As they are generally elective procedures, surgeons have the chance to optimize preoperative variables. We reviewed the relationship between preoperative serum albumin and BMI with short-term postoperative panniculectomy complications. Methods: Patients undergoing panniculectomy between January 2005 and December 2019 were identified via CPT code 15830 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate logistic regression was performed on intra/postoperative bleeding and postoperative wound infection against preoperative serum albumin, diabetes status, age, body mass index (BMI), and smoking status. Odds ratios were adjusted for comorbidities. We established statistical significance at p value <0.01. Results: Out of 1472 patients, 69 sustained intra/postoperative bleeding and 31 suffered wound infection. Lower preoperative albumin levels (R2 = 16.3%, p < 0.0001) and elevated BMI (R2 = 9.4%, p < 0.0001) were both significantly associated with increased likelihood of wound infection. For every 1 g/dL decrease in albumin, patients’ odds of bleeding increased 1.85 (OR = 1.85, CI 95%= [1.14–2.99]) times, and odds of wound infection increased 5.03 (OR = 5.03, CI 95%= [2.78–9.10]) times (p < 0.0001). BMI and albumin were weakly correlated (r = -0.28) suggesting each had independent effects on complications. Conclusion: In patients undergoing panniculectomy, preoperative albumin level is significantly inversely associated with postoperative bleeding and wound complications. More research is needed to evaluate whether proactively optimizing albumin may reduce complications.

While panniculectomy is traditionally considered a cosmetic surgery, there is growing interest in the potential role of panniculectomy for the treatment of low back pain. We present a case of a 69-year-old man with a history of over 10 years of significant low back pain with radiculopathy rated as 7 out of 10 and resistant to conservative measures as well as multiple spinal decompression surgeries. He had undergone bariatric surgery 14 years prior and maintained a stable body mass index. He presented with a large pannus desiring panniculectomy for aesthetic purposes. He underwent an uncomplicated panniculectomy. As an unintended benefit of his procedure on his 1-month post-op visit, he reported near resolution of his low back pain and radiculopathy. His reported pain had been reduced to 1–2 out of 10. More research needs to be done to assess the potential of panniculectomy as a treatment for low back pain in patients with massive weight loss.

Background: Abdominoplasty continues to be a frequently performed plastic surgery procedure. Futhermore, an increase in both surgical and medical weight loss is contributing to the procedure's increasing popularity. Technical refinements have improved surgical outcomes and safety. Despite this, it remains a procedure with one of the highest morbidity and mortality risks in aesthetic plastic surgery. Methods: A review of abdominoplasty complications and best practices was performed in order to provide a succinct review of the most prevalent safety issues in abdominoplasty surgery. Proposal: In order to mitigate the risk of complications, risk stratification, patient selection, and using evidence-based techniques are essential. In the present study, the authors provide recommendations for approaching the most common safety considerations of this procedure. Conclusion: Appropriate patient selection, surgical technique and proper protocols, ensures surgeons control the modifiable risk factors that increase complications. Implementing nonpharmacologic and pharmacologic interventions reduce the risk of venous thromboembolism. Using evidence-based techniques tailored to the specific patient's anatomy ensures the vascular territories of the abdominoplasty flap are respected and perfusion for wound healing is optimized.

Introduction: Abdominoplasty is a common aesthetic surgical procedure primarily performed under general anesthesia (GA). However, GA is aerosol-generating and involves extended immobilization associated with systemic complications like venous thromboembolisms (VTEs). There is increasing interest in performing abdominoplasties without GA because of potential lower complication rates and shorter postoperative recovery time. This review sought to summarize all available literature on the safety and outcomes of abdominoplasty performed without GA. Methods: A scoping review was conducted with no date limits in October 2023 encompassing Medline, Embase, Web of Science, and CINAHL. The type of anesthesia was separated into 3 categories: conscious or intravenous (IV) sedation, regional anesthetic blocks (RAB: spinal and epidural), and local anesthesia (direct local infiltration and field blocks). Results: A total of 28 studies were included. Safety data was reported for abdominoplasty alone (n = 6), with liposuction (n = 14), or both (n = 1). The employed anesthesia methods were IV and local (n = 13), RAB and local (n = 3), IV and RAB (n = 2), IV and RAB and local (n = 2), and IV only (n = 1). A total of 48 379 patients were identified, with 30 cases of VTEs reported. Two studies reported GA conversion rates between 4.8% and 6.0%. A total of 11 studies assessed abdominoplasty outcomes, highlighting high patient satisfaction and low postoperative pain. The majority of analyzed studies had a “high” or “critical” risk of bias. Conclusion: Our review provides preliminary evidence that performing abdominoplasty without GA is safe and feasible. Additional high-quality studies are necessary to further validate our findings and to develop a standardized approach.

