January-March 2024 Edition
- thestitchprs
- Mar 12, 2024
- 8 min read
We are excited to kick off our first edition in 2024! Lots of new updates for this year to come!
If you are interested in submitting a guest contribution or wish to share announcements or opportunities, please complete the form at the link at the bottom of the newsletter.
Best, The Stitch Editorial Board
Plastic Surgery in Global Health
Article Review by Sarah Moffitt, USF Morsani College of Medicine
If someone asks you what field of medicine you are interested in, and you respond “plastic surgery”, odds are the cosmetic side of the field comes quickly, if not first, to their mind. However, the scope of Plastic and Reconstructive Surgery expands well beyond what the media displays. In fact, it can stretch further than your local community, and even into the global health scene.
A review from 2018 estimates that 11% of disease adjusted life years (DALYs) are attributed to surgical conditions worldwide, with 66% of those (injuries, malignancies, and congenital anomalies) commonly treated by plastic surgeons. Injuries and trauma from war, natural diseases, car accidents, and other damaging events constitute the greatest surgical burden. Wound debridement, compartment syndrome management, and fracture fixation are other procedures performed by plastic surgeons that can drastically change the outcomes of injuries for patients. For example, proper management following burn injuries is crucial to preserving function and form of the affected area. Without it, sepsis, contracture, and life-long disability can result.
Repair of cleft lips and cleft palates is another life-changing procedure in the plastic surgery field. Reconstruction of the cleft deformities allows a child to eat, speak, and breathe properly, along with lowering risks of infection and malnutrition. Beyond that, children with cleft lips or palates are often excluded and denied opportunities for jobs or education in some areas of the world.
These are some of the few, and certainly not all, of the ways plastic surgeons can transform the lives of people without access to surgical care. As a field that operates on any area of the body, plastic surgery has a vast capacity for global health efforts.
Source: Borrelli, M. R. (2018). What Is the Role of Plastic Surgery in Global Health? A Review. World Journal of Plastic Surgery, 7(3), 275–282. https://doi.org/10.29252/wjps.7.3.275
Common Approaches to Axillary Burn Scar Contracture Release
Medical Illustration by Hilary Liu, University of Pittsburgh School of Medicine
Z-plasty in red, V-Y advancement in blue
From the Bench to the Clinic: Engineering Soft Tissue Flaps
Article Review by Olivia Waldron, Pennsylvania State College of Medicine
Current treatments for soft tissue reconstruction are accompanied by the inherent disadvantage of limited autologous tissue and donor site morbidity. Therefore, researchers have focused on developing engineering replacement tissues using techniques like arteriovenous loops (AVL) to induce vascularization. Although promising, long-term volume retention of these engineered soft tissue flaps remains a challenge.
Using 28 immunocompromised rats, microsurgical techniques were utilized to harvest and anastomose a contralateral vein graft between the right saphenous artery and vein in the rat hindlimb. These AVLs were then placed into chambers and embedded in either acellular human dermal scaffolds (n=14) or bovine collagen and elastin matrices (n=14) (Figure 1). Tissues were explanted for immunohistochemistry and micro-computed tomography on either postoperative day 21 or 28. Microvasculature was quantified for each sample to evaluate de novo vascularization.
This study found that there were comparable rates of vascularization between the acellular human dermal scaffolds and the bovine collagen and elastin matrices at days 21 and 28 respectively (mean vessel counts 95% CI –672.8 to 669.3,P = 0.99; .1182 to 530.1,P = 0.40). Uniquely, the dermal scaffolds maintained their volume to a greater degree than the bovine matrices (p=<0.0001).
Acellular dermal scaffolds paired with AVLs present an exciting platform for tissue engineering and may help promote prevascularization in engineered soft tissue flaps.
