Introduction:Plastic surgery consultations are frequently required in emergency department settings; however, some hospitals lack plastic surgery call coverage. This study evaluated the geographic distribution of plastic surgeons providing call coverage within Ontario and the accessibility of emergency plastic services for the population. Methods:Demographic data on practicing plastic surgeons were obtained from the College of Physicians and Surgeons of Ontario database. Call coverage was determined by the number of surgeons by primary practice location and hospital affiliations per surgeon in each region. A survey was sent to switchboard personnel at all hospitals in Ontario to further assess call coverage. Results were reported as absolute counts and surgeons per 100 000 population-ie, population density ratios (PDRs). Results:A total of 289 plastic surgeons reported their primary practice location in Ontario. Most practice within Metropolitan Toronto and Central Ontario (66.8%). Northern Ontario had the lowest PDR compared to Metropolitan Toronto with the highest (PDR = 1.29 vs 3.72, 95% CI: 1.41-3.78, P < .001). For 254 hospitals identified, our survey response rate was 64%. Fifty-eight percent of responding hospitals reported no plastic surgery coverage. Over half of hospitals in Metropolitan Toronto and Central Ontario reported plastic surgery call coverage, compared to only 24% in Northern Ontario. Conclusions:This study demonstrates that 95 (58%) hospitals are without plastic surgery call coverage and highlights the discrepancies in the geographic spread of plastic surgeons in Ontario. Further studies are needed to determine the impact of this discrepancy on patient outcomes.
Introduction:Preoperative simulation technologies are increasingly utilized in plastic surgery to enhance surgical planning and patient communication. While their technical benefits have been established, the impact on patient-reported outcomes (PROs), in particular satisfaction and perceived accuracy, remain underexplored. This systematic review evaluated the effect of preoperative simulation on patient-reported satisfaction, decision-making, and perceived accuracy in breast and facial aesthetic plastic surgery. Methods:A systematic search of MEDLINE, Embase, and Cochrane databases up to April 2025 identified studies reporting PROs in adult patients undergoing breast (aesthetic or reconstructive) or facial aesthetic surgery with preoperative simulation. Data on demographics, simulation type, satisfaction, accuracy, and complications were extracted and analyzed. Results:Seventeen studies (1333 patients; 970 simulation, 363 control) met inclusion criteria. Breast surgery patients using simulation showed higher satisfaction with appearance (Breast-Q: 75.0 vs 58.1), surgical outcomes (84.9% vs 78.8%), and psychosocial well-being. Simulation patients reported higher satisfaction with the simulation experience (95.4%) and greater trust in their surgeon (95.2%), with lower complication rates (4.1% vs 41.5%). In facial surgery, simulation users demonstrated greater overall satisfaction (79.2% vs 67.3%) and improved understanding of outcomes. Perceived accuracy was higher in breast (91.0%) than facial surgery (74.1%). Across procedures, simulation enhanced shared decision-making and surgeon-patient rapport. Conclusion:Current evidence suggests that preoperative simulation may enhance patient satisfaction, trust, and engagement in plastic surgery, particularly in breast procedures. However, findings are based on heterogeneous studies with diverse patient populations, simulation technologies, and outcome measures. Further prospective comparative studies using standardized PRO measures are needed to better define the role of preoperative simulation across aesthetic and reconstructive plastic surgery.
