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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 28  |  Issue : 3  |  Page : 171-175

What is the role of hand surgery in plastic surgery? Analysis of hand surgery papers presented in Turkish national congresses of plastic, reconstructive, and aesthetic surgery


Department of Plastic Reconstructive and Aesthetic Surgery, Division of Hand Surgery, Selcuk University Medical Faculty, Konya, Turkey

Date of Submission28-May-2019
Date of Acceptance04-Aug-2019
Date of Web Publication26-May-2020

Correspondence Address:
Dr. Gokce Yildiran
Department of Plastic Surgery, Division of Hand Surgery, Alaaddin Keykubat Campus, Selcuk University Medical Faculty Hospital, Selcuklu, Konya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_49_19

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  Abstract 


Context: Scientific studies are often presented primarily to a group of colleagues at annual scientific meetings. All year rounds are turned into products in congresses. Aims: The aim of the study is to evaluate the extent of the hand surgery in plastic surgery and plastic surgeons' papers related with hand surgery in national congresses; the past eight plastic surgery congresses were classified and presented. Settings and Design: The abstract books of Turkish National Congresses of Plastic, Reconstructive, and Aesthetic Surgery between 2011 and 2018 have been evaluated retrospectively. Subjects and Methods: Distribution of hand surgery according to the topics was evaluated according to the European White Book rules and standards. Distribution of oral and posters and distribution by years were shown. Results: The ratio of hand surgery reports to all reports was 17.3%. Hand and upper extremity surgery topics were presented at 19.7% in the 38th congress, which is the most hand surgery-included congress. The most frequently presented subjects were tumors, flaps, trauma, congenital anomalies, and replantation. Conclusions: Although there are arguments that plastic surgeons have disregarded hand surgery, there is no similar situation for Turkish plastic surgeons in the national platform. It has been found that the most common topics such as tumor excision and repair of the tissue defect were the most presented issues rather than arthroscopy, paralytic hand, and arthritis, which are specific to the hand surgery. Increasing the number of plastic surgery specialists who have been trained with hand surgery as a subspecialty will bring up the subjects that have not been presented in the hand surgery so far, in the future congresses.

Keywords: Congress papers, hand surgery, plastic surgery


How to cite this article:
Yildiran G, Sutcu M, Erkol EE, Akdag O. What is the role of hand surgery in plastic surgery? Analysis of hand surgery papers presented in Turkish national congresses of plastic, reconstructive, and aesthetic surgery. Turk J Plast Surg 2020;28:171-5

How to cite this URL:
Yildiran G, Sutcu M, Erkol EE, Akdag O. What is the role of hand surgery in plastic surgery? Analysis of hand surgery papers presented in Turkish national congresses of plastic, reconstructive, and aesthetic surgery. Turk J Plast Surg [serial online] 2020 [cited 2020 Jul 10];28:171-5. Available from: http://www.turkjplastsurg.org/text.asp?2020/28/3/171/284959




  Introduction Top


A scientific research is usually first presented at annual scientific meetings. These annual congresses are critical in the transmission of new information.[1] For this reason, the congress presentations are the best indicators of what is being done in a specific branch nationally. Hand surgery has been recognized as a subspecialty of plastic surgery since 2009.[2] In this study, the papers about hand and upper extremity surgery in the past eight national plastic surgery congresses were classified and analyzed, and it was aimed to demonstrate what plastic surgery does and does not do in the hand surgery.


  Subjects and Methods Top


The abstract books of Turkish National Congresses of Plastic, Reconstructive, and Aesthetic Surgery between 2011 and 2018 were evaluated retrospectively.

Free papers (oral presentations), posters, and presentations in resident presentation competitions were included in the study, while the speeches of the invited speakers were not included.

