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INTRODUCTION: Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices. METHODS: We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group. RESULTS: The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017). CONCLUSION: This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety.
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Cadáver , Competencia Clínica , Electrocirugia , Internado y Residencia , Entrenamiento Simulado , Humanos , Electrocirugia/educación , Electrocirugia/métodos , Internado y Residencia/métodos , Entrenamiento Simulado/métodos , Cirugía General/educación , Masculino , Femenino , Educación de Postgrado en Medicina/métodos , CurriculumRESUMEN
PURPOSE: Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS: A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS: Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION: Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.
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Competencia Clínica , Recto del Abdomen , Entrenamiento Simulado , Humanos , Estudios Transversales , Recto del Abdomen/cirugía , Modelos Anatómicos , Endoscopía/educación , Endoscopía/métodosRESUMEN
BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.
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Humanos , Formularios de Consentimiento , Consentimiento Informado , Traducciones , Encuestas y Cuestionarios , LenguajeRESUMEN
BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.
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Formularios de Consentimiento , Consentimiento Informado , Humanos , Lenguaje , Encuestas y Cuestionarios , TraduccionesRESUMEN
BACKGROUND: Microsurgery depends largely on simulated training to acquire skills. Courses offered worldwide are usually short and intensive and depend on a physical laboratory. Our objective was to develop and validate a portable, low-cost microsurgery training kit. METHODS: We modified a miniature microscope. Twenty general surgery residents were selected and divided into two groups: (1) home-based training with the portable microscope (MicrosimUC, n = 10) and (2) the traditional validated microsurgery course at our laboratory (MicroLab, n = 10). Before the intervention, they were assessed making an end-to-end anastomosis in a chicken wing artery. Then, each member of the MicrosimUC group took a portable kit for remote skill training and completed an eight-session curriculum. The laboratory group was trained at the laboratory. After completion of training, they were all reassessed. Pre- and posttraining procedures were recorded and rated by two blind experts using time, basic, and specific scales. Wilcoxon's and Mann-Whitney tests were used to compare scores. The model was tested by experts (n = 10) and a survey was applied to evaluate face and content validity. RESULTS: MicrosimUC residents significantly improved their median performance scores after completion of training (p < 0.05), with no significant differences compared with the MicroLab group. The model was rated very useful for acquiring skills with 100% of experts considering it for training. Each kit had a cost of U.S. $92, excluding shipping expenses. CONCLUSION: We developed a low-cost, portable microsurgical training kit and curriculum with significant acquisition of skills in a group of residents, comparable to a formal microsurgery course.
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Internado y Residencia , Entrenamiento Simulado , Animales , Competencia Clínica , Curriculum , Microcirugia/educación , Entrenamiento Simulado/métodosRESUMEN
BACKGROUND: Conducting research during specialty training provides an opportunity to develop critical thinking and leadership skills along with a better understanding of the scientific literature. However, trainees often find it difficult to undertake research, in the context of labor-intensive surgical training. The aim of this study is to evaluate the research output and limitations of plastic surgery residents in different countries. METHODS: An international cross-sectional study involving plastic surgery trainees and recent postgraduates from Brazil, Chile, Germany, and the United Kingdom was conducted. A survey inquiring into academic productivity, limitations to conducting research, and working-hours patterns was distributed among eligible participants. RESULTS: From September to December 2019, 106 surveys were retrieved. Most respondents declared having participated in at least 1 project that resulted in a presentation or publication during their training (90.6% in national presentations, 68% international presentations, 67% in national publications, and 66% international publications). Having completed a previous research fellowship was associated with a statistically higher academic output (P < 0.05). Seventy-nine percent of respondents felt that their participation in research activities would have been greater if limiting factors had been addressed, including lack of time (72.5%) and insufficient supervision and mentoring (55%). CONCLUSIONS: Optimizing plastic surgery trainees' participation in scientific research is beneficial both for residents and their mentors. Research fellowships can provide an opportunity for academically oriented trainees to further develop their research skills. Protected time and adequate mentoring can help not only to increase residents' research output, but also to recruit the next generation of academic plastic surgeons.