Purpose: Gender-affirming mastectomy surgery is highly desired within both transmasculine and nonbinary patient populations. The development of cardiac arrhythmias has been reported within this population. Acute intraoperative bradycardia in patients undergoing gender-affirming mastectomy has not been well described previously. This study aimed to describe the frequency of acute intraoperative relative bradycardia in patients undergoing gender-affirming mastectomies and identify potential risk factors that contribute to its occurrence. Methods: A retrospective review was performed for all patients who underwent gender-affirming mastectomy at a single institution. Data regarding patient demographics, comorbidities, and perioperative course were collected. Patients were separated into those who did and did not develop acute intraoperative bradycardia. The definition of relative intraoperative bradycardia was a heart rate below sixty beats per minute. Logistic regression was performed to determine which variables were predictive of bradycardia. Results: A total of 337 patients underwent gender-affirming mastectomy between January 2018 and January 2023. Of these patients, 144 (42.7%) experienced acute intraoperative relative bradycardia, with 97 (67.4%) requiring anesthetic intervention and 5 (3.5%) requiring halting or abortion of surgery. Two patients (1.4%) required compressions for asystole. Fluoxetine as an outpatient medication (OR: 2.63, P = .002) and harvest of a nipple graft (OR: 2.77, P = .018) were associated with a significantly increased risk of developing acute intraoperative bradycardia. Conclusion: Acute intraoperative relative bradycardia may be a unique phenomenon in patients undergoing gender-affirming mastectomies due to variables specific to this patient population. A future study comparing patients undergoing gender-affirming mastectomy to those undergoing elective breast surgeries is forthcoming to assess further risk factors.

Introduction: Brachial plexus birth injury (BPBI) is a condition affecting newborns and involves damage to the nerve fibers compromising the brachial plexus during birth. Although most newborns recover spontaneously, a large subset require surgery to regain function, and others will have permanent disability despite intervention. Deciding when to pursue surgical intervention remains a challenge for clinicians treating BPBI. Methods: A comprehensive search of the literature was conducted using PubMed, Scopus, and MEDLINE databases. A total of 24 primary and secondary sources were chosen for inclusion following full-text assessments. All sources were analyzed to provide a comprehensive review on the development of BPBI treatments and interventions over time. Results: Spontaneous recovery can be achieved in many cases of BPBI, but most patients require physical therapy and other forms of treatment to avoid muscle imbalance and prevent contracture formation. In addition to physical therapy, the most common non-surgical interventions include botulinum toxin injections and splinting. In cases requiring surgery, clinicians may use several tests and diagnostic imaging to aid in decision making. Common surgical interventions for BPBI include nerve grafting, nerve transfers, and muscle and tendon transfers. Conclusion: Most newborns recover from BPBI within the first 3 months of life. However, some require treatment to restore optimal function. In general, non-surgical interventions should be the primary course of treatment, and surgery should be avoided unless the patient is deemed unable to recover with any other treatment.

