Mind the Gap: a Competency-Based Scoping Review of Aesthetic and Reconstructive Reported Simulation Training Models.


Journal

Aesthetic plastic surgery
ISSN: 1432-5241
Titre abrégé: Aesthetic Plast Surg
Pays: United States
ID NLM: 7701756

Informations de publication

Date de publication:
Oct 2021
Historique:
received: 29 11 2020
accepted: 29 11 2020
pubmed: 24 1 2021
medline: 12 10 2021
entrez: 23 1 2021
Statut: ppublish

Résumé

Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide. Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models. A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%. This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sections du résumé

BACKGROUND BACKGROUND
Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide.
METHODS METHODS
Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models.
RESULTS RESULTS
A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%.
CONCLUSIONS CONCLUSIONS
This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery.
LEVEL OF EVIDENCE III METHODS
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Identifiants

pubmed: 33483780
doi: 10.1007/s00266-020-02089-z
pii: 10.1007/s00266-020-02089-z
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

2483-2490

Informations de copyright

© 2021. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.

Références

Agrawal N, Turner A, Grome L et al (2020) Use of simulation in plastic surgery training. Plast Reconstr Surg Glob Open 8:e2896
pubmed: 32802639 pmcid: 7413819 doi: 10.1097/GOX.0000000000002896
Kazan R, Cyr S, Hemmerling TM et al (2017) The evolution of surgical simulation: the current state and future avenues for plastic surgery education. Plast Reconstr Surg 139:533e–543e
pubmed: 28121895 doi: 10.1097/PRS.0000000000002956 pmcid: 28121895
Minhàr S, Shefet D, Sagi D et al (2016) “See One, Sim One, Do One”—a National Pre-Internship Boot-Camp to Ensure a Safer “Student to Doctor” Transition. PLoS ONE 11:e0150122
doi: 10.1371/journal.pone.0150122
Aggarwal R, Darzi A (2006) Technical-skills training in the 21st century. N Engl J Med 355:2695–2696
pubmed: 17182997 doi: 10.1056/NEJMe068179 pmcid: 17182997
Berner JE, Ewertz E (2018) Bases teóricas del uso simulación para el entrenamiento en cirugía. Rev Chil Cir 70:382–388
doi: 10.4067/s0718-40262018000300382
Okuda Y, Bryson EO, DeMaria S et al (2009) The utility of simulation in medical education: what is the evidence? Mount Sinai J Med J Trans Personalized Med 76:330–343
doi: 10.1002/msj.20127
Konia M, Yao A (2013) Simulation-a new educational paradigm? J Biomed Res 27:75–80
pubmed: 23554798 pmcid: 3602865
Motola I, Devine LA, Chung HS et al (2013) Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Med Teach 35:e1511–e1530
pubmed: 23941678 doi: 10.3109/0142159X.2013.818632 pmcid: 23941678
Iskander M (2019) Simulation training in medical education—an exploration through different theoretical lenses. Med Sci Educator 29:593–597
doi: 10.1007/s40670-019-00696-3
Thomson JE, Poudrier G, Stranix JT et al (2018) Current status of simulation training in plastic surgery residency programs: a review. Arch Plast Surg 45:395–402
pubmed: 30282409 pmcid: 6177637 doi: 10.5999/aps.2017.01585
Badash I, Burtt K, Solorzano CA, Carey JN (2016) Innovations in surgery simulation: a review of past, current and future techniques. Ann Trans Med 4:453–453
pubmed: 28090509 pmcid: 5220028 doi: 10.21037/atm.2016.12.24
Khamis N, Satava R, Kern DE (2020) Stepwise Simulation Course Design Model: Survey Results from 16 Centers. JSLS 24. https://doi.org/10.4293/JSLS.2019.00060
Maiorana FA, Mayer HF (2018) How to avoid common errors in writing scientific manuscripts. Eur J Plast Surg 41:489–494
doi: 10.1007/s00238-018-1418-z
Masic I (2014) Plagiarism in scientific research and publications and how to prevent it. Mater Sociomed 26:141–146
