August 2023
- thestitchprs
- Aug 21, 2023
- 10 min read
Updated: Aug 30, 2023
Welcome!
Welcome to the first newsletter for all things plastic and reconstructive surgery. We are so glad you are here with us :)
The Stitch is the first student-run Plastic Surgery newsletter that offers insight into the field, subspecialties, and plastic surgery programs. We plan to share quick, digestible updates on the current literature and research and promote wellness, fun, and authenticity through art, personal stories, etc.
We hope to continue this platform for years to come with more students becoming interested, involved, and aware of the ongoings in our field.
Best, The Stitch Editorial Board
A Letter from our Faculty Advisor
Welcome to The Stitch!
We look forward to sharing with you pertinent information on Plastic Surgery and showing the many facets of those in the field. We are truly a multidimensional group. From art, to creative writing, to profound research, to innovative surgical techniques, we are all so different. There is no “cookie cutter” plastic surgeon, yet we share a common love of Plastic Surgery. We hope your time with us will not only make you excited about Plastic Surgery, but also excited to embrace your individual passions and what makes you authentically you.
When we bring our whole authentic selves to the playing field, that’s when the game really gets exciting. That’s when we find joy. That’s when we find our purpose. We, as a specialty, have a history of drawing on our uniqueness, seeing what is beyond the problem or algorithm, and pushing the envelope to get there. The Stitch will showcase these accomplishments, our uniqueness, and will also encourage you to think of what is possible.
Thank you for joining us!
Jessica A. Ching, MD
University of Florida
Associate Professor, Plastic Surgery & Pediatrics
Program Director, Plastic Surgery
Surgical Director, Craniofacial Center
Regenerating Complexity:
Stem Cell Use in Facial Regenerative Surgery
Article Review by Matthew Henn, Oregon Health and Science University
The future of facial regenerative surgery is evolving, with recent studies focusing on harnessing the use of stem cells to facilitate tissue regeneration and enhance aesthetic outcomes in reconstructive procedures. This article explores current cutting-edge clinical applications and opportunities on the horizon in the field of facial regenerative surgery.
Mesenchymal stem cells (MSC) are the preferred differentiator as exhibited by definitive therapeutic and regenerative research in clinical trials (Brown et al, 2019). These cells are easy to obtain through various sources, with emphasis on the bone marrow and adipose tissue locales within this scope of research. MSC utilize extensive proliferation and self-renewal through their multipotency, providing an avenue to a more complete and seamless regenerative process.
Bone, skin, and soft tissue regeneration procedures are prioritized among researchers. Skin and soft tissue studies primarily focus on aesthetics due to aging concerns. In a study of twenty patients impacted by solar elastosis, a significant positive impact in elastic fiber regeneration was seen when treated with MSC (Tel et al, 2023). Further optimistic results showed in bone tissue regeneration, where MSC were utilized in a range of complex craniofacial malformations and trauma injuries. Future applications in intricate procedures, such as maxillary cleft, show potential.
Despite promise surrounding stem cell applications in facial regenerative surgery, the field remains under-researched and lacks compelling experimental efficacy. Bioprinting and facial scaffold fabrication with stem cells are emerging, but the current inability to replicate nervous, muscular, and vascular networks in vivo indicates implementation into a practical setting remains far from reality. Though the road to clinical application may be long and demanding, the current advancements in stem cell research offer hope for a future where regenerative surgery will redefine the possibilities of facial regeneration.
References
Brown C, McKee C, Bakshi S, Walker K, Hakman E, Halassy S, Svinarich D, Dodds R, Govind CK, Chaudhry GR. Mesenchymal stem cells: Cell therapy and regeneration potential. Journal of tissue engineering and regenerative medicine. 2019 Sep;13(9):1738-55.
Tel A, Miotti G, Ius T, De Marco L, Robiony M, Parodi PC, Panciani PP, Zeppieri M. Stem Cells in Facial Regenerative Surgery: Current Clinical Applications. A Multidisciplinary, Systematic Review. Frontiers in Bioscience. 2023;28(6):123.
The Role and Ethics of ChatGPT in Plastic Surgery
Opinion by Hilary Liu, University of Pittsburgh SOM
Artificial intelligence (AI) is revolutionizing healthcare, and plastic surgery is no exception. The large language model (LLM) ChatGPT represents the dawn of a new era, with potential applications in research, education, and clinical practice (Alessandri-Bonetti et al. 2023). However, it also brings forth myriad ethical considerations that must be addressed.
