Abstract

The optimal timing for introducing microsurgical training during surgical residency remains unclear. Beginning too early—before acquiring fundamental surgical skills—can discourage trainees, while delaying training until late in residency may leave insufficient time for skill mastery. This study aimed to identify the most effective timepoint during surgical residency to introduce microsurgical training. Data were collected from participants in our International Microsurgery Course (2018–May 2025) conducted across 10 centers in North America and Europe. The course provided intensive training in microvascular anastomosis using live animal models under expert supervision. Trainees completed evaluations regarding optimal timing for microsurgery training initiation (beginning, middle, or end of residency), and demographic data were collected. Most trainees believe mid-residency represents the ideal timepoint for microsurgery training, coinciding with well-developed foundational surgical skills. However, early exposure may offer advantages in habit formation and technical skill development. These findings support individualized approaches to integrating microsurgical training into surgical education.

Abstract

As we know, decision in reconstructive surgery needs to be thorough immediate. Flap is a basic procedure in reconstructive surgery. The understanding of angiosome and perforasome that was developed by Ian Taylor has boost flap utility. Creating a flap need a reliable of vascular supply. Many ways have been published to ensure flap’s vascular supply. In some country, the special tools to read contrast agent is expensive and can not be covered by the government. The non-invasive tools can be a good alternative and also cheap.  Doppler ultrasonography (US) has been widely used to determine the flow of major arteries and vein. The same machine with higher frequency probe can be used to asses blood flow in the angiosome and perforasome. Bed side pre-operative mapping can be useful in arteriosclerotic and revision of reconstructive trauma. Although it is operator dependent, US also able to see the blood flow to the flap after insetting and anastomosis.  Repetitive thermal recording or thermography proves to be a good monitoring tool. Smartphone thermal camera can distinguish the “hot zone” and “cold zone” in the mapping. Intraoperative flap conditioning can be assured prior to transfer. An image after anastomosis can determine that the flap has good flow. In the monitoring, changes of 2oCelcius can differ the flap from normal to vein or arterial compromised. Early vein thrombosis is hard to determine. The use of vein viewer can be useful to ensure this. Superficial vein mapping can be use designing the SCIP flap.

Abstract

Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include biofilm, surgical site infections, history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Though bacterial contamination of breast protheses is associated with adverse sequelae, there are not universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix, leukotriene inhibitors, surgical techniques, and others. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. The objective of this review was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.

Abstract

Septorhinoplasty (SRP) is one of the more challenging operations performed by facial plastic surgeons. It has a steep learning curve to master the techniques that are necessary to improve function. Reconstruction of nasal deformities requires an understanding of how the nose is structured and supported in a three-dimensional space. In a multi-institutional, cross-sectional questionnaire, rhinoplasty was among one of the most common procedures that residents did not feel comfortable completing by R5 level. Only 18% of year-5 residents reported having performed a SRP independently. In a survey of 138 Canadian and American residents, 76.1% felt that nasal osteotomies were one of the most difficult steps in rhinoplasty, followed by caudal septum/anterior nasal spine manipulation (65.2%) and nasal tip sutures (55.8%). In this survey, up to 75% of residents felt that simulator training would substantially improve their confidence to perform such procedures (7). We believe that using a 3-D printed rhinoplasty model for residents will help build their surgical skill set and confidence by giving them hands-on experience to the steps of rhinoplasty, particularly osteotomies, in addition to training with cadevers. The aim of this pilot study is to assess the comfort and confidence of residents by using a validated survey before and after correcting common nasal deformities using a cheap and effective printed 3-D rhinoplasty model.