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J Reconstr Microsurg 2024; 40(05): 348-356
DOI: 10.1055/a-2182-1315
Original Article

Lymphedema Surgical Education and Faculty Demographics in United States Plastic Surgery Residency Programs

Emily R. Finkelstein 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Meaghan Clark
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Michael Ha
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
,
Devinder Singh
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Kyle Y. Xu
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Juan Mella-Catinchi
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Yvonne Rasko
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
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Abstract

Background Recent advancements in supermicrosurgery and promising preliminary outcomes have led to a surge in physiologic lymphedema surgery. This study is the first to evaluate lymphedema surgical education among U.S. plastic surgery residency programs, along with the background and experience of plastic surgeons subspecializing in the field.

Methods Cross-sectional evaluation of 103 accredited U.S. plastic surgery residency programs was performed in January 2023. Web-based searches of program curricula, faculty profiles, and main institutional pages indicated whether a program provided nonclinical or clinical exposure to lymphedema surgery. Review of online faculty profiles, surname searches, Doximity, and Scopus determined the perceived demographics, academic productivity, and procedures performed by lymphedema surgeons.

Results Compared with the 11 programs that incorporated lymphedema surgery into their online curriculum, 67 programs had a rotation site with a surgeon performing lymphedema procedures. Of the 33 programs without evidence of clinical exposure, 76% (n = 25) did not provide or specify providing elective time. Faculty perceived to be female or a race underrepresented in plastic surgery had significantly more assistant professor titles (p < 0.0214) and significantly fewer years of experience (p < 0.0293) than their counterparts.

Conclusion Great variation in lymphedema surgical education exists among U.S. plastic surgery residency programs. While few programs incorporate lymphedema surgery into their advertised curriculum, programs without clinical exposure frequently did not provide elective time to obtain it. Faculty that were female or a race underrepresented in plastic surgery were most often early in their career, suggesting lymphedema surgeons may grow increasingly diverse in years to come.