In research, ChatGPT can sift through vast amounts of data with astounding speed and precision, thus transforming how studies are conducted. ChatGPT can help identify trends in the literature and has even demonstrated the ability to formulate novel plastic surgery systematic review ideas (Gupta, Park, et al. 2023; Gupta, Herzog, et al. 2023). However, it is essential to recognize the tool’s limitations. ChatGPT still lacks the human ability to interpret and apply context in a nuanced way. Therefore, human oversight remains paramount in ensuring accurate interpretations and implementations.
In education, ChatGPT can play a role as an intelligent tutor, assisting in the instruction of surgical techniques or providing simulated patient interactions. Indeed, ChatGPT has demonstrated impressive performance on the plastic surgery in-service exam (Gupta et al. 2023; Humar et al. 2023). However, dependence on AI for training could diminish the value of human-to-human learning experiences, which are crucial for developing interpersonal skills and professional growth. It's important to strike a balance between traditional pedagogy and AI-assisted education.
As for clinical practice, AI has the potential to provide insights into case planning, offer decision support, and enhance patient education. For example, ChatGPT can effectively answer the most common questions about breast reconstruction (Liu et al. 2023). Nevertheless, introducing AI into the patient-physician dynamic prompts considerable ethical considerations. Issues of privacy and consent become more complex, given the extensive data that AI systems process. Furthermore, the risk of miscommunication or misunderstanding is a concern. AI lacks the human touch in understanding and managing emotions—a crucial aspect in sensitive conversations around plastic surgery.
ChatGPT offers a future teeming with possibilities in plastic surgery—revolutionizing research, streamlining education, and augmenting clinical practice. Yet, as we move forward, we must address the ethical considerations that come with it. Striking a balance between utilizing AI's capabilities and preserving the irreplaceable value of the human touch is crucial. AI should be the plastic surgeon’s tool, not their replacement.
References
Alessandri Bonetti M, Giorgino R, Gallo Afflitto G, De Lorenzi F, Egro FM. How Does ChatGPT Perform on the Italian Residency Admission National Exam Compared to 15,869 Medical Graduates?. Annals of Biomedical Engineering. 2023 Jul 25:1-5.
Gupta R, Herzog I, Weisberger J, Chao J, Chaiyasate K, Lee ES. Utilization of ChatGPT for plastic surgery research: friend or foe?. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2023 May 1;80:145-7.
Gupta R, Park JB, Bisht C, Herzog I, Weisberger J, Chao J, Chaiyasate K, Lee ES. Expanding cosmetic plastic surgery research with ChatGPT. Aesthetic Surgery Journal. 2023 Mar 21:sjad069.
Humar P, Asaad M, Bengur FB, Nguyen V. ChatGPT is equivalent to first year plastic surgery residents: evaluation of ChatGPT on the plastic surgery in-service exam. Aesthetic Surgery Journal. 2023 May 4:sjad130
Liu HY, Bonetti MA, Jeong T, Pandya S, Nguyen V, Egro FM. Dr. ChatGPT Will See You Now: How Do Google and ChatGPT Compare in Answering Patient Questions on Breast Reconstruction?. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2023 Jul 27.
3D Printed Wound Dressings for Burn Patients:
The Future of Burn Care
Article Review by Anjalika Chalamgari, University of Florida COM
The proper care and treatment of burn wounds is complex, and poses many challenges to medical professionals (Kowal et al, 2019). Perhaps the most important of these is proper wound dressing. Current standard of care relies on hydrogels, a class of polymers notable for their potential to give and absorb water to the wound appropriately (Kordestani, 2019). Hydrogels are often composed of alginate and gelatin, which offer debridement and accelerate the immune response, respectively. Though hydrogels can be effective at promoting the healing process, they are limited by their quick degradation and short-term adherence to the wound.
Furthermore, a given hydrogel composition, which is generally dictated by the aforementioned gelatin:alginate ratio, may not be adequate to treat a certain burn type or size. Thus, a more personalized approach is called for-- 3D printing.
A recent study by Fayyazbakhsh et al found that 3D printed dressings enhanced wound healing over same-composition, non-printed methods (Fayyazbakhsh et al, 2022). 3D printed hydrogels healed wounds faster and were associated with less traumatic dressing removal in rats. The authors also examined different gelatin:alginate ratios. Using in vitro models, they concluded that a ratio of 75:25 was ideal in terms of hydrogel hydration, degradation time, and skin viability. The exact effect on patients remains to be seen.
Though the available literature is limited, 3D printed dressings in the management of burn wounds show great promise. As we trend towards a greater interest and attention to personalized medicine, it is clear that 3D printing (and specifically, compositional burn care) will be a part of our future.
References
Fayyazbakhsh F, Khayat MJ, Leu MC. 3D-Printed Gelatin-Alginate Hydrogel Dressings for Burn Wound Healing: A Comprehensive Study. Int J Bioprint. 2022 Sep 19;8(4):618. doi: 10.18063/ijb.v8i4.618.
