September 2023

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Patient Education Resources Related to Neophallus Reconstruction:

Readable or Not?

Article Review by Olivia Waldron, Pennsylvania State University

Some transgender men may undergo phalloplasty, a multi-stage, irreversible surgery used to create a neophallus (Papadopulos et al., 2021). This type of surgery has the greatest rate of post-surgical complications of all gender-affirming surgeries. Other procedures that accompany neophallus construction include urethroplasty, which is the reconstruction or creation of a urethra. Due to the procedure’s relatively recent development and ongoing refinements, patient education materials are lacking in existence and in readability. A study by Paidisetty et al sought to change this (2023).

The authors queried Google Scholar using the following keywords in both English and Spanish, respectively: Phalloplasty, Urethroplasty, Faloplastia, and Uretroplastia. URLs were categorized by domain (institutional, non-institutional, or academic) to identify insights into resources used by the public versus physicians. Using validated readability scales like the Simple Measure of Gobbledygook (SMOG) and Spanish Simple Measure of Gobbledygook (SOL), the years of education required to understand the text in each resource were determined. A final score resulted corresponding to grade-level of comprehension. The Mann-Whitney U test was then used to identify statistically significant differences between the readability score and the search engine ranking.

All the patient education materials were found to exceed the recommended reading levels of the public. Furthermore, they found that English materials were more difficult to understand than Spanish. Most Americans read at a 6th to 8th-grade reading level (Cotunga et al, 2005). Poor health literacy has known negative health outcomes that are compounded by difficult-to-read patient education materials. Supplemental online educational material in various languages should be developed that suits the readability of the common public and patient populations undergoing phalloplasty.

References

Cotugna N, Vickery CE, Carpenter-Haefele KM. Evaluation of literacy level of patient education pages in health-related journals. Journal of community health. 2005 Jun;30:213-9.

Paidisetty P, Sathyanarayanan S, Kuan-Pei Wang L, et al. Assessing the Readability of Online Patient Education Resources Related to Neophallus Reconstruction [published online ahead of print, 2023 Jul 26]. J Surg Res. 2023;291:296-302. doi:10.1016/j.jss.2023.06.012

Papadopulos NA, Ehrenberger B, Zavlin D, Lellé JD, Henrich G, Kovacs L, Herschbach P, Machens HG, Schaff J. Quality of life and satisfaction in transgender men after phalloplasty in a retrospective study. Annals of Plastic Surgery. 2021 Jul 1;87(1):91-7.

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Fostering Compassion and Expertise:

The Crucial Role of Patient Understanding and Historical Context in Plastic Surgery

Opinion by Kimberley C Brondeel, University of Texas Medical Branch, John Sealy School of Medicine

In the world of surgery, meticulous preparation is paramount. Before donning those sterile gloves and stepping into the operating room, there's a checklist that goes far beyond the instruments and drapes. It begins with a fundamental act of humanity – introducing oneself to the patient. Without this, we risk becoming mere technicians, our actions devoid of context and compassion.

Why is it so crucial to know who the patient is, why they're here, and what they're about to undergo? Because understanding their journey, potential outcomes, and postoperative course is not just a courtesy; it's a professional obligation. We owe it to our patients to be fully informed, to be more than "that guy" who disregards the sterile field before surgery even commences.

Preparation extends to mastering the nuances of the procedure itself. From indications to contraindications, and complications to anatomy, a surgeon's knowledge must be unwavering. Textbooks and manuals are our allies in this quest for excellence.

Yet, in our pursuit of perfection, we sometimes overlook a vital aspect of our craft – the history behind it. I recently scrubbed into a paramedian forehead flap procedure, a cornerstone of nasal reconstruction. It struck me that we often forget to delve into the historical roots of our craft, to appreciate how far we've come.

The history of plastic surgery, I discovered, reaches back to 600 BC. Sushruta, an ancient surgeon, described a comprehensive approach that included using a leaf to create a wound template, a cheek flap to supply tissue, and hollowed reeds as nasal stents (Singh, 2017). This technique, born out of necessity, evolved over time.

The power of this historical perspective is profound. It connects us to a legacy stretching back millennia, reminding us that we stand on the shoulders of countless surgeons who shaped our field. Instead of rote memorization, I urge my colleagues to explore the rich history of our procedures. It's a journey that illuminates and deepens our appreciation for the art and science of surgery, offering insight into the hands that have crafted its evolution.

References

Singh V. Sushruta: The father of surgery. Natl J Maxillofac Surg. 2017 Jan-Jun;8(1);1-3. doi: 10.4103/njms.NJMS_33_17. PMID: 28761269; PMCID: PMC5512402.

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Utilization of PRP in Reconstructive and Aesthetic Facial Surgery:

An Evidence-Based Approach

Literature Review by Kasra Rahmati, Gergen SOM at UCLA

Platelet-rich plasma (PRP) is classically defined as equal to or greater than a twofold increase in platelet concentration compared with that of whole blood suspended in autologous plasma (Sommeling et al, 2013). The U.S. Food and Drug Administration does not currently recognize PRP, leading to a lack of consensus on its variety of formulations, further complicating clinical research analysis.

In this article, I will discuss the utility and status of PRP in reference and regard to facial plastic surgery, specifically in reconstructive and aesthetic applications, using an evidence-based approach of the current available literature.