Background: Reporting the 50 most cited manuscripts on virtual surgical planning (VSP) for craniofacial surgery, thereby providing a comprehensive review of landmark papers. Methods: The Web of Science Citation Index was used to identify the 50 most cited manuscripts on VSP in craniofacial surgery. These were classified by level of evidence, type of study, topic of interest, and anatomic site. Results: The mean number of citations was 126.3 ± SD 51.7. Twenty were clinical papers: 9 reviews, and 21 workflow or technology. The most common level of evidence (LoE) was 4 (n = 12), followed by 3 (n = 6), 2 (n = 1), and 5 (n = 1). Thirty-nine of 50 articles focused on the maxillomandibular area of the face, 5 zygomatic, 5 orbit, 2 cranial vault, and 1 nasal ethmoid bone. The majority of articles (37 of 50) were on orthognathic surgery, 11 facial reconstruction, 2 calvarium reconstruction or craniosynostosis, and 2 free flap procedures. Year of publication ranged from 2000 to 2019; 34 articles were published in craniomaxillofacial journals. Conclusion: VSP is a relatively new technology and most highly cited articles on this topic pertain to workflow, technology, and protocols, as these are necessary for its integration into clinical practice. In our list, VSP was most used in orthognathic surgery; however, due to the potential increased efficiency and accuracy, it is being explored in other areas of craniofacial surgery such as facial reconstruction and craniosynostosis. Accordingly, we expect to see increasingly widespread usage of VSP in other areas of surgery, which could potentially lead to highly cited papers.

Introduction: Pressure injuries, particularly among patients with spinal cord injuries and the elderly, significantly contribute to morbidity, mortality, and financial sequelae. Surgical interventions, including debridement and flaps, may improve outcomes, especially for stage 3 and 4 pressure injuries. This survey assesses Canadian plastic surgeons’ perspectives and practices regarding the surgical management of these injuries. Methods: A web-based survey was distributed to 405 registered members of the Canadian Society of Plastic Surgeons (CSPS) and remained open for a 6-week period. The 16-question survey explored management practices for pressure injuries and the training associated with resident education. Results: Responses from 129 surgeons (31.8%) were analyzed. Of these, 85% manage stage 3 or 4 pressure injuries, though only 67.5% performed both debridement and flap coverage. The majority believe care should ideally occur in community facilities with plastic surgery coverage rather than being centralized in academic centers, although careful patient selection, perioperative planning, and rehabilitation are critical to justify the surgical investment. Most respondents (83%) agreed that plastic surgery residents should be proficient in both debridement and flap coverage by the end of their training. Conclusion: The survey indicates that most surgeons prefer managing pressure injuries in facilities with adequate plastic surgery support rather than exclusively at academic centers. However, structured management pathways and enhanced training in pressure injury care remain crucial. Future healthcare policy and research should focus on improving care delivery and patient outcomes, ensuring that all facilities involved in this care are equipped with the necessary resources and multidisciplinary expertise.

Background: Being named in a medicolegal complaint can be a lengthy process filled with uncertainties. Its current impact on Canadian plastic surgeons is unknown. We aim to review the impact of medicolegal complaints and provide advice for surgeons on how to prevent, minimize, and navigate through the medicolegal process. Method: An anonymous survey was sent to registered Royal College of Physicians and Surgeons of Canada certified plastic surgeon members. The survey collected data on surgeon demographics (clinical status, gender, practice type, volume), medicolegal complaint history and outcome, impact on practice, and insights into the process. Surgeons with an inactive practice and invalid contact information were excluded. Results: Out of 456 invited plastic surgeons, 100 responses were included, 73% were male, with an even distribution of practice types and years in practice. Most were Canadian Medical Protective Association (CMPA) members. A significant portion (62%) had been named in a medicolegal action, primarily related to treatment complications (42%) and poor outcomes/disease progression (34%). Factors associated with complaints were greater years in practice (P<.01), and a higher annual volume of operating room cases (P=.02). The duration of the medicolegal process varied, with the majority taking 1-2 years. Respondents predominantly agreed that CMPA provided adequate legal defence (83%, 53/64). However, most surgeons felt the process had a significantly negative impact on their mental health (75%, 48/64). After being involved in a complaint, many surgeons modified their practice pattern by increasing documentation/consent process (45%, 29/64), avoiding certain procedures (22%, 14/64), and avoiding care of high-risk patients (19%, 12/64). Conclusion: Despite legal resolution in favour of the physicians, the results of this survey indicate the medicolegal complaint process has a significant impact on plastic surgeons’ practices, time, and mental health. Understanding the medicolegal process and outcome is crucial for risk mitigation.

