Micro Focus: Venous Congestion, Breast Algorithms, & Chest Wall Recon

I recently conducted a survey with over 240 votes in the plastics field, asking about your research motivations and challenges. The results were quite eye-opening.

• Nearly half of you have fewer than five publications, while just over 10% have more than 20.
• Only one in three believe their research has a significant clinical impact.
• Half of you feel there isn’t enough time to conduct research in your current roles.
• The top motivation for research is enhancing your CV, while contributing to science ranked the lowest.

It seems research has turned into a currency, adding career value regardless of its scientific impact. This focus on quantity over quality is understandable but somewhat disheartening.

The incentive structure clearly favors volume, especially early in one’s career, often at the expense of quality. In the most recent episode of Behind the 'Fella, we talk about the importance of collaborative research, leading to better results. Despite these changes, academia still largely values the sheer number of publications.

Our system pushes us toward producing high volumes of publications, often overshadowing quality. Case reports and series, while clinically valuable, are not always considered rigorous research. This distinction needs to change in how we evaluate and reward research efforts.

Love,
P'Fella

Here's the rest of the leaderboard.

Sternal Wound Infections

Definition
Sternal wound infections are divided into superficial (skin subcutaneous tissue and fascia) and deep (extending down to sternal bone hardware and mediastinum).

Classification
SWIs are often classified according to timing from surgery; for example, the Palierolero classification.

Risk Factors
Risk factors can be grouped into patient-related (e.g., diabetes and obesity), intraoperative (e.g., increased surgical time), and postoperative factors (e.g., prolonged ICU stay).

Diagnosis
Diagnosis is clinical and can be supported by laboratory tests such as FBC, ESR, CRP, and blood culture and imaging such as CXR and CT.

Treatment
Superficial infections can be treated with antibiotics and local wound care while DSWI requires debridement, hardware removal, and early closure including flap closure.

Flap Reconstruction
Pectoralis major, rectus abdominis, latissimus dorsi, and omental flaps are the main flaps used for soft tissue cover in SWIs.

Complications
Complications with sternal wound infections include recurrent wound infections and wound dehiscence flap donor site morbidity (e.g., hernia) post rectus abdominis harvest.

Read the Article

Venous congestion is a significant complication in free flap surgery. Various techniques have been proposed to manage this issue. Local subcutaneous injection of low molecular-weight heparin has shown effectiveness in salvaging congested flaps (Pérez et al., 2014). Medical leeches have also been successfully used to treat venous insufficiency (Soucacos et al., 1994; Pannucci et al., 2014). Vacuum-assisted closure therapy has been reported as a novel approach to alleviating venous congestion (Uygur et al., 2008).

Venous catheterization can increase venous outflow (Gürsoy et al., 2008). The superficial inferior epigastric vein is commonly used to augment venous drainage when congestion occurs (Kim et al., 2015; Niranjan et al., 2001; Rohde & Keller, 2005). Preserving the opposite pedicle or superficial veins during flap harvest provides options for venous augmentation if needed postoperatively (Niranjan et al., 2001).