Hand surgery topics in the official report book of the European Federation of Hand Surgery Associations (White Book), which sets the rules and standards of hand surgery in Europe, were identified.[3] “Hand injuries” (wound, skeletal, vascular, tendon, and nerve damage), “hand fractures and malunion treatments,” “ligament ruptures and instabilities,” “arthroscopy of hand and wrist,” “hand amputations,” “burns,” “mutilated hand reconstructive surgery,” “brachial plexus and nerve damage,” “tetraplegia/stroke/cerebral palsy (CP),” “tendon transfers,” “congenital anomalies,” “arthrosis,” “arthritic hand,” “Dupuytren's contracture,” “overuse syndromes,” “nerve compressions,” “hand infections,” “vascular diseases,” and “hand tumors” were the determined topics. In this study, “epidemiology,” “technical definitions,” “anatomical variations,” “nail,” “pressure injuries,” and “other topics” (cosmetic problems such as hyperpigmentation correction, functional fat injections, snake bite, simultaneous diseases, subcutaneous emphysema, scarring, and subspecialty education) were added to the topics.

The ratio of the number of papers in the hand surgery topics to oral presentations and poster categories was calculated according to the total number of papers. In addition, analysis and total number of papers were evaluated according to the years.

To take into consideration the possibility of presenting on the international platform rather than being presented first in the national platform of less presented topics, all the papers presented by Turkish plastic surgeons in the Federation of European Societies for Surgery of the Hand (FESSH) Congresses for the past 8 years were also evaluated, and the subjects were classified according to the years.


  Results Top


A total of 4328 papers were presented in the congresses between 2011 and 2018, of which 1306 were oral and 3022 were in the poster format [Figure 1]a. The hand surgery reports in all congresses were 754 (17.4%) in total, 139 (10.6%) were oral, and 615 (20.3%) were poster presentations [Figure 1]b.
Figure 1: Oral and poster presentations rate, (a) oral and poster presentations' rate among all plastic surgery presentations, (b) oral and poster presentations' rate among all hand surgery presentations

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When the absolute values are taken into consideration, the congress with the highest number of papers is the 36th congress with 712 papers, and the congress with the lowest number of papers is the 40th congress with 392 papers. The highest number of hand surgery papers was presented in the 36th congress with 120 papers. In the field of hand surgery, the most oral presentations were presented in the 36th and 40th congresses with 21 papers, and the maximum number of poster papers was presented in the 35th congress with 106 papers [Figure 2] and [Figure 3].
Figure 2: Hand surgery presentation number according to years (33rd–40th congresses)

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Figure 3: Oral and poster presentations rate of hand surgery between 33rd and 40th congresses

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When the averages are taken according to the years, the congress with the highest hand surgery paper is the 38th congress with 19.7% and the congress with the highest rate of oral presentation is the 38th congress with 15.38%. The 35th congress is the congress with the highest number of posters in the hand surgery area [Figure 4].
Figure 4: All presentations and hand surgery presentations (the rate of hand surgery reports is shown in parentheses)

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The most commonly presented topics were “tumors” (n = 142), “reconstruction and flaps” (n = 116), “trauma” (n = 78), “congenital anomalies” (n = 65), and “replantation” (n = 48). The topics that were presented at least were the “wrist joint range of motion measurements,” “wrist arthroscopy,” “carpometacarpal joint arthrosis,” “Kienböck's disease,” “calciphylaxis,” and one presentation was performed for each [Table 1].
Table 1: All hand surgery presentation topics (oral and poster) in plastic surgery congresses

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“Tumors” were the most presented topic (n = 142); four of the 142 papers about “tumors” were the oral presentations (2.81%). The second most commonly presented subject is “reconstruction and flaps” (n = 116), 42 of which is oral presentation (36.2%). The third most commonly presented topic was “trauma” (n = 78), and 20 of them were the oral presentation (25.64%).

The most submitted papers in the oral presentation format are “reconstruction and flaps” (n = 42), “trauma” (n = 20), “replantation” (n = 13), “congenital anomalies” (n = 10), and “entrapment neuropathies” (n = 8), respectively [Figure 5].
Figure 5: Plastic surgery topics presented ≥10 times

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The most submitted papers in the poster format are “tumors” (n = 138), “reconstruction and flaps” (n = 74), “congenital anomalies” (n = 55), “trauma” (n = 58), “replantation” (n = 35), and “anatomical variation” (n = 27), respectively.