Falkner F, Mayer SA, Heuer M, Brune J, Helt H, Bigdeli AK, Dimmler A, Heimel P, Thiele W, Sleeman JP, Bergmeister H, Schneider KH, Kneser U, Thomas B. Comparison of Decellularized Human Dermal Scaffolds versus Bovine Collagen/Elastin Matrices for Engineering of Soft-Tissue Flaps. Plast Reconstr Surg. 2024 Jan 1;153(1):130-141. doi: 10.1097/PRS.0000000000010511. Epub 2023 Apr 5. PMID: 37014963.
Opinion: Shifts in the Cost of Plastic Surgery
Article Review by Parul Rali, University of Texas Medical Branch
How have the costs of aesthetic treatments and procedures changed amid the skyrocketing inflation in recent years? (1) Notably, while surgical procedure costs have risen, those of noninvasive treatments are declining. (2) The economic impact of COVID-19 impacted the supply chain and greatly influenced overall costs as a result. (1) In the experience of plastic surgeon Dr. R. Laurence Berkowitz, the surgeon's fee itself has not changed significantly; rather, factors such as operating room expenses, anesthesia, and supplies have contributed to rising surgical costs. (2)
Conversely, the prices of noninvasive treatments such as Botox and laser hair removal have consistently declined since 2008, perhaps due to their increased availability and popularity. (2) Medical professionals across nearly all specialties are now offering noninvasive aesthetic treatments, contributing to driving the market rate down. As a result, plastic surgeons are facing increased competition in the aesthetic medicine.
Regardless of whether the procedure is surgical, patient safety must come first. With newer patient safety measures, such as Florida’s law requiring ultrasound-guided gluteal-fat grafting, (3) There is a need for multiple professionals to be on staff during invasive procedures, which may be a factor behind why costs of invasive procedures have been on the rise. Additionally, we must continue to inform patients to prioritize the qualifications, quality of service, and safety practices of their aesthetic providers over the cost.
References:
1. Chakraborty O. Inflation and COVID-19 Supply Chain Disruption. In: Managing Inflation
and Supply Chain Disruptions in the Global Economy. IGI Global; 2023:10-23.
doi:10.4018/978-1-6684-5876-1.ch002
2. Lynam R. What’s Behind the Rising Cost of Plastic Surgery? NewBeauty. Published
December 28, 2023. Accessed January 22, 2024. https://www.newbeauty.com/rising-plasticsurgery-
cost/
3. Lane R. Florida Passes BBL Law Mandating Use of Ultrasound Guidance. MedEsthetics.
Published July 25, 2023. Accessed January 22, 2024.
A Day in the Life of a Resident:
Featuring Michelle Oberoi, MD, PGY-2 from Baylor Scott White
Interview by Youssef Aref, California University of Science & Medicine SOM
Quick background
Hometown: Los Angeles
Medical School: UC Riverside School of Medicine
Interests: Powerlifting, indoor plants/orchids, traveling
Career path
I started off at UC Irvine thinking I would pursue a PhD in neuroscience and even interviewed for programs but ultimately decided that I would really miss direct patient communication, thus I pivoted and decided to pursue an MD. I was most inspired by my volunteer experience at the hospital and the experiences I had in the hospital setting interpreting for my Spanish-only speaking grandmother. After shadowing at an internist’s office in South Central Los Angeles who primarily had Spanish-speaking patients I was sold on pursuing a primary care related specialty and at the time was leaning towards Internal Medicine or Emergency Medicine. This led me in choosing to pursue my medical degree at UC Riverside School of Medicine. I ultimately fell in love with my general surgery rotation and knew I had to be in the OR. I still remember the day where I realized “this was it.” I had never considered plastic surgery until a UC Irvine attending demonstrated face transplant on non-fixed cadavers as well as autologous breast reconstructive techniques. Once again, I found myself saying “this was it”- after this I did a deep dive and discovered that there was a lot to plastic surgery than the aesthetic surgeries, I had been privy to having grown up in Los Angeles. I became fascinated with craniofacial surgery and was fortunate enough to serve as a research fellow in Dr. Lee’s craniofacial lab at UCLA where I was able to apply my prior basic science knowledge at the bench running western blots, performing rabbit craniotomies, while investigating patient outcomes in the pediatric craniofacial population and in patients undergoing facial affirming surgery. It was in this lab that I was able to speak with patients directly in Spanish and debunk the concept of not being able to serve underserved communities if I pursue plastic surgery; this was also the case on my several sub-Is and to date, many of our hand trauma patients are laborers only speak Spanish. Now, as a PGY2 at BSWH, I’ve been exploring the possibility of pursuing a microsurgery or craniofacial surgery fellowship as our experience with both is robust here, however time will tell!
