Facial Flap Necrosis From COVID-19 Face Mask Precautions

ABSTRACTUse of facial mask coverings has been a strong Centers for Disease Control and Prevention recommendation as an essential mitigation measure in the spread of the SARS-CoV-2 novel coronavirus (COVID)-19 virus. Face mask utilization has been shown to induce changes in the skin microclimate, especially around the perioral and perinasal regions. This results in increased mask adjustments and development of friction between masks and the underlying skin. The authors report novel findings of 2 individuals with skin cancer who underwent facial reconstruction during the COVID-19 pandemic. They encountered untoward sequelae of facial flap pressure necrosis due to the use of face mask coverings. These individuals were ultimately successfully treated with local wound care. One individual experienced auricular implant extrusion and flap loss. It is critical that reconstructive surgeons be aware of potential complications and the need for potential revision surgeries due to the use of face masks, and educate their patients to properly position the protective face masks based on the type of reconstruction performed. Plastic surgeons might also reconsider reconstructive management options in light of these additional obstacles

A positive correlation of leadership, faculty, and fellow gender and racial diversity in US academic hand surgery

Gender and racial disparities remain prevalent in academic surgery. Moreover, reports on racial distributions are scarce. We aim to assess the state of diversity among faculty and fellowship trainees in academic hand surgery and identify if program faculty diversity correlates with trainee diversity. Working from the American Society for Surgery of the Hand (ASSH) fellowship list, a database of 84 hand fellowship programs, 622 faculty, and 582 recently graduated fellows was created. ASSH and American Association for Hand Surgery (AAHS) membership databases and clinical and research websites were accessed to determine gender, race (white or person of color [POC]), and practice and training details, for each faculty and fellow. Women comprise 17% of the faculty cohort and 25% of fellows. Gender disparity was similar between orthopedic surgery-trained and plastic surgery-trained faculty and fellows. Women represented 24% assistant, 16% associate, and 9% full professor faculty positions (p = 0.002). White race was assigned to 75% and 71% of faculty and fellows, respectively. POC accounted for 28%, 27%, and 21% of assistant, associate, and professor positions, respectively (p > 0.05). Female and POC leadership correlated with significantly more female and POC faculty/fellows, respectively. Relative to medical school and academic medicine, females and racial minorities are under-represented in academic hand surgery, especially with higher academic rank and in leadership positions. Diversity in leadership and related allyship may be an important strategy for increasing diversity at all levels. •Programs having a female or person of color chair correlates with gender and racial diversity.•Women and racial minorities are under-represented in academic hand surgery.•Gender and racial is lacking with higher academic rank and in leadership positions.•Diversity in leadership may be an important strategy for increasing diversity at all levels

Gynecomastia: Evaluation and Surgical Tips and Tricks

Gynecomastia, excess development of the male breast, is a common deformity encountered by plastic surgeons. It is the most common breast alteration in males, commonly developing without a pathologic basis during periods of physiologic change such as infancy, puberty, and old age. It may accompany a wide variety of systemic and metabolic diseases, and it may be drug induced. Given the number of pathophysiologic mechanisms, detailed presurgical workup is essential prior to determining whether surgical management is appropriate. This chapter highlights different surgical techniques performed in our practice, along with standardized preoperative evaluation and postoperative care. We believe that a dynamic approach to patients with gynecomastia decreases common complications and increases patient satisfaction in various degrees of gynecomastia. This chapter includes some “tricks” we use during our markings, preoperative steps, and intraoperative approaches that help us optimize patient safety, while maintaining operative efficacy and improving aesthetic outcomes in gynecomastia

Coverage of Fertility Preservation and Treatment Among Surgical Trainees in the United States of America

•Fertility preservation is gaining relevance among US surgical trainees, yet availability of fertility resources and institutional coverage of fertility services are lagging.•Current utilization of fertility services is low, but demand is high with almost 10-fold of trainees reporting interest should better insurance coverage become available.•Residency is a unique and limited window of opportunity to provide timely family planning support and coverage for our future surgeons. Both residents (avg. age 31.3 years) and fellows (avg. age 34.5 years) are within the crucial age period to consider oocyte cryopreservation as a family planning option.•Appropriate level of program support, and adequate coverage of family planning services are key to building a surgical workforce that has healthy work-life balance and is well physically, emotionally, and financially. Surgery trainees spend their prime fertility years in training, which leads to delays in childbearing, accompanying infertility challenges, and high-risk pregnancies. Literature report of institutional support for fertility preservation (egg/sperm freezing) and treatment is lacking. The cost is particularly prohibitive while receiving a resident physician salary. This study aimed to assess availability of fertility resources and institutional coverage of fertility services to US General Surgery Residents (GSR) and Breast Fellows. We composed and distributed a 26-question survey to GS residency and fellowship program directors nationwide to survey residents and fellows. Summary and descriptive statistics were tabulated, and categorical variables were analyzed using Pearson's chi square test. A total of 234 US surgical trainees (male n = 75, female n = 155, unreported n = 4) completed the survey. Total of 12 % of trainees reported having been counseled on family planning/fertility treatment during training, and only 5.1% were counseled on fertility preservation. Perceived lack of support from program (p = 0.027) and counseling of fertility preservation (p = 0.009) were significantly associated with female gender. A minority (12.5%) reported having insurance coverage for fertility preservation and 26% had coverage of fertility treatment. In addition, 2.6% respondents pursued fertility preservation while in training and 33% reported they would pursue fertility preservation if it was covered by insurance. Fertility preservation is rarely discussed in US General Surgery residency programs. The large majority of GSR lacks awareness of insurance coverage of fertility preservation and treatment. Strong efforts are necessary to improve fertility education for GSR and insurance coverage to meet trainee's needs

Reflecting on Plastic Surgery Training During Early COVID-19 Pandemic: Resident Exposure and Telemedicine

Coronavirus disease 2019 (COVID-19) pandemic has been an unprecedented public health crisis. As hospitals took measures to increase their capacity to manage COVID-19 patients, plastic surgeons have also had to modify their routine to continue serving their vital role within the hospital environment. In an effort to reduce exposure to COVID-19 and conserve hospital resources, many plastic surgery programs drastically modified call schedules, restructured inpatient teams, triaged operative cases, and expanded telemedicine encounters. Plastic surgery programs focused on craniofacial procedures were impacted by precautionary preventative protocol and shifts in case load made to protect both the healthcare teams and the patients. At academic centers, plastic surgery trainees of all domains felt the impact of these changes. Recognizing the implications on future craniofacial surgical practice, the pandemic has made, the goal of the authors’ study is to measure initial impacts of COVID-19 on plastic surgery trainees using a nationwide survey. The authors’ results present the first quantitative analysis of plastic surgery trainees’ exposure to COVID-19, deployment to other medical specialties, usage of personal protective equipment, and implementation of telemedicine during the pandemic. While healthcare systems have greatly adapted to pandemic complications and can anticipate vaccination, resurgence of COVID-19 cases linked to the delta variant heightens the authors' urgency in understanding the early pandemic, and its lasting impacts on healthcare. In the months following pandemic onset, telemedicine has become a mainstay in healthcare, trainees have adapted and become integrated in patient care in novel ways, and visits unable to transition to telemedical settings received substantial attention to ensure patient and provider safety