pubmed: 24944543 pmcid: 4035147 doi: 10.5455/msm.2014.26.141-146
Picardi N (2016) Rules to be adopted for publishing a scientific paper. Ann Ital Chir 87:1–3
pubmed: 28474609
Rosen JM, Long SA, McGrath DM, Greer SE (2009) Simulation in plastic surgery training and education: the path forward. Plast Reconstr Surg 123:729–38; discussion 739–740
Accreditation Council for Graduate Medical Education (2016) ACGME program requirements for graduate medical education in plastic surgery, pp 1–29
McNichols CHL, Diaconu S, Alfadil S et al (2017) Cosmetic surgery training in plastic surgery residency programs. Plastic Reconstr Surg Global Open 5:e1491
doi: 10.1097/GOX.0000000000001491
Diamond IR, Grant RC, Feldman BM et al (2014) Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 67:401–409
pubmed: 24581294 doi: 10.1016/j.jclinepi.2013.12.002
Nagy K, Mommaerts MY (2009) Advanced s(t)imulator for cleft palate repair techniques. Cleft Palate-Craniofacial J 46:1–5
doi: 10.1597/08-004.1
Podolsky DJ, Cheng H, Fisher DM et al (2018) Reply: evaluation and implementation of a high-fidelity cleft palate simulator. Plast Reconstr Surg 142:980e–981e
pubmed: 30489541 doi: 10.1097/PRS.0000000000005031 pmcid: 30489541
Cheng H, Podolsky DJ, Fisher DM et al (2018) Teaching palatoplasty using a high-fidelity cleft palate simulator. Plast Reconstr Surg 141:91e–98e
pubmed: 29280875 doi: 10.1097/PRS.0000000000003957 pmcid: 29280875
Zheng Y, Lu B, Zhang J, Wu G (2015) CAD/CAM silicone simulator for teaching cheiloplasty: description of the technique. Br J Oral Maxillofac Surg 53:194–196
pubmed: 25476261 doi: 10.1016/j.bjoms.2014.10.001
Schendel S, Montgomery K, Sorokin A, Lionetti G (2005) A surgical simulator for planning and performing repair of cleft lips. J Craniomaxillofac Surg 33:223–228
pubmed: 15975810 doi: 10.1016/j.jcms.2005.05.002
Hubli EH, Noordhoff MS (2013) Smile train: changing the world one smile at a time. Ann Plast Surg 71:4–5
pubmed: 22214793 doi: 10.1097/SAP.0b013e318231adbc
Davis CR, Fell M, Khan U (2014) Facial reconstruction using a skull and foam training model. J Plast Reconstr Aesthet Surg 67:126–127
pubmed: 23890531 doi: 10.1016/j.bjps.2013.07.024
Liew SH, McPhail J, Morton JD et al (2004) A non-animal facial model for teaching local flaps to trainees. Br J Plast Surg 57:374–375
pubmed: 15145747 doi: 10.1016/j.bjps.2003.11.027
Kite AC, Yacoe M, Rhodes JL (2018) The use of a novel local flap trainer in plastic surgery education. Plast Reconstr Surg Glob Open 6:e1786
pubmed: 30276039 pmcid: 6157937 doi: 10.1097/GOX.0000000000001786
Hassan Z, Hogg F, Graham K (2014) A 3-dimensional model for teaching local flaps using porcine skin. Ann Plast Surg 73:362–363
pubmed: 23797025 doi: 10.1097/SAP.0b013e3182996efd pmcid: 23797025
Isaacson DS, Edmonds PR, Isaacson G (2014) The galliform (Turkey thigh) model for resident training in facial plastic surgery. Laryngoscope 124:866–868
pubmed: 23939997 doi: 10.1002/lary.24350 pmcid: 23939997
Chan W-Y, Dalal M (2010) Cost-effective plastic surgery skills training. J Plast Reconstr Aesthet Surg 63:e136–7; author reply e138
Sheckter CC, Kane JT, Minneti M et al (2013) Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. J Surg Educ 70:466–474
pubmed: 23725934 doi: 10.1016/j.jsurg.2013.02.008 pmcid: 23725934
Carey JN, Rommer E, Sheckter C et al (2014) Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthet Surg 67:e42–e48
pubmed: 24094541 doi: 10.1016/j.bjps.2013.09.026 pmcid: 24094541
Nykiel M, Wong R, Lee G (2014) An economical training model to teach and practice deep inferior epigastric artery perforator dissection. Ann Plast Surg 72(Suppl 1):S66-70
pubmed: 24740027 doi: 10.1097/SAP.0000000000000176 pmcid: 24740027
Kayano S, Nakagawa M, Nagamatsu S et al (2010) Why not perforator flap training models in rats? J Plastic Reconstr Aesthetic Surg 63:e134–e135