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Internado y Residencia , Cirugía Plástica , Estudios Transversales , Becas , Humanos , Mentores , Cirugía Plástica/educación , Encuestas y CuestionariosRESUMEN
BACKGROUND: Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide. METHODS: Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models. RESULTS: A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%. CONCLUSIONS: This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Procedimientos de Cirugía Plástica , Entrenamiento Simulado , Cirugía Plástica , Educación de Postgrado en Medicina , Estética , Humanos , Cirugía Plástica/educaciónRESUMEN
Background: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. Aim: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. Material and Methods: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. Results: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. Conclusions: The adherence reported by health care workers was adequate in most of the evaluated recommendations.
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Humanos , COVID-19 , Chile , Estudios Transversales , Personal de Salud , Adhesión a Directriz , SARS-CoV-2RESUMEN
BACKGROUND: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. AIM: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. MATERIAL AND METHODS: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. RESULTS: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. CONCLUSIONS: The adherence reported by health care workers was adequate in most of the evaluated recommendations.
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COVID-19 , Chile , Estudios Transversales , Adhesión a Directriz , Personal de Salud , Humanos , SARS-CoV-2RESUMEN
Resumen Objetivo: Presentar una serie de reconstrucciones con colgajos perforantes en pacientes con casos severos de hidradenitis supurativa y sus resultados. Pacientes y métodos: Se realizaron 7 reconstrucciones axilares y un caso de reconstrucción esternal en 5 pacientes. Todos los pacientes correspondieron a la clasificación II o III de Hurley, y fueron derivados a nuestro servicio después de por lo menos un año de tratamiento médico sin obtener resultados. El equipo de cirugía plástica realizó tanto la resección como la reconstrucción en todos los casos. Los vasos perforantes fueron marcados con un dispositivo Doppler sonido. Resultados: Se obtuvo cobertura en todos los casos, con solo una pérdida parcial de colgajo que fue resuelta con curaciones. Tras un seguimiento de 26 meses, no hubo recidiva de hidradenitis supurativa. Todas las reconstrucciones evolucionaron con resultados funcionales óptimos. Conclusión: Los colgajos perforantes son una buena alternativa para el tratamiento de casos severos de hidradenitis supurativa, tanto esternal como axilar. Por esta razón, debe ser considerado en el armamento de cirujanos plásticos que traten esta enfermedad, una vez que el tratamiento médico haya fallado.
Abstract Aim: To present a brief series of reconstructions with perforator flaps in severe cases of hidradenitis suppurativa patients and results. Patients and methods: Seven axillary and one sternal case in five patients were operated on. All patients were in stage II or III according to Hurley classification, and were referred after at least one year of medical treatment with no satisfactory result. The plastic surgery team performed both, resection and reconstruction in all cases. Perforator vessels were marked using a handheld Doppler device. Results: One partial flap failure occurred, which healed with standard wound care. After a median follow up of 26 months, no relapse of hidradenitis suppurativa occurred. All reconstructions evolved with full functional results. Conclusion: Perforator flaps are a good choice in the treatment of severe cases of hidradenitis suppurativa, both sternal and axillary. It should be considered in the armamentarium of any plastic surgeon treating patients with this condition, once the medical treatment has failed.