Introduction:Mentorship is important for professional development, reducing burnout, and promoting diversity within surgical programs. Notably, mentorship has been established as a tool for encouraging women to pursue surgical careers. In Canada, female plastic surgeons make up a third of surgeons. However, no study to date has investigated the effect of mentorship on female plastic surgeons in Canada. Methods:We conducted a cross-sectional study assessing the impact of mentor-mentee relationships of female plastic surgeons across Canada. An online questionnaire was sent to female plastic surgeons across 13 Canadian academic institutions. The survey included mentee and mentor demographics, mentee-mentor relationship, and mentorship perspectives. Results:Twenty-five participants completed the survey with a mean age of 33.2 (SD ± 9.4) from 10 academic institutions. 72% (n = 18) were residents and 28% (n = 7) were consultants. 60% (n = 15) had a mentor, with 40% (n = 6) having more than three mentors; 60% (n = 9) of mentors were women and 30% (n = 6) were men. Most participants met mentors through research (33%; n = 5) and formal mentorship programs (33%; n = 5). Main topics discussed include academic proclivity (80%; n = 12), surgical skills (80%; n = 12), and work-life balance (80%; n = 12). Main mentor contributions include development of surgical (93%; n = 14) and clinical skills (80%; n = 12), pursuit of plastic surgery (80%; n = 12), and research (73%; n = 11). Conclusion:Mentorship plays an instrumental role for female plastic surgeons in developing clinical and surgical skills and providing encouragement to pursue a career in plastic surgery. This investigation identifies strengths and gaps in mentor-mentee relationships that can promote future effective mentorship and diversity in plastic surgery.
Introduction:Canadian medical students receive limited exposure to Plastic and Reconstructive Surgery (PRS) during pre-clerkship. To address this gap, a longitudinal PRS case-based learning (PRS-CBL) curriculum was developed to parallel the pre-clerkship curriculum, with an aim to increase early exposure to PRS concepts. Methods:Guided by Medical Council of Canada objectives, PRS faculty and residents co-designed a 5-part case-based learning curriculum: Introduction to PRS, Skin and Soft Tissue Infections, Benign and Malignant Skin Lesions, Hand and Wrist Trauma, and Burns. Each session combined a didactic presentation, clinical case with facilitated discussion, and hands-on workshop. Eligible participants were first- and second-year medical students. Presession and postsession tests were compared using the Mann-Whitney U test. Written feedback was analyzed using thematic analysis. Results:From 2023 to 2025, 10 PRS-CBL sessions were delivered, with a mean of 45 (SD 28.8) registrants per session. Of 453 total registrants, 201 were unique participants, with 41% reporting no prior interest in PRS. Significant improvements in presession versus postsession test scores were observed at each session (p < .05), except for session 4. Over 83% of respondents strongly agreed that the learning objectives were met, content was appropriate, and sessions were highly effective. Qualitative themes highlighted the value of hands-on, multimodal teaching and opportunities to interact with PRS faculty and residents. Conclusion:The PRS-CBL curriculum filled a void in the current undergraduate medical curriculum, improved PRS knowledge, received favorable evaluations, and included students without prior interest in PRS. This adaptable model may support early career exploration in PRS and other underrepresented specialties.
Background:Keloids are benign, fibroproliferative skin lesions due to abnormal wound healing. While keloid formation disproportionately varies by race and ethnicity, epidemiological data on racial and ethnic differences remain fragmented. This study aimed to quantitatively compare keloid prevalence among different racial and ethnic groups. Methods:A systematic literature search identified keloid prevalence among different racial (White, Black, Asian, Unknown, and Other/Mixed) and ethnic (Hispanic/Latinx and non-Hispanic/Latinx) groups (CRD420251113908). Pairwise comparisons using a random-effects model and a network meta-analysis were conducted. Results:Eight studies were included in the network meta-analysis on race, encompassing 31,964 keloids and 373,390 nonkeloids. Compared to White individuals, pooled odds ratio (OR) was highest among Black individuals (OR = 6.14; 95% CI: 3.75-10.07), followed by Asian individuals (OR = 3.70; 95% CI: 2.16-6.34), Unknown race (OR = 1.94; 95% CI: 1.06-3.54), and Other/Mixed (OR = 1.93; 95% CI: 1.07-3.49). Four studies were included for the pairwise analysis on ethnicity. Pooled OR of keloid prevalence comparing Hispanic/Latinx with non-Hispanic/Latinx was 1.12 (95% CI 0.41-3.03). Conclusions:This study demonstrates a statistically significant association between race and keloid formation, with greater odds of keloid formation among Black and Asian individuals compared to White individuals. No statistical difference was demonstrated between ethnic groups, although findings were underpowered. Findings support race as an important risk factor for keloid development, further informing prevention strategies, patient counselling, and practices to provide equitable care.