The topics that have been presented as poster but have not been presented as oral presentations were “complications” (n=24), “burns” (n=23), “high-pressure injuries” (n = 8), “compartment syndrome” (n = 6), “trigger finger” (n = 6), “foreign body” (n=5) “wound” (n = 3), “tenosynovitis” (n = 2), “ligament repair” (n = 2), “Kienböck” (n = 1), and “calciphylaxis” (n = 1) [Figure 6].
Figure 6: Plastic surgery topics presented <10 times

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“Malunion therapies,” “arthritic hand,” “overuse syndromes,” “instabilities,” “mutilated hand,” and “tetraplegia/stroke/CP therapies” in the FESSH report book were not presented at the National Plastic Surgery Congresses.

The distribution of 26 presentations presented in the FESSH congresses by Turkish plastic surgeons in the past 8 years were six “reconstruction and flaps,” five “tendon,” four “brachial plexus,” three “congenital,” three “trauma,” one “tumor,” one “entrapment neuropathy,” one “Dupuytren's contracture,” one “bone defect,” and one “burn.” According to the years, 2016 (n = 7), 2015 (n = 5), 2013 (n = 5), 2011 (n = 5), 2017 (n = 2), 2014 (n = 1), 2012 (n = 1), and 2018 (n = 0), presentations were made, respectively.


  Discussion Top


A scientific study is usually presented at national annual meetings. The annual congresses of the Turkish Society of Plastic, Reconstructive, and Aesthetic Surgery are also widely accepted by the national surgeons and have a high participation and high scientific level. Hand surgery is the subspecialty of plastic surgery since 2009, where it has been given the degree of specialty after a 2-year residency of a plastic surgeon with the subspecialty examination. Of the 583 presentations per year presented in the national congresses of plastic surgery over the past 8 years, 92.75% were in the field of hand surgery. This may lead to the misconception that hand surgery occupies a large space in plastic surgery in this area. The most frequently presented papers were “soft-tissue tumors,” but only 2.81% of them were oral presentations. This suggests that case reports were presented rather than large case series or research articles in terms of soft-tissue tumors. It is no surprise that the “reconstruction and flaps” topic is the second most presented issue and prominent in the congresses because plastic surgery is mainly concerned with the repair of tissue defects. The “trauma, tendon, and neurovascular injuries” which are very common in the emergency practice of plastic surgeons, were determined as the third most frequent presentation; however, these topics were orally presented for 20 times in 8 years.

On the other hand, it was determined that “wrist arthritis,” “arthroscopy,” “endoscopic approaches to the entrapment neuropathies,” “bone fracture and defect repair,” and “brachial plexus surgery” were not presented or rarely presented at plastic surgery national congresses.

The rate of conversion of oral papers to articles in annual meetings determines the scientific quality of these meetings.[4] Therefore, oral presentations have greater importance. In this study, it was found that 9.95% of the oral presentations presented in the Turkish Plastic, Reconstructive and Aesthetic Surgery Association (TPCD) national congresses belonged to hand surgery.

In 2015, “The Accreditation Council for Graduate Medical Education” determined the minimum number of hand surgery operations that a minimum plastic surgery resident should perform.[5]

From these categories, “fracture repairs,” “compression syndromes,” “tendon repairs,” and “reconstruction” were the most common. In this study, the most frequently presented subjects were “tumor,” “reconstruction and flaps,” and “trauma,” which were correlated with the most frequent procedures that were determined by this committee.

Hand surgery is a critical part of the plastic surgery. However, there is no consensus on the extent of plastic surgeons' hand surgery practice. In the literature, it was shown that plastic surgeons were mostly faced with “trauma” related to hand surgery, whereas 44% of the plastic surgeons did not perform (or too little) elective hand surgery.[6] In this study, “trauma” was found to be the third most frequently presented subject, and it was concluded that Turkish plastic surgeons frequently encountered with hand trauma, and this was found to be compatible with the literature.