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Humanos , Masculino , Femenino , Adulto , Axila/cirugía , Hidradenitis Supurativa/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajo Perforante , Esternón/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: The current treatment of keloids includes surgery, intralesional steroids, and radiotherapy, among others. Radiotherapy is not recommended in children due to its effects on growing tissues. Our aim was to study intralesional triamcinilone therapy of keloids in children and analyze the impact of body location, age of the lesion, and etiology of the keloid on clinical response. METHODS: We conducted a prospective clinical trial with patients 1 to 14 years of age evaluated for keloid treatment. A soft tissue ultrasound was performed to measure the keloid volume, prior to intralesional infiltration with triamcinolone acetonide. A posttreatment ultrasound quantified the volume differences attributed to therapy. For the analysis, Mann-Whitney/Wilcoxon test for paired samples and a multiple regression analysis were performed. RESULTS: Twenty-one patients with a total of 25 keloids were enrolled, with a median age of 12 years (range 6-14 yrs). The initial lesional volume was 1.25 cc (range 0.2-6.3 cc) and the final volume was 0.2 cc (range 0.0-1.53 cc), corresponding to 82.7% of size reduction (p < 0.001). Regarding the relationships between response and body location, etiology and age of the lesion, the multiple regression analyses obtained p-values of 0.46, 0.16, and 0.87, respectively. One patient failed to improve. Average follow-up was 30 months. CONCLUSIONS: Triamcinolone acetonide is highly effective for the treatment of pediatric keloids. There is no relationship between clinical response and the factors evaluated, such as lesion location, etiology and age of the keloid.
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Glucocorticoides/administración & dosificación , Queloide/tratamiento farmacológico , Triamcinolona Acetonida/administración & dosificación , Adolescente , Niño , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Inyecciones Intralesiones , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Dermal substitutes, such as Integra(®) introduced as a new alternative to our surgical arsenal and its use in burn treatment, in both acute and chronic phases, have gained great importance. OBJECTIVE: The aim of the experiment is to describe the results of the functional evaluation of patients with burned hands treated with Integra(®) in both acute and chronic phases. MATERIAL AND METHODS: A retrospective review of a transversal cohort. Patient characteristics evaluated were sociodemographic characteristics, burn mechanism, burn extension and depth, treatments received previous to Integra(®) and complications related to its use. Clinical and photographic evaluations were performed evaluating skin elasticity, range of articular movement, prehensile strength, pain and functional evaluation using the validated 400 Point Evaluation Test. RESULTS: A total of 17 burned hands in 14 right-handed patients, were treated with Integra(®), three being bilateral hand burns. Eleven were treated in the acute phase and in nine in the scar reconstruction phase. Range of articular motion was complete in 15 of 17 hands. In 88% of the hands, flexible skin coverage was achieved. No statistically significant difference was observed in prehension strength of the burned hand versus the contralateral non-burned hand. Sixteen hands had a painless evolution. The 400 Point Evaluation score was 92.8 ± 6.3% (80 - 100%). Nearly four-fifths (79%) of the patients returned to normal active working activities.
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Quemaduras/cirugía , Sulfatos de Condroitina , Colágeno , Traumatismos de la Mano/cirugía , Mano/fisiología , Procedimientos de Cirugía Plástica/métodos , Recuperación de la Función , Adulto , Anciano , Quemaduras/fisiopatología , Femenino , Estudios de Seguimiento , Traumatismos de la Mano/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Piel Artificial , Resultado del Tratamiento , Cicatrización de Heridas , Adulto JovenRESUMEN
Parotid fistulae are a very infrequent complication after ear reconstruction in microtia when the local conditions are favorable. We report 2 cases of salival fistulae after microtic ear reconstruction. Timing of the diagnosis is important to decide the treatment. We recommend conservative management by restricted citric diet in early postoperative salival fistulae and Botox injections in the case that it persists.
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Toxinas Botulínicas/uso terapéutico , Oído Externo/anomalías , Oído Externo/cirugía , Asimetría Facial/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/tratamiento farmacológico , Fístula de las Glándulas Salivales/tratamiento farmacológico , Niño , Femenino , Humanos , Ultrasonografía IntervencionalRESUMEN
The use of a local island flap, designed with retroauricular skin, is an excellent, simple, and reproducible innovation to the classic microtia ear reconstruction, allowing adequate coverage of the cartilage framework, specifically of the conchal area, sparing tense skin closure, reducing skin suffering and necrosis, with a better aesthetic result achieving the naturally depressed concha aspect. The flap design and surgical technique is described. This flap was used in 13 consecutive microtia ear reconstructions in our unit, no complications were encountered, and aesthetic results were excellent.