Background:Proximal interphalangeal (PIP) joint volar plate injuries are common hand injuries in children. Commonly employed treatments include splinting or buddy taping, with no consensus regarding best practice. This pilot study compares outcomes by treatment protocol for children with PIP joint volar plate injuries and informs a power calculation for a larger study. Methods:A prospective observational pilot study of children with stable PIP joint volar plate injuries was conducted. Standard treatment protocols were: 1 or 2 weeks of splinting followed by buddy taping, or direct to buddy taping. Patient-reported pain and range of motion (ROM) at 1 to 2 weeks and 4-weeks post injury, as well as time to return to activity were analyzed. A power calculation for a future equivalency study was performed. Results:Ten patients per group were included in the study. At 1 to 2 weeks, the direct-to-buddy taping group had significantly greater active ROM and less pain than the 1-week splinting group (ROM 99o vs 78o, P = .03; FACES 1.6 vs 5.0, P = .02). At 4-weeks, there were no differences in ROM and pain by treatment group. Only one patient (direct to buddy taping) did not return to activity due to pain. Using pain with active ROM at 4-weeks, a sample size of 27 patients per group for an equivalence study was determined. Conclusion:This pilot study suggests similar outcomes at 4-weeks postinjury by 1 or 2 weeks of splinting followed by buddy taping, or direct to buddy taping treatment. These findings support performing a larger equivalency trial.
Introduction:Gender affirming surgery (GAS) is an umbrella term for procedures that can be a part of the transition process for transgender and nonbinary individuals. Plastic surgeons play an important role in gender affirming surgical care. Our purpose was to assess the GAS landscape in Plastic and Reconstructive Surgery (PRS) residency programs across Canada, including both the didactic and clinical context, along with assessing PRS residents on their perceived interest and competence relating to performing GAS. Methods:A survey was created based on existing literature relating to gender affirming care in surgical and medical postgraduate education. The survey was distributed to all PRS residents in Canada through their program director. Results were analysed using descriptive statistics. Results:Almost all residents surveyed agreed that transgender care is an important part of PRS. Despite this, little educational content regarding GAS was seen. The majority of individuals had never been exposed to any GAS clinically despite having at least one surgeon who performs GAS affiliated with their institution. For individuals who have had exposure, top surgery was the most common procedure seen. While few residents plan on pursuing a fellowship in GAS, some residents did comment they planned to offer top surgery or facial feminization as general plastic surgeons. Conclusion:The majority of PRS residents demonstrated a positive response towards the importance of GAS in PRS. As access to GAS in Canada remains limited, providing greater exposure to GAS in PRS residency may help in promoting willingness and competence to perform these procedures.
Introduction:Individual studies have suggested a benefit in using Arnica and Bromelain for reducing ecchymosis following facial plastic surgery; however, the literature remains inconsistent and methodologically heterogeneous. An up-to-date review is therefore necessary to synthesize the available evidence and provide clearer guidance to clinicians and patients alike. The objective of this study was therefore to investigate the effectiveness of Arnica and Bromelain in reducing postoperative ecchymosis after facial plastic surgery. Methods:A PRISMA-guided search of Medline, Embase, Cochrane databases, Epistemonikos, and ClinicalTrials.gov was conducted up to August 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies evaluating Arnica and/or Bromelain use in facial plastic surgeries. The primary outcome was postoperative ecchymosis. Secondary outcomes included edema, adverse effects, and patient satisfaction. Results:Ten articles were included, comprising 6 RCTs, 3 prospective, and one retrospective cohort study, with a total of 696 patients (mean age 35 years, range 15-78). Most studies examined rhinoplasty (60%), followed by blepharoplasty (30%). Most studies (80%) evaluated Arnica use, of which 63% demonstrated significant reductions in postoperative ecchymosis at various time points. Edema was assessed in 2 Arnica studies, both of which showed significant reductions. Two studies evaluated Bromelain, with one demonstrating reduced ecchymosis by postoperative day 7. Adverse events were rare and mild. Conclusion:Arnica may help reduce postoperative ecchymosis and edema after facial plastic surgery; however, the evidence for Bromelain is limited. Marked heterogeneity in dosing and assessment tools limits the generalizability of findings and the ability to perform meta-analysis.