Within the reconstructive scope, PRP demonstrates significant advantages over conventional mechanical fixation in skin grafting, including reduced graft loss, morbidity, and hospitalization duration, accompanied by the benefit of instant graft uptake (Chigurupati et al, 2023). In regard to scar treatment, findings were more equivocal, with mixed outcomes in keloid treatment and scar quality improvement (Alser et al., 2018). Limited evidence exists for the application of PRP in burn treatment. PRP may exhibit potential positive healing effects on chronic wounds, however, there’s an insufficient amount of literature analyzing its effects on face-specific wounds (Martinez-Zapata et al, 2016).

Regarding aesthetic procedures, PRP alone does not seem to have major beneficial effects on rhytidectomy or facial rejuvenation; however, combining PRP with hyaluronic acid (HA) results in a significant benefit of facial appearance and skin elasticity (Hersant et al., 2017). PRP also seems to be a viable option for managing hair loss, with improvements in hair regrowth, density, and count; however, its superiority over other therapeutic approaches is not consistently proven (Badran & Sand, 2018). PRP injections have also been shown to increase the rate of skin recovery and improve acne scarring after ablative CO2 fractional resurfacing (Galal et al., 2019).

Further clinical research, ideally alongside an established universal standard for PRP, is necessary to fully understand the therapeutic benefits, and potential adverse effects, of PRP in reconstructive and aesthetic facial plastic surgery.

References

Alser OH, Goutos I. The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review. Scars, burns & healing. 2018 Nov;4:2059513118808773.

Badran KW, Sand JP. Platelet-rich plasma for hair loss: review of methods and results. Facial Plastic Surgery Clinics. 2018 Nov 1;26(4):469-85.

Chigurupati VS, Khanna S, Kumar S, Khanna R. Efficacy of platelet-rich plasma in alleviating split skin graft morbidities. Journal of Cutaneous and Aesthetic Surgery. 2023:10-4103.

Galal O, Tawfik AA, Abdalla N, Soliman M. Fractional CO2 laser versus combined platelet‐rich plasma and fractional CO2 laser in treatment of acne scars: image analysis system evaluation. Journal of cosmetic dermatology. 2019 Dec;18(6):1665-71.

Hersant B, SidAhmed-Mezi M, Niddam J, La Padula S, Noel W, Ezzedine K, Rodriguez AM, Meningaud JP. Efficacy of autologous platelet-rich plasma combined with hyaluronic acid on skin facial rejuvenation: a prospective study. Journal of the American Academy of Dermatology. 2017 Sep 1;77(3):584-6.

Martinez‐Zapata MJ, Martí‐Carvajal AJ, Sola I, Expósito JA, Bolibar I, Rodriguez L, Garcia J, Zaror C. Autologous platelet‐rich plasma for treating chronic wounds. Cochrane Database of Systematic Reviews. 2016(5).

Sommeling CE, Heyneman A, Hoeksema H, Verbelen J, Stillaert FB, Monstrey S. The use of platelet-rich plasma in plastic surgery: a systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2013 Mar 1;66(3):301-11.

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Monkeys and Itches

Poem by Anjalika Chalamgari, University of Florida COM

Is a bottomless depth.

The sense of understanding

Even more so.

The brain itches with facts

And claws at opinions,

Opinions that so accurately grasp the world

That they become facts.

And then the brain itches with facts.

How large is the universe?

The itches I carry are prickly.

A scratch can grant the tiniest of satisfactions

A dulling of the perpetual sensation,

But the itches come back.

Jarringly,

Painfully,

Inscrutably,

The itches tingle.

Why are humans shaped this way?

Monkeys, I'm told,

Are the culprit.

Our primitive forefathers,

Drunk on the perceived slight

Of ignorance,

Take revenge on their big-brained descendants.

The itches aren’t anything but

Their screams.

How much matter exists in the known and unknown universe?

One monkey cries amongst a chorus of screeches.

Or is it just an itch amongst a sea of itches?

The monkeys,

The itches,

They sit there

Up in my head

Knocking on the door of my peace

With a loud, resounding

What happens after we die?

Thud.

How do you kill a monkey?

How do you scratch an itch?

Do you set a trap for it,

Leave a bright yellow banana under some bushes?

Is time real?

Does the itch have a special ointment,

A healing balm that medicine says will cure all?

What about for thousands,

For millions of monkeys whose howls

Resound into the depths of the night,

Shaking your eardrums until they bleed?

Billions of itches that

Do aliens exist?

Itch,

Are there multiple realities?

Itch,

Why do we get angry?

Itch,

How do we think?

Itch until

The brain’s wrinkled folds

Give way to a smooth,

Scrubbed surface.

I tell myself

That it’s all temporary.

The monkeys have to sleep sometime,

Have to eat the banana I’ve left

So conveniently under that bush for them.

How do we feel pain?

The itches will resolve themselves,

Like a cold that disappears

After a day with a warm blanket.

But I know

That it is not the disease

Are fish conscious?

But the reprieve that is temporary.

They say

The only way to get rid of a tumor

Is to kill it entirely,

To destroy every molecule

So that it’s malignant spawn spreads no longer.

But what if

Why do we need oxygen to breathe?

It’s

Why is the Earth round?

Unkillable?

Perhaps then the best cure

How did life begin?

Is to do absolutely

Will humanity ever end?

Nothing at all.

To hear the monkeys’ shrieks

As laughter,

Is curiosity good for you?

And to feel the itches

As caresses.

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