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Background Large language models (LLMs), such as ChatGPT-4 and Gemini, represent a new frontier in surgical education by offering dynamic, interactive learning experiences. Despite their potential, concerns about the accuracy, depth of knowledge, and bias in LLM responses persist. This study evaluates the effectiveness of LLMs in aiding surgical trainees in plastic and reconstructive surgery through comparison with traditional case-preparation textbooks. Methods Six representative cases from key areas of plastic and reconstructive surgery—craniofacial, hand, microsurgery, burn, gender-affirming, and aesthetics—were selected. Four types of questions were developed for each case to cover clinical anatomy, indications, contraindications, and complications. Responses from LLMs (ChatGPT-4 and Gemini) and textbooks were compared using surveys distributed to medical students, research fellows, residents, and attending surgeons. Reviewers rated each response on accuracy, thoroughness, usefulness for case preparation, brevity, and overall quality using a 5-point Likert scale. Statistical analyses, including ANOVA and unpaired T-tests, were conducted to assess the differences between LLM and textbook responses. Results A total of 90 surveys were completed. LLM responses were rated as more thorough ( p  < 0.001) but less concise ( p  < 0.001) than textbook responses. Textbooks were rated superior for answering questions on contraindications ( p  = 0.027) and complications ( p  = 0.014). ChatGPT was perceived as more accurate ( p  = 0.018), thorough ( p  = 0.002), and useful ( p  = 0.026) than Gemini. Gemini was rated lower in quality ( p  = 0.30) compared to ChatGPT along with being inferior to textbook answers for burn-related questions ( p  = 0.017) and anatomical questions ( p  = 0.013). Conclusion While LLMs show promise in generating thorough educational content, they require improvement in conciseness, accuracy, and utility for practical case preparation. ChatGPT generally outperforms Gemini, indicating variability in LLM capabilities. Further development should focus on enhancing accuracy and consistency to establish LLMs as reliable tools in medical education and practice.

Incorporating infection prevention and control (IPC) is crucial for strengthening global surgery, particularly in low- and middle-income countries (LMICs). This review article highlights the critical role IPC plays in ensuring equitable and sustainable surgical care, aligning with the Sustainable Development Goals (SDG) 3 and 10, which aim to promote health and reduce inequalities. Surgical site infections (SSIs) and other healthcare-associated infections (HAIs) disproportionately affect LMICs, where IPC infrastructure is often underdeveloped. Without robust IPC measures, surgeries in these regions can result in higher morbidity, mortality, and healthcare costs, exacerbating disparities in healthcare access and outcomes. Despite global efforts, such as the World Health Organization (WHO) Guidelines on the Prevention of Surgical Site Infections, IPC integration in surgical practices remains inconsistent, particularly in resource-constrained settings. More widespread adoption and implementation are necessary. By embedding IPC within global surgery frameworks, health systems can improve surgical outcomes, reduce costs, and enhance the resilience of healthcare systems. Effective IPC reduces extended hospital stays, limits the spread of antimicrobial resistance, and increases trust in surgical services. Moreover, the cost savings from preventing SSIs are substantial, benefiting both healthcare systems and patients by reducing the need for prolonged care and antibiotic treatments. This review article calls for greater integration of IPC measures in global surgery initiatives to ensure that surgical interventions are both life-saving and equitable. Strengthening IPC is not optional but essential for achieving the broader goals of universal health coverage and improving public health outcomes globally.

Background Instagram (Menlo Park, CA) has become a popular means of advertisement for aesthetic surgery procedures, influencing patients’ likelihood of undergoing a procedure. In this study, the authors aim to explore public interest in aesthetic procedures before and after the Instagram platform started gaining in popularity through Google Trends (Google, Mountain View, CA), a platform with previously demonstrated utility for tracking interest in surgical procedures. Objectives The authors hypothesize that as a result of increased medical marketing on Instagram, there is an increase in public interest in elective procedures of plastic surgery. Methods Trends in the United States for given search terms and volumes were gathered through Google Trends between April 2004 and January 2022. Search terms included popular aesthetic procedures based on the 2020 Aesthetic Plastic Surgery National Data Bank Statistics. The search volumes were normalized, and a bivariate regression analysis of panel data was then applied to the aggregate trendlines to determine whether a statistically significant change in search volume occurred following the increase in user traffic of the Instagram platform. Results The authors found significant variations in search volume for plastic surgery procedures before and after April 2012. Blepharoplasty, Botox, brachioplasty, breast implant removal, breast reduction, brow lift, butt lift, hair transplantation, lip augmentation, male breast surgery, mastopexy, mentoplasty, otoplasty, platysmaplasty, rhinoplasty, and thighplasty (P < .000) had statistically significant increases in search volume, whereas buccal fat removal (P = .003) had a statistically significant decrease in search volume after April 2012. Conclusions The authors observed a significant increase in public interest in both surgical and nonsurgical aesthetic procedures after Instagram gained popularity in the April of 2012.