Kordestani SS. Atlas of Wound Healing: A Tissue Engineering Approach. Elsevier Health Sciences; 2019 Apr 2.
Kowal S, Kruger E, Bilir P, Holmes JH, Hickerson W, Foster K, Nystrom S, Sparks J, Iyer N, Bush K, Quick A. Cost-Effectiveness of the Use of Autologous Cell Harvesting Device Compared to Standard of Care for Treatment of Severe Burns in the United States. Adv Ther. 2019 Jul;36(7):1715-1729. doi: 10.1007/s12325-019-00961-2.
A Day in the Life of a Resident
Featuring Arhana Chattopadhyay, PGY-6 from Stanford University
Interview by Sabrina Han, University of Florida COM
Quick background
Hometown: Texas
Medical school: Stanford University
Interests: Craniofacial and Gender
Career path: I had a mentor who completed an anatomy dissection of the hand and I just loved it. It just clicked for me. I honestly didn’t love all the other coursework in medical school, but in my second semester of first year, I started shadowing this mentor. I got involved in his lab, did research, and got to know the people in the department and residents. I loved everyone and it was the perfect fit for me.
In residency, I did still love hand, but I gravitated towards the facial cases. I had this strong interest in international health prior to residency and it was one of the reasons I went into medicine. It became this natural evolution into cleft care. Then in my fourth year, there was a talk by Justine Lee talking about facial feminization and it all clicked. I saw the opportunities in craniofacial and facial gender. It is a newer field and there’s a lot of aspects of advocacy and social justice.
When do you wake up? I usually wake up around 5 to get ready for rounds at 6. I take my dog on a quick walk. As I get ready, he sits next to me and falls back asleep. I’m not the biggest breakfast person so I make a quick protein shake, and I’m on my way to the hospital.
At 6 AM, I am… rounding with the team. After we see all our patients, the team splits into their assignments for the day. As chief resident, I text my attending and coordinate the care for the morning.
At 7 AM, I am… heading to the OR. I did a cleft rhinoplasty last week, one of my favorite surgeries.
At 12 PM, I am… finished with the case and the patient is in PACU. I head to the cafeteria and grab some food with one of my co-residents before clinic.
At 1 AM, I am… in clinic.
At 5 PM, I am… in pm rounds. Checking on all of our patients!
At 6 PM, I am… in didactics. On Tuesdays, we have an afternoon lecture series. This past week, we practiced elevating flaps and dissecting facial nerves on cadavers.
How does the workday end for you? My co-residents and I try to grab a drink and hang out for a little bit after Tuesday lectures. I head home around 7:30-7:45, eat dinner with my husband, and hang out/relax with my dog.
What do you do after work? From 9:30 to 10 pm, I prep for the next day’s cases and read up. Ideally, I try to be in bed by 11, but sometimes that doesn’t happen!
What grounds you?
I really prioritize my life outside of work. Whether that's time with my family, my dog - I know the things that make me really happy. Even if I’m on call, my husband and I will try to do a date night each week and we put away our phones. My dog brings me a lot of joy. He’s still a little puppy but he is a bright spot in my life and I love any time I get to spend with him. I also try to pursue my hobbies outside of medicine, like fashion. It doesn’t always happen, but I know it makes me a happier doctor with more longevity.
What keeps you motivated?
I recently went on a service trip to Guatemala for cleft care. After long, busy 12-hour days of nonstop operating, it was so gratifying seeing that you have the skill to change someone’s life. It is very meaningful to me. A 7-year program is long, and it can be tough. We are lucky to be helping people every day, but in the daily grind, you can sometimes lose yourself in what you’re doing. Whatever fills your cup. Whether it’s service or even a conference of inspirational speakers, when you can take a step back, you realize what an amazing career we are a part of.
What’s one piece of advice you have for someone who wants to do what you do?
There’s so many pieces of advice - can I do three!?
First, find a mentor at different levels. A senior who can open doors for you, younger faculty who you want to emulate, and a peer resident who you admire. Find role models and mentors at different stages in life.
Second, understand what you need to do in order to be effective. Exercise or whatever it is for you, in order to be a good doctor, and have longevity in your career, figure out what your priorities are. It’s easy to lose them but it makes a huge difference when you hold sight of your other lives.
Third, have an image in your mind of why you’re doing this. You’ll be tired, something may go wrong in the case, and there will be difficult times. Have a mental mood board for why you are doing this. If you have this in your mind, of what motivates you, what excites you about your future- any time you have difficulties, you can look back at that. And of course, it changes - who I am and what I want to do. But the principles are the same, what you want to achieve. It is an amazing reflection. Everyone has different motivations, but for me, it is having a purpose. Coming back to that mental image keeps me going.
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