by Jordan Frey (@JordanFreyMD), MD & Shuja M. Shafqat, MD (@shujashafqatmd)
The first time I heard the words “PRS Journal Club” was before 2016 was upon us, before the holiday madness, and even before Thanksgiving feasts. The organizers of this concept have spent months coordinating this significant endeavor and, after the first wave, I can safely speak for all of us when I say, we are extremely grateful.
Your first reaction is likely the same as mine was those many weeks ago. What is PRS Journal Club?! All of us have been part of our divisional or departmental journal clubs at some point. A collection of articles is picked, presented, and discussed. Opinions are given and arguments are had. These can sometimes get quite heated, but overall they are a fantastic learning experience. However, we all know that the quality of these discussions is only as good as the participants. What if we could expand this exercise and include the authors AND the world experts?
This is exactly what the goal of PRS Journal Club is: to link readers with experts on the topics as well as the authors of the articles. They are the minds that can answer the hard questions and give opinions based on years of experience. I can think of no better way to facilitate an interesting and intellectually stimulating discussion.
The coordinators have tapped into the power of social media and made this event even more revolutionary. Not only have they hand picked articles along with supplemental reading for the PRS website, but they have recorded and posted YouTube videos and podcasts examining the selected articles. They also launched a 3 day long discussion via Twitter and, utilizing #PRSJournalClub, all Twitter users could ask questions about alar contour grafts to the authors of one selected article, Dr. Rod Rohrich (@DrRodRohrich), Dr. Jacob Unger (@DoctorJacob), Dr. Kevin Small (@DrKevinSmall), Dr. Ron Pezeshk (@ronsurfer), Dr. Michael Lee (@DrLeePlastic), and Dr. Jason Roostaeian (@DrJasonPlastics). The authors could then directly answer questions and have discussions between themselves using the hash tag. A user simply has to click on the #PRSJournalClub to get a list of all the tweets and the entire discussion is at your fingertips. We have all been privilege to see the rise in popularity of social media and the power it can hold in many fields. Those of you who are active Twitter users know the power of information sharing using #plasticsurgery. Those of you who are not, I strongly urge you to join us, not only to distribute information amongst ourselves, but with the community and to educate the public about what plastic surgery truly is.
Every month, the three PRS Journal Club articles can be identified by an icon next to the article in that issue of Plastic & Reconstructive Surgery (http://journals.lww.com/plasreconsurg/Pages/currenttoc.aspx) or through links at the PRS Residents’ Gateway (http://journals.lww.com/plasreconsurg/Pages/Residents-Gateway.aspx). The PRS Resident Ambassadors, Rajendra Sawh-Martinez (@DocRFSM), Amanda Silva (@AmandaKSilvaMD), and Sammy Sinno (@sammysinnoMD), also discuss all three articles in a podcast, moderated this month by Dr. Charles Thorne, which is available online.
The first PRS Journal Club article is “Comparative Outcomes of Primary Gingivoperiosteoplasty and Secondary Alveolar Bone Grafting in Patients with Unilateral Cleft Lip and Palate” by Dr. Wang et al. Using cone-beam CT scans, the authors find that secondary alveolar bone grafting is superior with less residual cleft and palatal defects and more bone when compared to primary gingivoperiosteoplasty. A theme in all three PRSJournalClub articles, this is an excellent article providing high quality evidence that can effect true changes in practice. The podcast for this article can be found at https://www.youtube.com/watch?v=wcI1udC40ys.
The next PRS Journal Club article is “A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects: Identification of Risk Factors for Complications” by Dr. Bekara et al. This article’s authors found that most propeller flaps were used for traumatic defects in the lower third of the leg while age, diabetes, and arteriopathy emerged as risk factors for flap complications (found in ~25% of patients). More surprisingly, smoking status and arc of rotation greater than 120 degrees, among other factors, were not risk factors for complications. With this large meta-analysis of >400 propeller flaps, the authors succeed in establishing baseline practice recommendations for propeller flap reconstruction of lower extremity defects. The podcast featuring a discussion of this article is also available (https://www.youtube.com/watch?v=gXYdutCOZ0M).
As will be done each month, one of the three PRS Journal Club articles was chosen for a 72-hour interactive Twitter discussion with the authors. The inaugural article selected to spark this worldwide discourse was “Alar Contour Grafts in Rhinoplasty: A Safe and Reproducible Way to Refine Alar Contour Aesthetics” by Dr. Unger et al. Alar rim deformities present a unique challenge in rhinoplasty. In this article, the authors describe their propensity of utilizing alar contour grafts (ACGs) in nearly all primary rhinoplasty patients and compare outcomes in patients with and without ACGs. In using these grafts, patients’ aesthetic parameters improved significantly while they actually worsened in the control group without ACGs. Further, as noted by Dr. Thorne in the PRS Journal Club Podcast (https://www.youtube.com/watch?v=cYf49ZOefas), there is very little downside in utilizing ACGs. Impressive results aside, perhaps the most exciting aspect of this article’s discussion was the ability to directly interact via Twitter with the article’s authors. As mentioned before, the strength of an article is its ability to effect change through high quality evidence. In a straw poll of ASPS members (@ASPSMembers) on Twitter, only 16% of participants indicated that they routinely use ACGs in their practice before the Journal Club. So, as asked by Rajendra Sawh-Martinez, could the first PRS Journal Club actually change practice habits? We say yes!