Purpose: Psychoactive substance use is often a complicating factor in injury that requires an emergency room visit. The present study examined data recorded in the National Electronic Injury Surveillance System (NEISS) database for patients who presented to an Emergency Department (ED) and had psychoactive substance involvement, requiring management by plastic surgery. Methods: A retrospective cohort study was performed using the NEISS database, from 2019 to 2021. Data from patients aged 0 to 102 who suffered burns (46, 47, 48, 49, 51, and 73), face injuries (76), hand injuries (34, 82, and 92), and had psychoactive substance use were queried. Data regarding the specific substances involved were collected. Analysis was performed using SAS to compare the incidence of various substances and the differences in admission status with psychoactive substance use. Results: According to the NEISS estimates, in the United States, 597,916 patients visited the ED for burns, 3,671,677 for facial injuries, and 6,230,087 for hand injuries from January 2019 to December 2021. Across this population, psychoactive substance use was noted in 5605 patients with burn (0.9%), 31,198 with facial (0.8%), and 26,174 with hand (0.4%) injuries. Across all 3 injury types, the total rate of admission was 20% in the substance-use population, and 5% in the nonsubstance-use population. Conclusions: For injuries presenting to the ED that require plastic surgery management, patients with documented psychoactive substance use have higher rates of admission. Given these higher rates of admission, it is important for providers to be aware of differences in the incidences of various substances and the potential for withdrawal.

Introduction: As scientific publishing has transitioned online, open access and predatory publishers have surged. This study describes the frequency of publications in potentially predatory and open access journals among applicants to a Canadian plastic surgery residency program, and explores applicant characteristics associated with open access and predatory publishing. Methods: A retrospective review of plastic surgery resident applicants’ curriculum vitae (CVs) from 2015 to 2018 was performed. Published articles listed in CVs were reviewed by 2 authors to identify publication availability, publication year, and publisher. Open access publications were identified using the Directory of Open Access Journals. Predatory publications were identified using Beall's list of potentially predatory publishers. Published applicants’ characteristics were summarized. Applicant characteristics associated with open access and predatory publishing were explored using logistic regression. Results: Of the 186 applicants, 117 published 388 articles and were included in the final analysis. 156 (40.2%) articles were published in open access journals by 76 (40.8%) applicants. 14 (3.6%) articles were published in predatory journals by 14 (7.5%) applicants. Applicant characteristics associated with open access publishing included total number of publications (OR: 1.56, 1.18-1.93, P < .001) and presence of at least one post-baccalaureate degree (OR: 0.36, 0.13-0.95, P = .038). Only an applicant's total number of publications (OR: 1.25, 1.06-1.48, P = .010) was significantly associated with publishing in a predatory journal. Conclusion: These findings stress the importance of raising awareness within the plastic surgery community, including medical students, about the deceptive nature of predatory journals.

Background: Many people are still infected with coronavirus disease 2019 (COVID-19), and the use of home test kits for diagnosis is becoming common. The misuse of the kits may cause unexpected patient harm. Purpose: The purpose of this case study was to report a rare case of facial skin necrosis caused by contact with a reagent in a COVID-19 Ag home test kit due to misuse of the kit. Case Study: A 50-year-old male patient with pain, redness, and swelling throughout the nose, right ocular area, and forehead visited the emergency room of the hospital. The symptoms were caused by using a COVID-19 Ag home test kit in the wrong way. Initially, partial skin color change and ulcerative skin lesions with pus-like discharge were observed throughout the wound. Finally, partial skin necrosis progressed and was treated using appropriate dressing treatment, antibiotics, and steroids. Conclusion: The use of COVID-19 Ag home test kits that can be easily used will gradually increase. As in this case, it should be kept in mind that problems due to incorrect use of COVID-19 Ag home test kits can occur, and initial treatment is important to prevent systemic infection or scar formation.

Reconstruction of large lower lip defects due to malignancies with good aesthetic result remains challenging. In this study we presented reconstruction of full thickness lower lip defect with modified hatchet flap. The charts of patients with 50% to 95% of the total lower lip defect due to lower lip tumor resection who had reconstruction with modified hatchet flap were reviewed. Seven of the patients had unilateral, two had bilateral modified hatchet flap. After follow-up period, it was concluded that this method provided a wide and functional mouth opening. Six of the patients stated that they were aesthetically satisfied with their appearance, while 3 patients found the result acceptable. None of the patients required additional surgical procedure. Modified hatchet flap is an easy-to-design, easy-to-remember flap with good aesthetic and functional results which makes it a reliable flap in the reconstruction of the large lower lip defects.