What’s your day like?
⁃ 0500 alarm goes off. I prechart patients and head to the hospital. Prepare my list and round on our patients.
⁃ 0650 run the patient list with the team and figure out what the tasks are for the day. As the lowest level on the service, I’m still learning the ropes and gaining graduated autonomy.
⁃ Four times a week we have an hour of protected study time.
⁃ I then get most tasks done prior to going into our first case at approximately 0745. Some of our cases can be on the quicker side such as bilateral breast reductions or carpal tunnel releases. Other surgeries can last over 20+ hours especially when it is a complicated multi-flap head and neck reconstruction.
⁃ If I’m holding the task pager during the day I will also handle floor questions from nurses, and ED and floor consults with an upper level resident. So depending on the length of the surgery, I get remaining tasks done and see consults between cases.
⁃ We check out around 1715 with the whole plastic surgery resident team and the task pager is handed off to the resident on call that night. We take one night of call a week and a weekend a month on average. At BSWH we cover all of face and mandible call and half of hand call so we are pretty busy but it gives us robust exposure to handling complicated facial lacerations in the trauma bay.
⁃ When I’m not on call, I’ll stop by the gym before heading home and studying for my cases for the following day over dinner. On weekends I head to Austin for some bouldering/yoga/meditation, or stay in and catch up on sleep/studying/hobbies.
What reminds you of the why behind this journey?
Whenever I get the opportunity to take care of Spanish-speaking only patients I remember it is a privilege to help serve as a direct interpreter for not only the plastic surgery care we provide, but also for on behalf of the interdisciplinary teams taking care of our patients as there are usually many gaps in communication from language and cultural barriers. It reminds me of my first experiences in medicine with the internist in South Central Los Angeles and inspires me to always work towards improving my medical Spanish knowledge.
What keeps you motivated?
Reading about well-known plastic surgery operative techniques and novel research inspires me to keep asking “Why?”. The more I learn, the more I realize how much I don’t know. It encourages me to voraciously acquire as much knowledge as possible to strive to be better and optimize my current techniques. Lastly, learning the various techniques and approaches different surgeons have for similar procedures has taught me that it is important to stay humble and be receptive to change as it breeds innovation.
What’s one piece of advice you have for someone who wants to do what you do?
Work hard and persevere despite the unsolicited advice you may get from others. Don’t listen to the naysayers or those who do not believe in you. Take advice (including my own) with a grain of salt, however be receptive to constructive criticism as it’ll allow you to grow as a clinician and as a person overall. And most importantly: if at first you don’t succeed, try, try again.
Lightning Round
Favorite Procedure?
⁃ 1. Septorhinoplasty, 2. Tubed anterolateral thigh free flap for reconstruction after a total laryngopharyngectomy
Music in the OR?
⁃ Reggaeton or EDM
Favorite On-Call Snack?
⁃ Protein shake or bar w/ at least >20g protein. If it’s a particularly rough day/call then I pivot from healthy to comfort food and get a Freddy’s double-double burger with fries.
Favorite shoes to wear in the OR?
⁃ Was a longstanding Crocs wearer since MS3, but recently converted to Calzuros and I’m never looking back. Sponsor me!
If you are interested in submitting a guest contribution or wish to share announcements or
opportunities, please complete the form at the link below.
Discover the latest in plastic and reconstructive surgery.
Made by medical students, for medical students.
Comments