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Oído Externo/anomalías , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Adolescente , Cartílago/trasplante , Niño , Pabellón Auricular/anomalías , Pabellón Auricular/cirugía , Oído Externo/cirugía , Estética , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trasplante de Piel/métodos , Técnicas de Sutura , Adulto JovenRESUMEN
BACKGROUND: Lipoaspiration is one of the most frequently performed aesthetic surgical procedures worldwide. The use of tumescent solution containing lidocaine to infiltrate subcutaneous fat before surgery has been accepted as the standard of care for these procedures. Its objective is to diminish postoperative analgesic necessities and secondary blood loss, but its role in hematocrit reduction is not clear at this time. This study aimed to measure the effect of subcutaneous lidocaine infiltration on blood loss secondary to corporal liposuction. METHODS: A prospective, randomized, double-masked clinical trial was performed. Between November 2005 and July 2007, 70 consecutive female patients submitted to corporal liposuction as a single surgery were included in the study. All the patients were randomly assigned to two groups. The study group received tumescent solution containing lidocaine and epinephrine, whereas the control group received tumescent solution containing only epinephrine. Hematocrit was measured preoperatively, then 2 to 4, 12, and 24 h postoperatively. RESULTS: The comparison between the two groups did not show significant statistical differences with respect to age, body mass index, infiltrated volume, aspirated fat volume, surgical time, hospital stay, preoperative hematocrit, or comparison of the areas lipoaspirated. The mean hematocrit reduction in the study group was 10.8% +/- 2.9% compared with 8.8% +/- 2.6% in the control group (P = 0.004). CONCLUSION: The use of lidocaine in the tumescent solution for subcutaneous fat infiltration significantly increases postoperative anemia compared with the results obtained when epinephrine infiltration alone is used.
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Pérdida de Sangre Quirúrgica/fisiopatología , Lidocaína/efectos adversos , Lipectomía/métodos , Adulto , Análisis de Varianza , Anestesia General , Índice de Masa Corporal , Distribución de Chi-Cuadrado , Método Doble Ciego , Estética , Femenino , Estudios de Seguimiento , Hematócrito , Humanos , Inyecciones Subcutáneas , Tiempo de Internación , Lidocaína/administración & dosificación , Lipectomía/efectos adversos , Persona de Mediana Edad , Dolor Postoperatorio/fisiopatología , Probabilidad , Estudios Prospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the methodological quality of published randomised controlled trials (RCTs) in burn care treatment and management. METHODS: Using a predetermined search strategy we searched Ovid MEDLINE (1950 to January 2008) database to identify all English RCTs related to burn care. Full text studies identified were reviewed for key demographic and methodological characteristics. Methodological trial quality was assessed using the Jadad scale. RESULTS: A total of 257 studies involving 14,535 patients met the inclusion criteria. The median Jadad score was 2 (out of a best possible score of 5). Information was given in the introduction and discussion sections of most RCTs, although insufficient detail was provided on randomisation, allocation concealment, and blinding. The number of RCTs increased between 1950 and 2008 (Spearman's rho=0.6129, P<0.001), although the reporting quality did not improve over the same time period (P=0.1896) and was better in RCTs with larger sample sizes (median Jadad score, 4 vs. 2 points, P<0.0001). Methodological quality did not correlate with journal impact factor (P=0.2371). CONCLUSIONS: The reporting standards of RCTs are highly variable and less than optimal in most cases. The advent of evidence-based medicine heralds a new approach to burns care and systematic steps are needed to improve the quality of RCTs in this field. Identifying and reviewing the existing number of RCTs not only highlights the need for burn clinicians to conduct more trials, but may also encourage burn health clinicians to consider the importance of conducting trials that follow appropriate, evidence-based standards.