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Κυριακή 1 Απριλίου 2018
“Is There Value to Seeing a Transgender Fellowship Trained Surgeon?”
We are presently at a unique crossroad in medicine, where the healthcare field has the opportunity to recognize and treat transgender patients on a scale that was previously unattainable. As more professionals join the effort to treat this increasingly visible population, we have a duty to set standards for training residents and credentialing our colleagues to protect the wellbeing of this already vulnerable group. Fellowship training may be the fundamental answer to surmounting the significant medical, legal, and social complexities entailed with treating this deserving population. Financial Disclosure Statement: We have no financial disclosures. Presented at (if applicable): 2016 Philadelphia Trans Health Conference, 9/8/17 Corresponding Author: Christopher J. Salgado, 1321 NW 14th St, Ste 200, West Bldg, Miami, FL 33125, Csalgado2@med.miami.edu ©2018American Society of Plastic Surgeons
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https://ift.tt/2EbwAqA
“Pathways to academic leadership in plastic surgery – a nationwide survey of program directors, division chiefs, and department chairs of plastic surgery”
Background: While plastic surgeons and plastic surgery residents aspire to leadership in academic plastic surgery, there is no well-established pathway. Methods: Plastic surgery residencies and program directors(PDs) were obtained from the AMA's FREIDA database. The division chief or department chair (academic head) of every academic plastic surgery program was identified. One internet-based survey was distributed to academic heads, another to PDs. Results: 90 academic heads were identified, 35 of whom also serve as PD. 67 unique PDs were identified. There was a 51% academic head response rate and a 65% PD response rate. Academic plastic surgery is overwhelmingly administered by mid-career males. The average PD was appointed at age 45 and has served for 7 years. S/he was trained via the independent track, completed additional training in hand surgery, and is a full professor. S/he publishes 2-3 peer reviewed manuscripts per year and spends 9 hours-per-week in administration. The average academic head was appointed at age 45 and has held his/her position for 12 years. S/he was trained in the independent model, completed fellowship training, and is a full professor. S/he publishes 5 peer reviewed manuscripts per year and spends 12 hours-per-week involved in administration. Conclusion: PDs and academic heads serve non-overlapping roles. Few PDs will advance to the role of academic head. Successful applicants to the PD position often serve as an associate program director and are seen as motivated resident educators. In contrast, those faculty members selected for the academic head role are academically accomplished administrators with business acumen. Financial Disclosure Statement: Drs. Fishman, Pang, and Nguyen have nothing to disclose. Dr. Losee receives book royalties from CRC press and Elsevier. Dr. Rubin receives book royalties from Elsevier, consulting fees from a medical device company, and has ownership interest in a number of plastic surgery related ventures. No funding was received for this article. Corresponding Author: Vu T. Nguyen MD1, University of Pittsburgh, Department of Plastic Surgery, 3550 Terrace Street, 6B – Sciafe Hall, Pittsburgh, PA 15261, fishmanje@upmc.edu ©2018American Society of Plastic Surgeons
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Optimal Use of Surgical Drains: Evidence-Based Strategies
Background: Closed-suction drains are a widely-used tool to reduce the incidence of seroma whenever potential spaces are surgically created. However, few studies have examined the parameters that affect drain efficacy. Methods: An in vitro model was created to assess the effects of tubing length, tubing size, tubing type, fluid viscosity, fluid clotting, evacuator type, evacuator squeeze method, evacuator fill and evacuator pressure on the performance of closed-suction drains. Results: Fluid flow rate through the drain increases with increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing negative pressure, decreasing fluid viscosity, and the use of perforated rather than fluted drains. Bulbs generate more effective suction when squeezed "side-to-side" than when squeezed "bottom-up", and evacuators were only able to generate half the maximal negative pressure when 25% full or greater. Stripping the drain tubing helped relieve obstruction due to clotting. Conclusions: Our findings have practical clinical implications for surgeons hoping to maximize the efficacy of closed-suction drains. Through this comprehensive review of the literature and in vitro analysis of relevant variables that affect drain function, the performance of closed-suction drains can be optimized by increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing the pressure differential, using perforated drains, squeezing bulbs "side-to-side", stripping drain tubing frequently, and evacuating containers whenever they are 25% full. Disclosures: Dr. Janis is a consultant for LifeCell, Bard and Daiichi Sankyo, has received prior honoraria from Pacira and KCI, and receives royalties from Thieme Publishing. Drs. Khansa, Khansa and Meyerson have no relevant financial disclosures. Corresponding author: Jeffrey E. Janis, MD, FACS, Professor and Executive Vice Chairman, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, Phone: (614) 293-8566, Fax: (614) 293-9024, Email: jeffrey.janis@osumc.edu ©2018American Society of Plastic Surgeons
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https://ift.tt/2IjzeNC
Wound Surface Area as a Risk Factor for Flap Complications Among Patients with Open Fractures
Background: Soft tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at our institution, we hypothesize that wounds greater than 200cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft tissue reconstruction with a rotational flap or free tissue transfer. Methods: We performed a secondary analysis of FLOW trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. Our primary outcome was flap-related reoperation within 12 months of injury. Our secondary outcome was wound complication, which included events treated operatively or non-operatively. Multivariable logistic regression was used to assess the association between wound size and the outcomes, adjusting for confounders. Results: 17.0% of the 112 patients required a flap-related reoperation. A wound size of greater than 200cm2 was not associated with reoperation in an unadjusted model (p=0.64) or adjusting for Gustilo type (p=0.70). The sample had an overall wound complication rate of 47.3%. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (Odds Ratio: 3.05, 95% CI 1.08- 8.62, p=0.04) when adjusting for moderate-severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates. * list of trial authors is listed in the Appendix Financial disclosure statement: The study was funded by the Canadian Institutes of Health Research (MCT-93173), the U.S. Army Institute of Surgical Research Orthopedic Trauma Research Program (W81XWH-08-1-0473), U.S. Army Institute of Surgical Research Peer Reviewed Orthopedic Research Program (W81XWH-12-1-0530), and Association Internationale pour l'Ostéosynthèse Dynamique. Dr. Bhandari reports receiving consulting fees from Stryker, Smith & Nephew, Amgen, Eli Lilly, DJO Global, Zimmer, and Ferring Pharmaceuticals, and grant support from Stryker, Amgen, DePuy Synthes, Eli Lilly, and DJO Global; Dr. Jeray, receiving consulting fees from Zimmer and Eli Lilly and lecture fees from Zimmer and AO North America; Dr. Petrisor reports consulting fees from Stryker and Pfizer, and research support from Stryker and Zimmer; Dr. Sprague, being an employee of Global Research Solutions; Dr. Pensy reports consulting fees from Globus Medical; and Dr. Slobogean reports being a paid presenter for Zimmer Biomet. No other potential conflict of interest relevant to this article was reported. Statement of institutional review board approval: The study was approved by the ethics committees at McMaster University, Greenville Health System, and each participating center. All the patients provided written informed consent. Clinical trial registration:ClinicalTrial.gov Identifier: NCT1069315 Corresponding Author: Raymond A. Pensy, MD, R. Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 Greene St., Baltimore, MD 21201, Email: rpensy@umoa.umm.edu ©2018American Society of Plastic Surgeons
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Ειδοποίηση Μελετητή:[ ωτα ] [HTML] Gender, identity and material: Film screening C Brand - 2017 ftypM4V *M4V M4A mp42isom*a┌moovlmvhd...
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Publication date: September 2017 Source: Free Radical Biology and Medicine, Volume 110 Author(s): Lucía Fernández-del-Río, Anish Nag, Elen...