Lipedema is a pathologic accumulation of adipose tissue in the subcutaneous layer of the extremities. This connective tissue disorder, which predominately affects females, is often misdiagnosed despite an incidence of ∼11%. Misdiagnosis often leads to delays in appropriate treatment, further increasing the morbidity of the condition. The authors report their facilities' experience in treating a patient with lipedema, requiring multiple surgical interventions involving liposuction and skin debulking to achieve desired aesthetic outcomes. The patient presented to the plastic surgery clinic with severe lipedema of the bilateral lower extremities. She previously underwent a panniculectomy and bilateral lower extremity liposuction without achieving the desired aesthetic results. Prior conservative management and liposuction alone were both unsuccessful treatment options and she required debulking procedures, along with further liposuction, as definitive management. The patient underwent 2 procedures at the clinic, both consisting of liposuction and panniculectomy of the lower extremities and buttocks. The procedures were conducted 1 year apart but were able to achieve the patient's desired aesthetics goals. Management of lipedema can be challenging, but not impossible. This case report shows that local excision is a viable option for treatment if minimally invasive options yield limited results. Level of Evidence: 5

Background Patients routinely use social media to locate providers, review before-and-after photographs, and discuss experiences, making it a powerful marketing tool for plastic surgeons. A few studies have systematically evaluated plastic surgery app content. Objectives This study aims to analyze engagement levels and content posted by top plastic surgeon influencers on Instagram (Menlo Park, CA). Methods The authors conducted a cross-sectional study in February 2022 to identify the top 10 global plastic surgeons on Instagram. Influencers were ranked based on the number of followers, and their latest 20 posts were analyzed. A total of 200 posts were categorized by 2 independent trainees as one of the following: marketing, education, personal, and miscellaneous. The number of likes was recorded as a proxy for engagement, and the average engagement for each category was calculated. Results The top 10 influencers work primarily in private practice focusing on aesthetic procedures. Out of 200 categorized posts on Instagram, marketing posts had the greatest presence (64.5%), followed by personal (20%), miscellaneous (11%), and educational (4.5%). More still images were posted (56.5%) than videos (43.5%). The highest average engagement was for personal content (P = .005). No significant differences in engagement levels were found between photo and video content (P = .24). Conclusions Although most content posted related to marketing efforts, many influencers were also using social media to post about their personal lives and promote their ancillary businesses. Although marketing content was the most common, engagement levels were the highest for personal and educational content, and no significant differences in engagement were found between videos and photos.

Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle. Together, the Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) have jointly completed an international declaration, highlighting the threat posed by antimicrobial resistance globally and the need for preventing and managing infections appropriately across the surgical pathway. The authors representing these surgical societies call all surgeons around the world to participate in this global cause by pledging support for this declaration for maintaining the effectiveness of current and future antibiotics.

Historically, global surgery has roots deeply entwined with imperialism and colonialism, as early medical missions limited regard for healthcare education or sustainable healthcare development within the LMIC setting. 2 This legacy created dependencies on external aid and prioritized foreign-led interventions over in-country driven solutions, shaping a global health landscape that, even today, is challenged by these remnants of inequitable power dynamics. 3 The TTT model is critical to addressing the needs in LMICs, where access to specialized surgical care remains limited and their continues to be heavy reliance on external surgical support. In addition to business development, SHARE contains a research track that helps to strengthen in-country research capacity, allowing surgeons in these LMIC settings to contribute high-quality surgical research to the global academic community. Importantly, it has been published that the SHARE program increases participants confidence and capabilities in performing microsurgical procedures. 6 SHARE is continuing to expand its subspecialty training with the goal of not only improving patient care, but establishing a sustainable model for future learning and in-country mentorship in these subspecialities as trained surgeons become capable of teaching the next generation on these subspecialty technical skills. Through the SHARE program, I have built long-lasting relationships with other international leaders. Because of this program, I now remain connected to this community from around the world and can help usher new Sub-Saharan African surgeons into this important surgical space.”

While a full analysis of LGBTQIA + patient outcomes is beyond this paper's scope, the ability of surgeons to build rapport with marginalized patients is directly influenced by the environments in which they are trained. Representation plays a critical role in improving both training environments and patient care. Racial and ethnic diversity among surgeons has been shown to improve trust, communication, and health outcomes, particularly in underserved populations. 6 , 7 These benefits are equally applicable to LGBTQIA + representation. 8 LGBTQIA + surgeons serve as role models, mentors, and advocates who challenge harmful stereotypes and foster inclusion.

[...]the disease burden in LMICs often includes conditions like infectious diseases or malnutrition, which are less prevalent in HICs but require tailored approaches. [...]much of the published policy that informs healthcare practices in LMICs is based on data from HICs, limiting policy applicability within the LMIC setting. 2 Many international surgical guidelines and recommendations are heavily based on data from the HICs, which can lead to misapplication in LMICs. [...]the quality of research in this setting suffers, with emphasis being placed on fulfilling the minimum requirements instead of producing rigorous, impactful work. [...]VIRDE enhances research capacity through an intensive training program that emphasizes study design, data analysis, and ethics.