April 2026 Edition
- thestitchprs
- 3 days ago
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5 min read
Welcome to the April edition of The Stitch. This month's edition explores the lasting legacy of Marko Godina, examines key factors that contribute to a successful match in plastic surgery, and highlights the often-overlooked costs associated with surgery.
We hope this issue inspires both thoughtful reflection and a deeper appreciation for the surgeons whose innovation and dedication have shaped the field and redefined what is possible.
The Stitch Editorial Board
The Legacy of Marko Godina: Lessons in Timing and Reconstruction
Article by Joyce Zhu, University of South Florida Class of 2027
Marko Godina is widely regarded as one of the most influential figures in modern plastic surgery, particularly in the evolution of reconstructive microsurgery. Born in Slovenia, he completed his medical training in Ljubljana. He also trained in Great Britain and the United States. His contributions fundamentally reshaped the management of complex traumatic injuries.
Godina’s work focused on microvascular reconstruction following trauma to extremities. Through meticulous observations and extensive surgical experiences, he demonstrated that early soft tissue coverage, specifically within 72 hours of injury, significantly improved outcomes compared to delayed or late coverage. His findings showed that delayed reconstruction was associated with higher rates of microsurgical failures, infection, and prolonged healing.
Godina was also an innovator whose work expanded the boundaries of what was considered surgically possible at the time. One of his most remarkable contributions was performing temporary ectopic implantation of an amputated hand into the axilla until it could be successfully replanted onto the arm two months later. He was also among the first to advocate for end-to-side arterial anastomoses in free flap transfers in lower extremity reconstruction, to contribute to the clinical application of the free latissimus dorsi muscle flap, and to perform both the free lateral arm flap and saphenous neurovascular flap. These innovations reflected his creative problem-solving, deep understanding of vascular physiology, and surgical precision.
Marko Godina’s legacy continues, not only through the techniques he developed, but through the principles he established that continue to guide reconstructive surgeons worldwide.
References:
Kosutic D. The life and work of Marko Godina: in memory of a pioneer in reconstructive microsurgery. J Plast Reconstr Aesthet Surg. 2007;60(10):1171-1172. doi:10.1016/j.bjps.2006.11.034
Godina M. Preferential use of end-to-side arterial anastomoses in free flap transfers. Plast Reconstr Surg. 1979;64(5):673-682.
Acland RD, Schusterman M, Godina M, Eder E, Taylor GI, Carlisle I. The saphenous neurovascular free flap. Plast Reconstr Surg. 1981;67(6):763-774. doi:10.1097/00006534-198106000-00009
Plastic Surgery Match Outcomes: A Data-Driven Analysis
Article by Makenna Ley, College of Medicine Tucson Class of 2027
Another match season has come and gone. For medical students that plan to apply in the next year or two, you may be wondering: what are the most important factors of the application that contribute to a successful match?
The Stitch PRS looked through the literature to identify papers that broke down the applicant review process that reveals various objective and subjective factors that programs use to evaluate plastic surgery applicants each year.
The most important objective criteria considered in the selection of future plastic surgery residents were identified as the following:
Research productivity: In 2024, the average number of research items was 7.3 publications among matched applicants. Matched applicants who took research years had higher match rates (29.6% vs 16.3%).
USMLE scores: Matched applicants had higher Step 2 scores (256.5 average for matched applicants vs 253.1 for unmatched applicants). Scores >265 were highly predictive of matching.
AOA membership: Remains a significant predictor of matching at top-ranked programs.
Medical school reputation: Graduation from a top 40 medical school was a significant predictor of success in the Plastic Surgery match.
The most important subjective factors considered in the application process are the following:
Letters of Recommendation: Letter content had the greatest increase in weight (according to 66.7% of program directors) after Step 1 became pass/fail. Letter strength was highly predictive of a successful match.
Performance on away rotations: Completing a subinternship raised odds of interview by 21-fold and matching by 13-fold at that program.
Interview Process: Number of interviews was one of the strongest predictors. Matched applicants attended more interviews (median 14 vs 5 for unmatched applicants). Having 13+ interviews increased odds of matching 3-fold.
