686 Emergencies in Plastic Surgery – The Impact of a One-Day Conference on Medical Students’ Confidence

Introduction

Plastic surgery emergencies, such as facial trauma, burns, and gunshot wounds, are commonly presenting injuries to the emergency department. However, these topics are rarely part of medical school curriculums and few educational conferences exist on these topics. Hence, we created a novel international medical student conference entitled “Emergencies in Plastic Surgery”. We then evaluated its effectiveness in improving confidence in management of plastic surgery-related emergencies.

Method

We administered pre- and post-event online questionnaires to delegates evaluating self-reported confidence for Facial Trauma, Gunshot Wounds, Burns, Tendon Repair, Splinting, and Lacerations on a 5-point Likert-scale. Responses were matched before statistical analysis.

Results

Of the 85 attendees, three quarters responded (76%, n = 65). The conference significantly increased confidence ratings in all topics (p < 0.001). Prior to the conference, Lacerations had the highest confidence scores (2.36 ± 1.19) whereas Facial Trauma scored the lowest (1.79 ± 0.858). Facial Trauma had the greatest improvement in confidence (mean difference = 2.09 ± 0.974), whereas Lacerations yielded the lowest improvement (mean difference 1.21 ± 1.28). Facial Trauma also yielded the greatest mean satisfaction rating (4.68 ± 0.594).

Conclusions

The conference improved student confidence in all plastic surgery emergencies topics. More complex topics, e.g. facial trauma, yielded the greatest satisfaction and improvement in confidence.

Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy

PURPOSE

Ventral hernia repair with concurrent panniculectomy (VHR-PAN) is associated with high wound complication rates despite reported increased patient satisfaction. Some surgeons believe negative-pressure therapy after primary closure of the surgical incision (ciNPT) may lower wound complications in high-risk abdominal wounds. This study aims to evaluate if ciNPT improves outcomes in patients undergoing VHR-PAN.

METHODS

An 8-year retrospective cohort study was performed on patients who underwent VHR-PAN. Patients were divided into two groups: those who received closed-incision negative-pressure therapy ("ciNPT") and those who received standard sterile dressings ("SSD"). The primary outcome of interest was the rate of postoperative complications between these groups. Complications were subdivided into surgical site occurrences (which included surgical site occurrences that required an intervention), return to the operating room, and hernia recurrence.

RESULTS

A total of 104 patients were analyzed: 62 in the ciNPT group and 42 in the SSD group. Median follow-up duration was similar between both groups (182 days vs 195 days, p = 0.624). Patients in the ciNPT group had fewer total complications (57% vs. 83%, p = 0.004) and fewer SSO (47% vs. 69%, p = 0.025). However, no differences were noted when comparing individual complications (SSI, wound dehiscence, skin necrosis, chronic wound, seroma, and hematoma). There was no difference in return to the operating room (27% vs. 26%, p = 0.890) or hernia recurrence (21% vs 19%, p = 0.811). Multivariate analysis showed that ciNPT decreased the risk of SSOPI nearly fourfold (odds ratio 0.28, 95% CI = 0.09-0.87, p = 0.027).

CONCLUSIONS

This study showed that closed-incision negative-pressure therapy in ventral hernia repair with concurrent panniculectomy may decrease the rate of wound complications in this high-risk population.