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Gender disparity in plastic surgery in Canada is an important issue. The Women Plastic Surgeons of Canada (WPSC) group was created to highlight the interests and concerns of female members of the Canadian Society of Plastic Surgeons (CSPS). Women Plastic Surgeons of Canada seeks to teach and implement measures to overcome the internal and external factors contributing to "the plastic ceiling." In addition, the WPSC group was created to raise awareness about the gender gap in our leadership and implement strategies to empower female surgeons to "lean in" and seek out leadership roles in plastic surgery. Education, mentorship, and networking among female CSPS members are first steps in empowering our female surgeons. All members of the CSPS are encouraged to learn about gender disparity in order to work together to address this issue.

La disparité entre les sexes est un enjeu important en chirurgie plastique au Canada. Le Groupe des chirurgiennes plasticiennes du Canada (GCPC) a été créé pour souligner les intérêts et les préoccupations des femmes membres de la Société canadienne des chirurgiens plasticiens (SCCP). Le GCPC cherche à enseigner et à adopter des mesures pour éliminer les facteurs internes et externes qui contribuent au plafond « de plastique ¼. De plus, le GCPC a été créé pour faire connaître l'écart entre les sexes au sein de la direction et adopter des stratégies qui inciteront les femmes chirurgiennes à solliciter des postes de direction en chirurgie plastique. L'enseignement, le mentorat et le réseautage entre plasticiennes de la SCCP sont les premières étapes pour favoriser leur autonomisation. Tous les membres de la SCCP sont invités à s'informer sur la disparité entre les sexes afin de collaborer à régler ce problème.

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BACKGROUND: Mastectomy flap necrosis is a common complication of immediate breast reconstruction that impacts recovery time and reconstructive success. Nitroglycerin ointment is a topical vasodilator that has been shown to improve skin flap survival in an animal model. The objective of this study was to evaluate whether the application of nitroglycerin ointment to the breast skin after mastectomy and immediate reconstruction causes a decrease in the rate of mastectomy flap necrosis compared with placebo. METHODS: This study was conducted as a randomized controlled trial and included patients aged 21 to 69 years undergoing mastectomy and immediate breast reconstruction at the University of British Columbia-affiliated hospitals (Vancouver, British Columbia, Canada). Patients with a medical history that precluded the administration of nitroglycerin were excluded from the study. The target sample size was 400 patients. Nitroglycerin ointment (45 mg) or a placebo was applied to the mastectomy skin at the time of surgical dressing. RESULTS: The trial was stopped at the first interim analysis after 165 patients had been randomized (85 to the treatment group and 80 to the placebo group). Mastectomy flap necrosis developed in 27 patients (33.8 percent) receiving placebo and in 13 patients (15.3 percent) receiving nitroglycerin ointment; the between-group difference was 18.5 percent (p = 0.006; 95 percent CI, 5.3 to 31.0 percent). Postoperative complications were similar in both groups [nitroglycerin, 22.4 percent (19 of 85); placebo, 28.8 percent (23 of 80)]. CONCLUSIONS: In patients undergoing mastectomy and immediate reconstruction, there was a marked reduction in mastectomy flap necrosis in patients who received nitroglycerin ointment. Nitroglycerin ointment application is a simple, safe, and effective way to help prevent mastectomy flap necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

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BACKGROUND: Direct-to-implant single-stage immediate breast reconstruction using acellular dermal matrix is a cost-effective alternative to two-stage expander-implant reconstruction. The purpose of this study was to identify predictors of direct-to-implant single-stage immediate breast reconstruction failure, defined as need for early (≤6 months) revision surgery. METHODS: The authors conducted a retrospective cohort study of all patients with direct-to-implant single-stage immediate breast reconstruction in 2010 and 2011 at three University of British Columbia hospitals. Data were compared between successful and failed single-stage reconstructions. Predictors of failure were identified using multivariate logistic regression. Patient demographics and complications were compared to a random sample of control patients with two-stage alloplastic reconstruction without acellular dermal matrix. RESULTS: Of 164 breasts that underwent direct-to-implant single-stage immediate breast reconstruction, 52 (31.7 percent) required early revision. Increasing breast cup size was the only significant predictor of early revision compared with bra size A (OR for bra size B, 4.86; C, 4.96; D, 6.01; p < 0.05). Prophylactic mastectomies showed a trend toward successful single stage (OR, 0.47; p = 0.061), whereas smoking history trended toward failure (OR, 1.79; p = 0.065). Mastectomy flap necrosis was significantly higher in direct-to-implant single-stage immediate reconstruction cases compared to two-stage controls. CONCLUSIONS: Direct-to-implant breast reconstruction can be reliably performed in a single stage in patients with small breast size. Increasing breast cup size confers a higher chance of early revision. A two-stage approach may be more cost-effective in larger breasted patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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PURPOSE: Vacuum-assisted closure (VAC) is a minimally invasive alternative to a muscle flap for closure of sternotomy wounds. The purpose of this study is to evaluate clinical predictors of VAC therapy failure in order to predict which patients would benefit from this approach. METHODS: A retrospective cohort study of all patients with VAC management of sternotomy wounds between January 1997 and July 2003 was conducted. In this study, 37 patients had VAC management of their wounds post-cardiac surgery. Prior to data collection, 12 risk factors for impaired wound healing were identified. Information was obtained from patient charts and laboratory values. RESULTS: Eight of the 36 patients failed the VAC therapy. Of the 12 variables studied, three were found to be predictive of VAC outcome. Bacteraemic patients had a higher failure rate as compared to patients with negative blood cultures (por=4 cm also had a greater occurrence of VAC failure (por=4 cm or a high degree of BESI tend to have worse outcomes with VAC and may be better managed by a surgical approach. Otherwise, VAC may be a reasonable option even in patients with high risks of impaired wound healing. Prospective randomised studies are needed to validate these hypotheses.

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