doi: 10.1016/j.bjps.2009.02.087
Bodin F, Diana M, Koutsomanis A et al (2015) Porcine model for free-flap breast reconstruction training. J Plast Reconstr Aesthet Surg 68:1402–1409
pubmed: 26184772 doi: 10.1016/j.bjps.2015.06.006 pmcid: 26184772
Ibrahim N, Chauhan I, Varma S (2018) A novel method for practising local skin flaps. Ann R Coll Surg Engl 100:338
pubmed: 27513802 doi: 10.1308/rcsann.2016.0252 pmcid: 27513802
Iqbal A, Ellabban MG (2006) The breast reduction and nipple reconstruction training models: real tissue training models. Plast Reconstr Surg 117:332–333
pubmed: 16404305 doi: 10.1097/01.prs.0000196262.13766.5c pmcid: 16404305
Cooper L (2017) Course review: cadaveric hand trauma course. Ann Plast Surg 78:611–612
pubmed: 28079532 doi: 10.1097/SAP.0000000000000958 pmcid: 28079532
Kennedy A-M, Carroll S, Traynor O, Gallagher AG (2008) Assessing surgical skill using bench station models. Plast Reconstr Surg 121:1869–1870
pubmed: 18454032 doi: 10.1097/PRS.0b013e31816b19bc
Tehrani H, McPhail J (2009) A simple refinement to the tendon repair model. J Plast Reconstr Aesthet Surg 62:136–137
pubmed: 18974030 doi: 10.1016/j.bjps.2008.06.079
Ingraham JM, Weber RA 3rd, Weber RA (2010) How we teach tendon repairs outside the operating room. Plast Reconstr Surg 125:266e-e267
pubmed: 20517079 doi: 10.1097/PRS.0b013e3181d5172d
Bari AS, Woon CY, Pridgen B, Chang J (2012) Overcoming the learning curve: a curriculum-based model for teaching zone II flexor tendon repairs. Plast Reconstr Surg 130:381–388
pubmed: 22495211 doi: 10.1097/PRS.0b013e3182589d06
Kamath J, Jayasheelan N, Sujir P (2017) A simulator for nerve repair. J Hand Surg Eur 42:960–961
doi: 10.1177/1753193417706249
Beth Grossman L, Komatsu DE, Badalamente MA et al (2016) Microsurgical simulation exercise for surgical training. J Surg Educ 73:116–120
pubmed: 26762839 doi: 10.1016/j.jsurg.2015.09.003
Korber KE (1991) A basic microsurgical skills curriculum for the plastic surgeon. Plast Reconstr Surg 87:810–811
pubmed: 2008495 doi: 10.1097/00006534-199104000-00052
Krähenbühl SM, Čvančara P, Stieglitz T et al (2017) Return of the cadaver: Key role of anatomic dissection for plastic surgery resident training. Medicine 96:e7528
pubmed: 28723767 pmcid: 5521907 doi: 10.1097/MD.0000000000007528
Malik MM, Hachach-Haram N, Tahir M et al (2017) Acquisition of basic microsurgery skills using home-based simulation training: a randomised control study. J Plast Reconstr Aesthet Surg 70:478–486
pubmed: 28161208 doi: 10.1016/j.bjps.2016.12.011
Willis RE, Wiersch J, Adams AJ et al (2017) Development and evaluation of a simulation model for microvascular anastomosis training. J Reconstr Microsurg 33:493–501
pubmed: 28472839 doi: 10.1055/s-0037-1602760 pmcid: 28472839
Galmiche C, Hidalgo Diaz JJ, Vernet P et al (2018) Learning of supermicrosurgical vascular anastomosis: MicroChirSim procedural simulator versus Anastomosis Training Kit procedural simulator. Hand Surg Rehabil 37:20–23
pubmed: 29233543 doi: 10.1016/j.hansur.2017.10.236 pmcid: 29233543
Karakawa R, Yoshimatsu H, Nakatsukasa S, Iida T (2018) A new method for microsurgery training using a smartphone and a laptop computer. Microsurgery 38:124–125
pubmed: 28895172 doi: 10.1002/micr.30241 pmcid: 28895172
Kim E, Singh M, Akelina Y et al (2016) Effect of microvascular anastomosis technique on end product outcome in simulated training: a prospective blinded randomized controlled trial. J Reconstr Microsurg 32:556–561
pubmed: 27303937 doi: 10.1055/s-0036-1584218 pmcid: 27303937
Graham WP 3rd (1974) Teaching exercises for medical students in the clinical aspects of wound healing. Plast Reconstr Surg 53:433–435
pubmed: 4815699 doi: 10.1097/00006534-197404000-00009 pmcid: 4815699