Keywords

lymphedema - resident education - VLNT - LVB - reconstruction


Publication History

Received: 16 May 2023

Accepted: 18 September 2023

Accepted Manuscript online:
26 September 2023

Article published online:
03 November 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Sleigh BC, Manna B. Lymphedema. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2023
    Google Scholar
  • 2 Cormier JN, Rourke L, Crosby M, Chang D, Armer J. The surgical treatment of lymphedema: a systematic review of the contemporary literature (2004-2010). Ann Surg Oncol 2012; 19 (02) 642-651
    CrossrefPubMedGoogle Scholar
  • 3 Park KE, Allam O, Chandler L. et al. Surgical management of lymphedema: a review of current literature. Gland Surg 2020; 9 (02) 503-511
    CrossrefPubMedGoogle Scholar
  • 4 Homans J. The treatment of elephantiasis of the legs - a preliminary report. N Engl J Med 1936; 215: 1099-1104
    CrossrefPubMedGoogle Scholar
  • 5 Charles H. Elephantiasis of the leg. In: Latham A, English TC. eds. A System of Treatment. London: Churchill; 1912
    Google Scholar
  • 6 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16 (06) 437-442
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Wu XQ, Liu HR, Yu ZY. et al. A super-microsurgery training model: the mouse caudal artery anastomosis model. Front Surg 2022; 9: 841302
    CrossrefPubMedGoogle Scholar
  • 8 Carl HM, Walia G, Bello R. et al. Systematic review of the surgical treatment of extremity lymphedema. J Reconstr Microsurg 2017; 33 (06) 412-425
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Chang EI, Schaverien MV, Hanson SE, Chu CK, Hanasono MM. Evolution in surgical management of breast cancer-related lymphedema: the MD Anderson Cancer Center experience. Plast Reconstr Surg Glob Open 2020; 8 (03) e2674
    CrossrefPubMedGoogle Scholar
  • 10 Rosian K, Stanak M. Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: a systematic review of prospective evidence. Microsurgery 2019; 39 (08) 763-772
    CrossrefPubMedGoogle Scholar
  • 11 Granzow JW. Lymphedema surgery: the current state of the art. Clin Exp Metastasis 2018; 35 (5-6): 553-558
    CrossrefPubMedGoogle Scholar
  • 12 Kania K, Chang DK, Abu-Ghname A. et al. Microsurgery training in plastic surgery. Plast Reconstr Surg Glob Open 2020; 8 (07) e2898
    CrossrefPubMedGoogle Scholar
  • 13 ACGME Program Requirements for Graduate Medical Education in Plastic Surgery (Integrated and Independent). Accessed November 5, 2022 at: https://www.acgme.org/globalassets/pfassets/programrequirements/360-362_plasticsurgery_2020.pdf
    PubMedGoogle Scholar
  • 14 Mueller MA, Pourtaheri N, Evans GRD. Microsurgery training resource variation among US integrated plastic surgery residency programs. J Reconstr Microsurg 2019; 35 (03) 176-181
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Lymphatic Education & Research Network. Centers of excellence. Accessed December 1, 2022 at: https://journals.lww.com/plasreconsurg/Pages/Instructions-for-Authors.aspx#TitlePage
    PubMedGoogle Scholar
  • 16 U.S. Census Bureau. Race. Accessed February 1, 2023 at: https://www.census.gov/quickfacts/fact/note/US/RHI625220
    PubMedGoogle Scholar
  • 17 Chawla S, Chawla A, Hussain M, Karimuddin AA, Khosa F. The state of diversity in academic plastic surgery faculty across North America. Plast Reconstr Surg Glob Open 2021; 9 (11) e3928
    CrossrefPubMedGoogle Scholar
  • 18 Xun H, He W, Chen J. et al. A new decade for diversity: trends in representation of women at the Northeastern Society of Plastic Surgeons. Ann Plast Surg 2021; 87 (1s, Suppl 1): S65-S69
    CrossrefPubMedGoogle Scholar
  • 19 Bregman DE, Ha G, Tanna N. Uneven progress in gender equality at plastic surgery conferences: lessons from a decade of meetings. Plast Reconstr Surg 2022; 149 (03) 581e-589e
    CrossrefPubMedGoogle Scholar
  • 20 Silvestre J, Tomlinson-Hansen S, Fosnot J, Taylor JA. Plastic surgery residency websites: a critical analysis of accessibility and content. Ann Plast Surg 2014; 72 (03) 265-269
    CrossrefPubMedGoogle Scholar
  • 21 Hashmi A, Policherla R, Campbell H, Khan FA, Schumaier A, Al-Mufarrej F. How informative are the plastic surgery residency websites to prospective applicants?. J Surg Educ 2017; 74 (01) 74-78
    CrossrefPubMedGoogle Scholar
  • 22 Breast Cancer Facts and Statistics. Accessed August 1, 2023 at: https://www.breastcancer.org/facts-statistics
    PubMedGoogle Scholar
  • 23 Lymphatic Education & Research Network. History. Accessed December 1, 2022 at: https://lymphaticnetwork.org/about/history/
    PubMedGoogle Scholar
  • 24 Kandi LA, Struve SL, Casey III WJ, Rebecca AM, Teven CM. Call to action: accreditation of microsurgery fellowship. Plast Reconstr Surg Glob Open 2021; 9 (10) e3874
    CrossrefPubMedGoogle Scholar
  • 25 Ozturk CN, Ozturk C, Glasgow M. et al. Free vascularized lymph node transfer for treatment of lymphedema: a systematic evidence based review. J Plast Reconstr Aesthet Surg 2016; 69 (09) 1234-1247
    CrossrefPubMedGoogle Scholar
  • 26 Butler PD, Britt LD, Longaker MT. Ethnic diversity remains scarce in academic plastic and reconstructive surgery. Plast Reconstr Surg 2009; 123 (05) 1618-1627
    CrossrefPubMedGoogle Scholar
  • 27 Hall JA, Chen W, Bhayana K. et al. Quantifying the pipeline of ethnically underrepresented in medicine physicians in academic plastic surgery leadership. Ann Plast Surg 2021; 87 (04) e51-e61
    CrossrefPubMedGoogle Scholar
  • 28 Hernandez JA, Kloer CI, Porras Fimbres D, Phillips BT, Cendales LC. Plastic surgery diversity through the decade: where we stand and how we can improve. Plast Reconstr Surg Glob Open 2022; 10 (02) e4134
    CrossrefPubMedGoogle Scholar
  • 29 Chun M, Girard A, Zhang Y. et al. What attributes make United States plastic surgery programs desirable? Perspectives from medical students and residents. Eplasty 2022; 22: e3
    PubMedGoogle Scholar
  • 30 Irwin TJ, Riesel JN, Ortiz R, Helliwell LA, Lin SJ, Eberlin KR. The impact of social media on plastic surgery residency applicants. Ann Plast Surg 2021; 86 (03) 335-339
    CrossrefPubMedGoogle Scholar
  • 31 Atashroo DA, Luan A, Vyas KS. et al. What makes a plastic surgery residency program attractive? An applicant's perspective. Plast Reconstr Surg 2015; 136 (01) 189-196
    CrossrefPubMedGoogle Scholar
  • 32 Ku MC, Li YE, Prober C, Valantine H, Girod SC. Decisions, decisions: how program diversity influences residency program choice. J Am Coll Surg 2011; 213 (02) 294-305
    CrossrefPubMedGoogle Scholar
  • 33 Chen VW, Hoang D, Garner W. Do websites provide what applicants need? Plastic surgery residency program websites versus applicant self-reported needs. Plast Reconstr Surg Glob Open 2018; 6 (10) e1900
    CrossrefPubMedGoogle Scholar