Background: Immediate breast reconstruction (IBR) contributes to comprehensive breast cancer care. Rural patients often face barriers to healthcare access and worse health outcomes versus urban counterparts. We sought to (1) compare rates of IBR among rural and urban residents; (2) identify sociodemographic and economic factors associated with breast reconstruction rates. Methods: In this systematic review and meta-analysis, MEDLINE, Embase, Web of Science, and CENTRAL were searched from inception to May 15, 2025, for studies comparing IBR rates among rural versus urban individuals globally. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies - of Exposures tool. The primary outcome was the literature-pooled odds ratio (OR) of rural patients receiving IBR versus urban patients, evaluated with a random-effects meta-analysis, followed by sensitivity and leave-one-out analyses. Univariate meta-regression was conducted to explore whether mean age, socioeconomic status (SES), and data collection year explain heterogeneity and rural-urban IBR disparities. Results: Fifteen studies were included, encompassing 46 986 rural and 1 833 906 urban mastectomy patients. Rural patients were significantly less likely to undergo IBR (OR 0.67; 95% confidence interval [0.57-0.79], I 2 = 97%). There was no temporal trend suggesting changes in geographic disparities in IBR rates. Mean age, SES, and midpoint data collection year did not significantly explain heterogeneity nor rural-urban IBR disparities. Conclusions: Rural patients were approximately 33% less likely to receive IBR versus urban patients. However, considerable heterogeneity suggested the need for research on moderators to explain this association and inform strategies to promote equitable IBR access, including ride-share programs and increased plastic surgeon density in rural communities.
Background:Diagnostic sural nerve biopsies can be taken as whole or fascicular nerve biopsies. It is unclear if this is associated with differences in diagnostic yield or procedural complications. We compared the clinical outcomes of fascicular versus whole sural nerve biopsies. Methods:This was a retrospective chart review of sural nerve biopsies performed between 2011 and 2024 at 4 tertiary academic hospitals in Canada. The primary outcome was the incidence of postoperative nerve-related complications. The secondary outcome was the concordance between the biopsy and the final diagnosis. Fisher's exact test was used to compare the incidence of postoperative complications. Two-sided Cochran-Armitage trend test was used to compare concordance between groups. Results:There were 75 patients who underwent whole sural nerve biopsies and 13 patients who underwent fascicular sural nerve biopsies; 54.6% of patients were male, with a mean age of 59.7 ± 15.9. The average nerve length sampled was 2.86 ± 1.3 cm in the whole nerve biopsy group and 2.35 ± 1.3 cm in the fascicular nerve biopsy group. Only a small proportion of patients had documented follow-up (whole: 26.7%; fascicular: 15.4%), among whom 40.0% in the whole nerve biopsy group and 0.0% in the fascicular group experienced complications (P = 1.00). The most common diagnosis was vasculitis in both groups (whole nerve biopsy: 17.0%, fascicular nerve biopsy: 36.4%). There was no statistically significant shift toward higher concordance in the whole nerve group (Z = 0.63, P = .53). Conclusion:Fascicular and whole sural nerve biopsies demonstrated similar diagnostic concordance. Prospective studies with larger sample sizes are needed to more accurately characterize postoperative complication rates.