Brackley PTH, Nguyen DQA, Williams J et al (2006) A simple and effective adjunct to microsurgical training—The Whiston cup. J Plastic Reconstr Aesth Surg 59:1010–1011
doi: 10.1016/j.bjps.2005.12.037
Satterwhite T, Son J, Carey J et al (2012) Microsurgery education in residency training: validating an online curriculum. Ann Plast Surg 68:410–414
pubmed: 22421490 doi: 10.1097/SAP.0b013e31823b6a1a
Schoeff S, Hernandez B, Robinson DJ et al (2017) Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training. Laryngoscope 127:2490–2494
pubmed: 28407264 doi: 10.1002/lary.26586
Rodriguez JR, Yañez R, Cifuentes I et al (2016) Microsurgery workout: a novel simulation training curriculum based on nonliving models. Plast Reconstr Surg 138:739e-e747
pubmed: 27673544 doi: 10.1097/PRS.0000000000002456
Ghanem AM, Al Omran Y, Shatta B et al (2016) Anastomosis Lapse Index (ALI): a validated end product assessment tool for simulation microsurgery training. J Reconstr Microsurg 32:233–241
pubmed: 26645156
Perry D, Albert M, Akyurek M (2015) Use of smartphone cameras for simplified and cost-effective video recording of microvascular techniques. Plast Reconstr Surg 135:941e–943e
pubmed: 25844519 doi: 10.1097/PRS.0000000000001197
Masud D, Haram N, Moustaki M et al (2017) Microsurgery simulation training system and set up: an essential system to complement every training programme. J Plast Reconstr Aesthet Surg 70:893–900
pubmed: 28526634 doi: 10.1016/j.bjps.2017.03.009 pmcid: 28526634
Wong AK, Davis GB, JoAnna Nguyen T et al (2014) Assessment of three-dimensional high-definition visualization technology to perform microvascular anastomosis. J Plast Reconstr Aesthet Surg 67:967–972
pubmed: 24838275 doi: 10.1016/j.bjps.2014.04.001 pmcid: 24838275
Lascar I, Totir D, Cinca A et al (2007) Training program and learning curve in experimental microsurgery during the residency in plastic surgery. Microsurgery 27:263–267
pubmed: 17477411 doi: 10.1002/micr.20352 pmcid: 17477411
Schaverien MV, Liu J, Butler CE, Selber JC (2018) Factors correlating with microsurgical performance: a clinical and experimental study. J Surg Educ 75:1045–1051
pubmed: 29199083 doi: 10.1016/j.jsurg.2017.11.003 pmcid: 29199083
Mokhtari P, Tayebi Meybodi A, Lawton MT et al (2017) Transfer of learning from practicing microvascular anastomosis on silastic tubes to rat abdominal aorta. World Neurosurg 108:230–235
pubmed: 28867319 doi: 10.1016/j.wneu.2017.08.132 pmcid: 28867319
Whallett EJ, McGregor JC (2011) An alternative model for teaching basic principles and surgical skills in plastic surgery. J Plast Reconstr Aesthet Surg 64:272–274
pubmed: 20619757 doi: 10.1016/j.bjps.2010.06.017 pmcid: 20619757
Cubison TCS, Clare T (2002) Lasagne: a simple model to assess the practical skills of split-skin graft harvesting and meshing. Br J Plast Surg 55:703–704
pubmed: 12550137 doi: 10.1054/bjps.2002.3947 pmcid: 12550137
Iqbal A, Ellabban MG, Srivastava S, Jaffe W (2005) Discard little, learn more: the real tissue training model. Plast Reconstr Surg 115:948–949
pubmed: 15731703 doi: 10.1097/01.PRS.0000153780.88650.3A
Esteban D, Fraga MF, Shimba LG et al (2009) Basic plastic surgery training using human skin. Plast Reconstr Surg 123:90e–92e
pubmed: 19182597 doi: 10.1097/PRS.0b013e3181959751
Ur R, Holmes JH, Johnson JE et al (2016) Development of a burn escharotomy assessment tool. J Burn Care Res 37:e140–e144
pubmed: 26594860 doi: 10.1097/BCR.0000000000000322
Denadai R, Kirylko L (2013) Teaching basic plastic surgical skills on an alternative synthetic Bench model. Aesthetic Surg J 33:458–461
doi: 10.1177/1090820X13477418
Wexler MR, Giladi A, Neuman Z (1973) Demonstrating the Z-plasty. Br J Plast Surg 26:417
pubmed: 4759984 doi: 10.1016/S0007-1226(73)90055-6 pmcid: 4759984
Iqbal A, Ellabban MG (2005) The dynamic tension real tissue training model for local flap design training. Plast Reconstr Surg 115:1434–1436