These data reflect general trends and benchmarks. However, not all medical students who successfully match meet each of these metrics, and there is considerable variability in individual pathways to success. It is also important to recognize that certain groups, including students without a home plastic surgery program, osteopathic (DO) applicants, and international medical graduates, often face baseline barriers in accessing mentorship, research opportunities, and clinical exposure when pursuing a career in plastic surgery. These structural differences can impact the ability to build a competitive application and should be taken into account when interpreting these metrics and advising applicants.
References
A Cross-Sectional Analysis of Research Productivity for Medical Students Matching Into Integrated Plastic Surgery Residency. Quick JD, Allbright M, Babb G, et al. Annals of Plastic Surgery. 2025;:00000637-990000000-00978. doi:10.1097/SAP.0000000000004576.
Characterizing the Past 5 Years of Integrated Plastic Surgery Applicants: A Texas STAR Analysis. Bao E, DePaola N, Mihalic AP, Huston TL. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS. 2025;105:88-94. doi:10.1016/j.bjps.2025.03.054.
Tipping the Scales: Quantifying the Impact of USMLE Step 1 Pass/Fail Scoring on Application Interpretation in the Integrated Plastic Surgery Match. Bird C, Godbe KN, Nazir N, et al. Journal of Surgical Education. 2025;82(9):103625. doi:10.1016/j.jsurg.2025.103625.
Update on the Selection Criteria of Plastic Surgery Residents: A Survey of Program Directors and Associate Program Directors. Asghari A, Hines E, Mocharnuk J, Leis A, Wang ED. Annals of Plastic Surgery. 2024;92(5S Suppl 3):S327-S330. doi:10.1097/SAP.0000000000003801.
A Survey of Applicants to Integrated Plastic Surgery Residencies and Factors Associated With a Successful Match. Lee J, Mihalic A, Drolet BC. Annals of Plastic Surgery. 2025;95(5):570-575. doi:10.1097/SAP.0000000000004509.
The Hidden Cost of Surgery
Article by Jenna Billingsley, University of South Florida Class of 2027
Behind the precision, sterility, and safety of surgery is the far less glamorous: waste.
Operating rooms are among the most resource-intensive environments in healthcare. Single-use instruments, sterile packaging, and energy-intensive workflows generate a significant environmental footprint -- all generally accepted as the cost of safety and efficiency.
Across surgical specialties, however, this assumption is beginning to be challenged. Efforts in anesthesia, orthopedics, and general surgery have started to examine waste streams, reduce unnecessary instrument use, and rethink disposable versus reusable supplies -- often with measurable cost savings and no compromise in patient outcomes.
Plastic and reconstructive surgery is also becoming part of this conversation. A recent article in Plastic and Reconstructive Surgery highlights the dual financial and environmental impacts of PRS operative care, pointing to inefficiencies such as routinely opened but unused instruments and excess supply utilization. These patterns are not unique to plastic surgery, but the specialty’s breadth -- spanning elective and reconstructive procedures -- makes it a particularly relevant space for change.
Importantly, most operating room waste is not the result of individual decision-making, but of established systems: preference cards, standardized trays, and workflows that prioritize preparedness over precision. Sustainability efforts, then, are less about restriction and more about refinement and identifying where “routine” may exceed what is actually required.
Plastic surgery has long defined itself through innovation. Applying that same mindset to how care is delivered -- not just what is delivered -- represents a natural next step.
As surgical practice continues to evolve, so too may the definition of high-quality care -- expanding to include not only outcomes, but the cost of achieving them.
References
Hyland CJ, Etheridge JC, Newell PC, Yates EF, Talbot SG. The Financial and Environmental Impacts of Optimizing Surgical Instrument Trays in Plastic Surgery. Plast Reconstr Surg. 2026;157(4):644e-647e. doi:10.1097/PRS.0000000000012444
Smith JT, Boakye LAT, Ferrone ML, Furie GL. Environmental Sustainability in the Orthopaedic Operating Room. J Am Acad Orthop Surg. 2022;30(21):1039-1045. doi:10.5435/JAAOS-D-22-00247
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