Introduction Surgical training, historically characterized by long hours, hierarchical culture, and critical feedback, has been associated with burnout and mental health challenges. Reforms, including duty-hour limits, competency-based education, and initiatives promoting wellness, equity, and psychological safety, have begun reshaping training in Canada. This review provides a national overview of these cultural shifts, mapping recommendations for best practices and research. Design A systematic review identified studies on Canadian surgical residency culture. Two reviewers independently screened and extracted data, with risk of bias (ROB) assessed. Results Twenty-one studies were included. Key themes were wellness and mental health (19 studies), feedback and learning environments (20), evolving surgical culture (17), equity, diversity, and inclusion (12), duty-hour reforms (14), and international transferability (8). ROB was low in 44.00%, medium in 36.00%, and high in 20.00% of studies. Discussion This review of 25 studies highlights evolving themes in Canadian surgical training culture. Traditional endurance-based models are shifting toward inclusivity, wellness, and equity, with increasing attention to mental health, mentorship, and structured feedback. Duty-hour reforms, parental leave policies, and competency-based initiatives indicate generational and structural changes, though implementation varies across programs. Studies emphasize culturally responsive mentorship, psychological safety, and systemic supports to improve learning environments. While Canadian experiences provide valuable insights, differences in legal, institutional, and cultural contexts limit direct transferability internationally. Recommendations include implementing fatigue management plans, mentorship, simulation-based learning, and national coordination to foster a sustainable, learner-centered surgical culture. Conclusion Canadian surgical training is evolving through duty-hour reforms, wellness initiatives, and equity-focused policies. While progress has been made, challenges remain in mentorship and cross-provincial consistency.
Introduction Keloid and hypertrophic scars are products of abnormal wound healing and can cause disfigurement, discomfort, and decreased quality of life. The precise mechanisms of how these scars form remain unclear, and despite several management strategies, there is currently no definitive management approach that prevents recurrence of keloid scars. Hyaluronan (HA) is a polysaccharide with critical functions in inflammation, fibrosis, and skin health. This narrative review explores what is currently known about the role of HA and associated proteins in keloid and hypertrophic scar pathogenesis and management. Methods The online MEDLINE and EMBASE databases were searched for articles on keloid and hypertrophic scarring and HA from 1946 to 2026. English-language, peer-reviewed articles with empirical evidence examining human keloid scar tissue, animal models, cell-culture models, hyaluronic acid, or hyaluronome-associated genes were included. Twenty-one studies met all inclusion criteria. Results HA concentration was diminished in cell-based models of keloid and hypertrophic scars relative to normal skin. Observed aberrant localization of HA was likely related to the altered expression of genes encoding proteins responsible for the synthesis, degradation, binding, and signaling properties of HA. Intralesional and topical applications of HA both improve appearance and reduce recurrence rates of keloid scars in the short term. Conclusion Our review suggests that altered HA production, metabolism, and localization play a key role in keloid and hypertrophic scar pathogenesis. While early evidence supports the potential utility of HA in keloid scar treatment, further robust clinical validation is necessary.
Introduction Although social media is widely used in plastic surgery, differences in content and posting patterns across practice settings are poorly understood. This study characterized Ontario plastic surgeons Instagram posting patterns and audience engagement by practice setting. Methods This observational cross-sectional study analysed publicly accessible professional Instagram profiles of registered academic, community, or mixed practice plastic surgeons in Ontario. Up to 30 posts (posted on or after January 1, 2020) per account were coded by content type and clinical domain. Chi-square, Kruskal-Wallis, and analysis of variance tests were used to evaluate the association between surgeon characteristics, posting patterns, and engagement rates. Results Eighty-six of 261 (33%) plastic surgeons had professional Instagram profiles, yielding 2032 posts. Pre-/post-procedure results (32%) and facial aesthetics (20%) were the most represented content type and domain, respectively. Academic surgeons posted significantly more announcements, research, and reconstructive content ( P < .001), while community surgeons posted significantly more advertising/promotional ( P = .02) and facial aesthetics ( P < .001) content. Engagement rates were highest for academic surgeons, personal posts, and craniofacial content, with significant differences among practice types, content categories, and domains ( P < .001). Conclusions Instagram use among plastic surgeons varies substantially by practice setting. Cosmetic content dominates posting volume, whereas reconstructive and academic content, despite higher observed engagement, remains under-represented. These findings identify content-practice mismatches that warrant further qualitative, longitudinal, and interventional study before practice recommendations can be made.