According to Higgins, the rate of new plastic surgeons who had “Certificate of Added Qualifications in Surgery of the Hand” decreased to 4%. The rate of plastic surgeons applying for the “Certificate of Added Qualifications in Surgery of the Hand” decreased from 30% to 15%. In this study, it was stated that plastic surgeons' hand surgery in the United States began to disappear.[7]

According to our study, no dramatic and systematic decreases were observed, except for the decrease in the number of papers in the hand surgery topics in the past 2 years. It is not possible to say that plastic surgeons have disregarded hand surgery in the Turkish Plastic Surgery Association Congresses. However, it will be possible to make more clear comparisons with the presence of Turkish plastic surgeons in the hand surgery congresses. The fact that 26 papers presented in the FESSH congresses in the past 8 years seem to support the fact that the surgeons prefer to present their work first on the national platform; however, the qualitative status of the papers rather than quantitative status should be discussed.

On the other hand, in the past 8 years, six papers were presented in the national congresses of Turkish Plastic Surgery Association, four of which were oral and 2 of which were posters, about “brachial plexus.” In the FESSH congresses, four papers were presented by Turkish plastic surgeons on “brachial plexus” in the past 8 years. Malunion therapies, arthritic hand, arthroscopies, endoscopic surgeries for entrapment neuropathies, overuse syndromes, instabilities, mutilated hand, and tetraplegia/stroke/CP therapies were not reported by Turkish plastic surgeons at FESSH congresses.

Turkish plastic surgeons sometimes prefer to present their works on hand surgery in the congresses of the National Hand and Upper Extremity Surgery Society which held once in 2 years. The fact that there is no review of the topics presented by the Turkish plastic surgeons in the national hand and upper extremity surgery congresses is a limitation of this study; however, these reports could not be included in this study because it was not possible to exclude the repeated presentations which were presented in both meetings.


  Conclusions Top


As a result, hand surgery has found a larger place in plastic surgery with “tumor,” “reconstruction,” and “trauma.” Tumor excision and reconstruction of the traumatic defect are inherent in plastic surgery; this may be the main reason of this result. Less presented topics will be discussed in plastic surgery national congresses because the hand surgery subspecialist plastic surgeons' number will be increased.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gregory TN, Liu T, Machuk A, Arneja JS. What is the ultimate fate of presented abstracts? The conversion rates of presentations to publications over a five-year period from three North American plastic surgery meetings. Can J Plast Surg 2012;20:33-6.  Back to cited text no. 1
    
2.
Available from: https://www.resmigazete.gov.tr/eskiler/2009/07/20090718-5.htm. [Last accessed on 2020 Apr 07].  Back to cited text no. 2
    
3.
Available from: https://fessh.com/white-book/. [Last accessed on 2020 Apr 07].  Back to cited text no. 3
    
4.
van der Steen LP, Hage JJ, Loonen MP, Kon M. Full publication of papers presented at the 1995 through 1999 European association of plastic surgeons annual scientific meetings: A systemic bibliometric analysis. Plast Reconstr Surg 2004;114:113-20.  Back to cited text no. 4
    
5.
Silvestre J, Lin IC, Levin LS, Chang B. Variable operative experience in hand surgery for plastic surgery residents. J Surg Educ 2017;74:650-5.  Back to cited text no. 5
    
6.
Lifchez SD, Friedrich JB, Hultman CS. The scope of practice of hand surgery within plastic surgery: The ACAPS national survey to assess current practice and develop educational guidelines. Ann Plast Surg 2015;74:89-92.  Back to cited text no. 6
    
7.
Higgins JP. The diminishing presence of plastic surgeons in hand surgery: A critical analysis. Plast Reconstr Surg 2010;125:248-60.  Back to cited text no. 7
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
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