Eric Shiah

Case: We present a 59-year-old male patient with recurrent right knee extensor mechanism deficiency who underwent reconstruction using a free vascularized tensor fascia lata flap from the ipsilateral thigh with submillimeter perforator-to-perforator anastomosis. Performed in a revisional setting (third surgery) with scarring and prior failure, novel aspects included dual-layer reinforcement and limited-incision harvest with tunneling. At 12 months, he regained full extension and a stable, pain-free gait. Conclusion: This case shows that a free vascularized tensor fascia lata flap with perforator-to-perforator anastomosis is a viable option for extensor mechanism reconstruction in complex, revisional cases.

Background Although the Hirsch index (H-index) has become one of the most accepted measures of scholarly output, its limitations have led to the proposition of newer alternative metrics. The i10-index, notable for being easy to calculate and free to access, has potential, given its association with the power and ubiquity of Google. This study aims to evaluate the utility of the i10-index for plastic surgery research by examining its relationship with author bibliometrics and article metrics, including the H-index and Altmetric Attention Score (AAS). Methods Article metrics were extracted from articles published in the highest impact plastic surgery journal, Plastic and Reconstructive Surgery, over a 2-year period (2017–2019). Senior author bibliometrics, including i10-index and H5-index, were obtained from Web of Science. Correlation analysis was performed using Spearman's rank correlation coefficient (r_s). Results A total of 1,668 articles were published and 971 included. Senior author i10-index measurements demonstrated moderate correlation with times emailed (r_s = 0.47), and weak correlations with H5-index, total publications, and sum of times cited with and without self-citations. The H5-index correlated very strongly with total publications (r_s = 0.91) and sum of times cited (both r_s = 0.97), moderately with average citations per item (r_s = 0.66) and times emailed (r_s = 0.41), and weakly with number of citations by posts, AAS, and times tweeted. Conclusions Although the i10 strongly correlates with the H5-index, it fails to prove superior to the H5-index in predicting the impact of specific research studies in the field of plastic surgery. This work was previously presented at 2020 Plastic Surgery The Meeting (Virtual). E.S. and A.H. contributed to data collection, data analysis and manuscript preparation. J.R. contributed to data analysis, manuscript preparation and project oversight. No human or animal subjects were involved in this study. Ethical approval was not required. Article published online: 02 February 2023 © 2023. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Background: Plastic surgery interest groups (PSIGs) provide an invaluable opportunity to enhance medical students’ exposure to and knowledge of plastic surgery. Despite this, there have been no studies that provide information on the formation of these groups as well as the aspects that make for a productive PSIG. Methods: An anonymous survey was distributed by email via RedCAP to US medical students who hold leadership positions within their medical school's PSIG. Participants were asked baseline medical school information, the structure of their interest group, and perspectives on the most impactful and challenging components of their interest group. Results: Sixteen members (27.6%) of PSIG leadership completed the survey. Eighty percent reported having a membership of greater than 20 students. Fifty percent of the PSIGs were led by advisors who were medical school or hospital-affiliated faculty. Sixty-nine percent of groups were allocated a predetermined amount of money to fund activities and events throughout the academic year. Based on member feedback, groups reported that interactions with plastic surgery faculty, mentorship opportunities, and research opportunities were the most impactful and beneficial components of their PSIG. Forty-four percent reported that the biggest challenge faced by their PSIG was having a small active member group, followed by a lack of funding. Conclusion: Our study provides an in-depth look at the current structure and impact of PSIGs in the United States. It also provides a framework for medical schools that wish to start a PSIG and suggestions for established groups who wish to revitalize their PSIG structure.

Background The benefits of preoperative perforator imaging for microsurgical reconstruction have been well established in the literature. Methods An extensive literature review was performed to determine the most commonly used modalities, and their applicability, advantages and disadvantages. Results The review demonstrated varioius findings including decreases in operative time and cost with the use of CT angiography to identification of perforators for inclusion in flap design with hand-held Doppler ultrasound. Modalities like MR angiography offer alternatives for patients with contrast allergies or renal dysfunction while maintaining a high level of clarity and fidelity. Although the use of conventional angiography has decreased due to the availability of less invasive alternatives, it continues to serve a role in the preoperative evaluation of patients for lower extremity reconstruction. Duplex ultrasonography has been of great interest recently as an inexpensive, risk free, and extraordinarily accurate diagnostic tool. Emerging technologies such as indocyanine green fluorescence angiography and dynamic infrared thermography provide real-time information about tissue vascularity and perfusion without requiring radiation exposure. Conclusion This article presents an in-depth review of the various imaging modalities available to reconstructive surgeons and includes hand held Doppler ultrasound, CT angiography, MR angiography, conventional angiography, duplex ultrasonography, Indocyanine Green Fluorescence Angiography and Dynamic Infrared Thermography.

Background: The US Medical Licensing Examination (USMLE) Step 1 change to pass/fail has been met with mixed reviews, and the impact on medical student education and residency match is unknown. We surveyed medical school student affairs deans regarding their thoughts on the upcoming transition of Step 1 to pass/fail. Methods: A questionnaire was emailed to medical school deans. Deans were asked to rank the importance of the following after the Step 1 reporting change: Step 2 Clinical Knowledge (Step 2 CK), clerkship grades, letters of recommendation, personal statement, medical school reputation, class rank, Medical Student Performance Evaluation, and research. They were asked how the score change will affect curriculum, learning, diversity, and student mental health. Deans were asked to select 5 specialties they thought would be most affected. Results: Regarding perceived importance of residency applications following the scoring change, the most frequent number 1 choice was Step 2 CK. The majority of deans (93.5%, n = 43) felt that the change to pass/fail would benefit medical student education/learning environment; however, most (68.2%, n = 30) did not believe their school curriculum would change. Students applying to dermatology, neurosurgery, orthopedic surgery, ENT, and plastic surgery were felt to be most affected by the scoring change; 58.7% (n = 27) felt it would not adequately address future diversity. Conclusion: The majority of deans feel the USMLE Step 1 change to pass/fail would benefit medical student education. Deans feel that students applying to traditionally more competitive specialties (ie, programs with fewer overall residency positions available) will be most affected.