In this week's edition
- ✍️ Letter from P'Fella
Forget gen-Z — gen “shaky hands” - 🤓 The Sunday Quiz
How well do you know the stages of skin grafting? - 🖼️ Image of the Week
Fish skin for burn treatment. - 🚑 Technique Tip
Optimising skin grafts: Mesh measuring. - 📖 What Does the Evidence Say
How to choose the best dressing for skin graft take? - 🔥 Articles of the Week
CT Angio before DIEP, why flaps fail, & microsurgical principles: with 1 sentence summaries. - 💕 Feedback
Suggest ideas & give feedback!
A Letter from P'Fella
Forget Gen Z — Gen “Shaky Hands”
👋
Hey Team!
Let’s call it what it is — residents aren’t cutting anymore, and it’s a crisis.
Surgical training has become a spectator sport. Hours are capped, attendings are too risk-averse, and residents leave with pristine exam scores but shaky hands. Watching isn’t learning. Reading isn’t operating. And yet, we act like this won’t have consequences.
Share your experience below 👇
Let’s call it what it is — residents aren’t cutting anymore, and it’s a crisis.
Surgical training has become a spectator sport. Hours are capped, attendings are too risk-averse, and residents leave with pristine exam scores but shaky hands. Watching isn’t learning. Reading isn’t operating. And yet, we act like this won’t have consequences.
Share your experience below 👇
What’s Really Happening?
- Hands off, skills down. Operative experience in aesthetic breast and hand surgery has plummeted (Hallam et al., 2013; Silvestre et al., 2017). Thanks to the European Working Time Directive and consultant-led services, trainees are being sidelined (de Blacam et al., 2017).
- Fellowships as damage control. More trainees are forced into extra years just to get basic hands-on experience. Sure, independent fellows log more cases overall (Iglesias et al., 2022), but that’s a band-aid, not a solution.
- Fear-driven training. Attendings, scared of complications or slowing down their lists, step in too often, leaving residents as glorified assistants.
A System Built to Fail
The next wave of surgeons will be brilliant on paper but useless in the OR. Microsurgery training? Hit-or-miss depending on where you train (Chang et al., 2023). Global surgery opportunities? Barely tapped into (Nayar et al., 2015; Park et al., 2018).
If we don’t course-correct, we’ll be watching a generation of “plastic surgeons” who can consult and document — but can’t operate.
Fix It or Face the Consequences
Surgical exposure needs to start earlier. Medical students barely see plastic surgery, yet it’s a key pipeline for future trainees (Austin & Wanzel, 2015). If you’re a resident stuck on the sidelines, speak up. If you’re an attending watching skills decline, call it out.
With love,
P'Fella ❤️
ps - basic procedures will be outsourced to robots within the decade.. and robots don't take sick days.
The Sunday Quiz
How Well Do You Know the Stages of Skin Grafting?
Are you ready to make it to the leaderboard?
Welcome to a fresh round of The Weekly Quiz.
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.
Welcome to a fresh round of The Weekly Quiz.
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro.
Image of the Week
Fish Skin for Burn Treatment
🖼️
Image of the Week
In this section, we feature an anatomical illustration. This week, we’re looking at the use of fish skin grafts in burn management. Rich in collagen and omega-3 fatty acids, these grafts promote healing, reduce pain, and serve as a natural biological dressing.
In this section, we feature an anatomical illustration. This week, we’re looking at the use of fish skin grafts in burn management. Rich in collagen and omega-3 fatty acids, these grafts promote healing, reduce pain, and serve as a natural biological dressing.
Technique Tip
Optimising Skin Graft Meshing
🚑
Technique Tip of the Week
This week’s technique focuses on mesh measurements for skin grafts. Meshing skin grafts increases coverage and promotes drainage, but choosing the right expansion ratio is key.
This image compares non-meshed, standard meshing (1:1), and overmeshed grafts (1:1.25 to 1:1.5). While larger expansion ratios maximize coverage, they may compromise dermal integrity and healing. Overmeshing can lead to excessive contraction and scarring, so balance is crucial for optimal graft take and cosmetic outcomes.
This week’s technique focuses on mesh measurements for skin grafts. Meshing skin grafts increases coverage and promotes drainage, but choosing the right expansion ratio is key.
This image compares non-meshed, standard meshing (1:1), and overmeshed grafts (1:1.25 to 1:1.5). While larger expansion ratios maximize coverage, they may compromise dermal integrity and healing. Overmeshing can lead to excessive contraction and scarring, so balance is crucial for optimal graft take and cosmetic outcomes.
What Does the Evidence Say?
Choosing the Best Dressing for Skin Graft Take
In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques.
Exploring various dressing techniques for skin grafts aims to improve graft take and patient outcomes. Traditional tie-over dressings have been compared to simpler, faster methods using skin staplers, showing comparable graft success rates with reduced operation times (Kim et al., 2018). Some research suggests that tie-over dressings may not be necessary for full-thickness skin grafts in certain circumstances (Marsidi et al., 2020).
Hydrocolloid dressings have shown promise, offering better graft survival and shorter treatment times compared to traditional methods (Jeong et al., 2011). Negative-pressure wound therapy has demonstrated significant improvements in graft take rates, particularly in irregular, high-mobility areas, and reduced dressing time compared to tie-over bolster dressings (Cao et al., 2022). Other innovative techniques, such as barbed suture tie-overs (Joyce et al., 2015) and redoable tie-over dressings using multiple loop silk threads (Jo et al., 2013), have also shown successful outcomes in skin graft procedures.
Hydrocolloid dressings have shown promise, offering better graft survival and shorter treatment times compared to traditional methods (Jeong et al., 2011). Negative-pressure wound therapy has demonstrated significant improvements in graft take rates, particularly in irregular, high-mobility areas, and reduced dressing time compared to tie-over bolster dressings (Cao et al., 2022). Other innovative techniques, such as barbed suture tie-overs (Joyce et al., 2015) and redoable tie-over dressings using multiple loop silk threads (Jo et al., 2013), have also shown successful outcomes in skin graft procedures.
Articles of the Week
3 Interesting Articles with 1 Sentence Summaries
✅
How to Skin Graft in 1924 (McWillians, 1924)
Let's go back in time to the a seminal paper on skin grafting. One that shaped our current plastic surgery landscape.
Let's go back in time to the a seminal paper on skin grafting. One that shaped our current plastic surgery landscape.
✅
Use a grapefruit to practice skin grafting (Whallet, 2011)
"The orange or grapefruit is divided into two, therefore two trainees can work on each fruit at any one time, and several procedures can be performed on the same model"
"The orange or grapefruit is divided into two, therefore two trainees can work on each fruit at any one time, and several procedures can be performed on the same model"
✅
How to secure a skin graft (Seretis, 2024)
"NPWT is the most effective for skin graft adherence as opposed to traditional techniques. FIB and TOB reduce hematoma and seroma rates in patients at high risk of bleeding"
"NPWT is the most effective for skin graft adherence as opposed to traditional techniques. FIB and TOB reduce hematoma and seroma rates in patients at high risk of bleeding"