pubmed: 15809623 doi: 10.1097/01.PRS.0000157611.39954.E7
Oneal RM, Dingman RO, Grabb WC (1967) The teaching of plastic surgical techniques to medical students. Plast Reconstr Surg 40:494–498
pubmed: 6074150 doi: 10.1097/00006534-196711000-00013
Turhan-Haktanir N, Sancaktar N (2007) Useful material for skin flap training for inexperienced residents. J Plast Reconstr Aesthet Surg 60:1169–1170
pubmed: 17707707 doi: 10.1016/j.bjps.2007.06.033 pmcid: 17707707
Dini PDGM, Dini GM, Gonella HA et al (2012) Training rhinoseptoplasty, sinusectomy, and turbinectomy in an animal model. Plast Reconstr Surg 130:224e–226e
pubmed: 22743940 doi: 10.1097/PRS.0b013e318255021e pmcid: 22743940
Schneider G, Voigt S, Rettinger G (2016) Computed tomography-based training model for otoplasty. Eur Arch Otorhinolaryngol 273:2427–2432
pubmed: 26541715 doi: 10.1007/s00405-015-3797-0 pmcid: 26541715
Murabit A, Anzarut A, Kasrai L et al (2010) Teaching ear reconstruction using an alloplastic carving model. J Craniofac Surg 21:1719–1721
pubmed: 21119407 doi: 10.1097/SCS.0b013e3181f3c755 pmcid: 21119407
Reis MGAD, Marim RG, Souto LRM (2018) Pinna synthetic mold for otoplasty techniques application. Braz J Otorhinolaryngol 84:159–165
pubmed: 28262543 doi: 10.1016/j.bjorl.2017.01.004 pmcid: 28262543
Bos EJ, Scholten T, Song Y et al (2015) Developing a parametric ear model for auricular reconstruction: a new step towards patient-specific implants. J Craniomaxillofac Surg 43:390–395
pubmed: 25703503 doi: 10.1016/j.jcms.2014.12.016 pmcid: 25703503
Matthes AGZ, Perin LF, Rancati A et al (2012) Mastotrainer: new training project for breast aesthetic and reconstructive surgery. Plast Reconstr Surg 130:502e-e504
pubmed: 22929295 doi: 10.1097/PRS.0b013e31825dc5fa
Zucca-Matthes G, Lebovic G, Lyra M (2017) Mastotrainer new version: realistic simulator for training in breast surgery. Breast 31:82–84
pubmed: 27821330 doi: 10.1016/j.breast.2016.08.009
Kazan R, Courteau B, Cyr S et al (2016) A novel mammoplasty part-task trainer for simulation of breast augmentation: description and evaluation. Simul Healthc 11:60–64
pubmed: 26836467 doi: 10.1097/SIH.0000000000000124
Wang C, Chen L, Mu D et al (2017) A low-cost simulator for training in endoscopic-assisted transaxillary dual-plane breast augmentation. Ann Plast Surg 79:525–528
pubmed: 29053519 doi: 10.1097/SAP.0000000000001239
Southern SJ, Sharpe DT (1997) A reduction mammaplasty model for the trainee and patient. Br J Plast Surg 50:142–143
pubmed: 9135434 doi: 10.1016/S0007-1226(97)91329-1
Ji C, Li R, Liang W et al (2016) Plasticine model: an useful surgical training in plastic surgery. Aesthetic Plast Surg 40:174–181
pubmed: 26715575 doi: 10.1007/s00266-015-0602-9

Auteurs

Rodrigo Tejos (R)

Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.

Juan Enrique Berner (JE)

Plastic Surgery Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Kellogg College, University of Oxford, Oxford, UK.

Felipe Imigo (F)

Servicio de Cirugía, Hospital de Puerto Montt, Región de los Lagos, Chile.
Facultad de Medicina, Universidad San Sebastian, Lago Panguipulli 1390, 5501842, Puerto Montt, Chile.

Nicolás Besser (N)

Servicio de Cirugía, Hospital de Puerto Montt, Región de los Lagos, Chile.

Andrea Ramírez (A)

Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.

Daniel Moreno (D)

Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.

Gonzalo Yañez (G)

Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.

Alvaro Cuadra (A)

Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.

Susana Searle (S)

Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile.

Claudio Guerra (C)

Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile. plasticsurgeryuc3@uc.cl.

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