Background: Despite advancements in total knee arthroplasty (TKA), complications requiring revisions still occur. In these cases, flap coverage is often required to achieve a stable soft tissue envelope. This study analyzes wound complications following flap coverage for revision TKAs (rTKA) on a national level. Methods: Patients who underwent rTKA from 2012 to 2020 were identified in the National Surgery Quality Improvement Program database using Current Procedural Terminology codes. The cohort was divided into 2 subgroups: patients who underwent rTKA with a pedicled or free flap and those without a flap. A propensity score was generated from patients’ baseline characteristics. A multivariable logistic regression model adjusting for propensity scoring and wound classification was constructed to assess differences in outcomes. Results: rTKA was performed in 33,922 encounters, 104 (0.3%) of which utilized a flap (99 pedicled and 5 free flaps). Patients who received flaps had poorer preoperative functional status, higher frailty scores, longer operative times, longer hospital stays, and were more likely to have contaminated or dirty/infected wounds. Patients who underwent flaps had higher reoperation rates compared to patients who did not (12.1% vs 3.0%, P < .001). Following propensity score matching, flap coverage was not associated with systemic complications, dehiscence, or superficial or deep surgical site infection. Conclusion: Soft tissue flap coverage was more common in large and infected wounds following TKA. Higher wound infection rates among flap patients are likely due to the complexity of the original wound and possibly lack of adequate source control. Patients undergoing rTKA for infection may benefit from wound optimization before flap reconstruction.
Background:Scholarly activity is a key aspect of plastic surgery training, influencing resident selection and career progression. However, research productivity among Canadian plastic surgery residents has not been quantified. Methods:This cross-sectional study included Canadian plastic surgery residents enrolled between 2015 and 2024, identified through a systematic web search. Scholarly metrics were extracted from Scopus and PubMed. Descriptive statistics summarized demographics and research metrics of residents. Multivariable logistic and negative binomial regression analyses were used to identify associations and predictors of research productivity, defined as publications-per-postgraduate year (PGY). Results:Overall, 309 trainees were included (163 active, 146 graduates). Among 163 active residents, 53% identified as female, 41% held a graduate degree, and 11% of active residents were enrolled in a Clinician-Investigator Program (CIP). Mean publication-per-PGY was 0.62 ± 0.92. Higher research productivity was independently associated with preresidency publications (incidence rate ratio [IRR] = 1.09, P < .001), CIP enrolment (IRR=1.88, P = .041), and female identification (IRR=0.58 for males, P = .017). Among 146 graduates, 58% were female, 46% held a graduate degree, and 84% pursued at least one fellowship. Twenty-seven percent hold faculty positions. Faculty appointment was associated with higher research metrics (P < .001), and graduate degree status was the sole independent predictor (odds ratio = 3.41, P = .015). Program requirements and the productivity of PDs and RDs were not significant. Conclusions:Research productivity among Canadian plastic surgery residents is primarily influenced by individual factors, specifically preresidency research and CIP enrolment. Program-level factors such as research requirements and metrics of PDs and RDs are not associated with higher productivity in residents. Graduate degree status is a predictor of academic career pursuit, but not of fellowship. These findings aim to enhance scholarly involvement throughout the trainee lifespan and those aspiring for a faculty appointment.
