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Introduction: Surgical practices constitute a common topic of complaint among medical students. The aim of this study is to analyze the type of surgical training that students receive in medical school and the impact of SARS-CoV-2 pandemic.
Methods: A survey based on the National Spanish Agency for the Quality of Evaluation and Accreditation (ANECA) guidelines was spread on social media between medical students and physicians waiting to start their residency. The time spent in surgical practices, the number of times that certain abilities were performed, and the desire of choosing a surgical specialty were analyzed.
Results: 1053 surveys were analyzed. Significant differences between the number of months that students rotate and the number of procedures performed as they gained seniority were found. A weak positive correlation between the number of months rotating and the number of procedures performed was found. The desire of choosing a surgical specialty was not associated with the time spent in surgical practice. SARS-CoV-2 pandemic has reduced the time spent in surgical practice and some of the surgical procedures performed.
Conclusion: The amount of surgical procedures performed by students is below the requirements of ANECA guidelines. A different level of dexterity between 6th year students’ group affected by SARS-CoV-2 pandemic and physicians’ group should not be expected because of the low number of procedures performed by both groups. Students’ role in the operating room and the need for different systems of skills learning should be reconsidered.
Background: Serial volumetric changes of reconstructed breasts have not been studied in detail. In this study, we analyzed serial volumetric changes of reconstructed and contralateral normal breasts during long-term follow-up, with a focus on the effect of various adjuvant therapies.
Methods: Among all patients who underwent immediate breast reconstruction with a unilateral pedicled transverse rectus abdominis musculocutaneous (p-TRAM) flap, 42 patients with valid data from ≥3 postoperative positron emission tomography-computed tomography (PET-CT) scans were included. The volumes of the reconstructed and normal breasts were measured, and the ratio of flap volume to that of the contralateral breast was calculated. Serial changes in volume and the volume ratio were described, and the effects of chemotherapy, radiation therapy, and hormone therapy on volumetric changes were analyzed.
Results: The mean interval between the initial reconstruction and each PET-CT scan was 16.5, 30, and 51 months respectively. Thirty-five, 36, and 10 patients received chemotherapy, hormone therapy, and radiation therapy, respectively. The flap volume at each measurement was 531.0, 539.6, and 538.0 cm3, and the contralateral breast volume was 472.8, 486.4, and 500.8 cm3, respectively. The volume ratio decreased from 115.1% to 113.4%, and finally to 109.6% (P=0.02). Adjuvant therapies showed no significant effects.
Conclusions: We demonstrated that the p-TRAM flap maintained its volume over a long-term follow up, while the volume of the contralateral native breast slowly increased. Moreover, adjuvant breast cancer therapies had no statistically significant effects on the volume of the reconstructed p-TRAM flaps or the contralateral native breasts.
The growth hormone is involved in skin homeostasis and wound healing. We hypothesize whether it is possible to improve pressure ulcer (PU) healing by locally applying the recombinant human growth hormone (rhGH) in a human skin mouse model. Non-obese diabetic/severe combined immunodeficient mice (n = 10) were engrafted with a full-thickness human skin graft. After 60 days with stable grafts, human skin underwent three cycles of ischemia-reperfusion with a compression device to create a PU. Mice were classified into two groups: rhGH treatment group (n = 5) and control group (n = 5). In the rhGH group for local intradermal injections, each had 0.15 mg (0.5IU) applied to the PU edges, once per week for four weeks. Evaluation of the wound healing was conducted with photographic and visual assessments, and histological analysis was performed after complete wound healing. The results showed a healing rate twice as fast in the rhGH group compared to the control group (1.25 ± 0.33 mm2/day versus 0.61 ± 0.27 mm2/day; p-value < 0.05), with a faster healing rate during the first 30 days. The rhGH group showed thicker skin (1953 ± 457 µm versus 1060 ± 208 µm; p-value < 0.05) in the repaired area, with a significant decrease in collagen type I/III ratio at wound closure (62 days, range 60–70). Local administration of the rhGH accelerates PU healing in our model. The rhGH may have a clinical use in pressure ulcer treatmen