Journal of Plastic, Reconstructive & Aesthetic Surgery (2014) 67, 157e158
INVITED COMMENTARY
Reply to: ‘The increased risk of adverse outcomes in bilateral deep inferior epigastric artery perforator flap breast reconstruction compared to unilateral reconstruction’ M. Felix Freshwater Voluntary Professor of Surgery, University of Miami School of Medicine, 9155 S Dadeland Blvd., Suite 1404, Miami, FL 33156-2739, USA Received 28 October 2013; accepted 2 December 2013
Even if you have no interest in breast reconstruction, you should study this paper if you have the slightest interest in evidence-based medicine and plastic surgery.1 There are several major points worth noting and worth applying to future systematic reviews and metaanalyses: 1. The authors eloquently established their reason for expressing the prevalence of adverse events per patient rather than per flap. This is important if our goal is to have informed pre-operative discussions with our patients. Simply put, flaps do not sue; patients do. For that reason, the more information that can be conveyed to the patient pre-operatively, the better. 2. The authors honestly admitted that their findings could be explained by selection bias and more importantly that their findings might be statistically significant, but clinically unimportant.
3. The authors demonstrated how to diligently navigate the morass of low quality studies. Although 43 published studies met the authors’ inclusion criteria, only 14 studies had complete data. Rather than being satisfied with the published data, the authors, in their quest to glean further data, pursued the investigators of the remaining 29 studies. Sadly, only three investigators provided their missing data, while 10 of 29 investigators claimed that any further data was unavailable. 4. Three authors completed this scholarly work. The entire Cherryfield Chowder and Marching Society is not required to perform a thorough systematic review and meta-analysis.2 What is required are few individuals who have no preconceived notions and who are willing to follow the PRISMA guidelines and Cochrane Handbook methodology.3,4
Funding and competing interests E-mail addresses: [email protected], mff@ miamihand.us.
None.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.12.007
158
References 1. Wormald JCR, Wade RG, Figus A. The increased risk of adverse outcomes in bilateral deep inferior epigastric artery perforator flap breast reconstruction compared to unilateral reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2013. http://dx.doi.org/10.1016/j.bjps.2013.10.024.
M.F. Freshwater 2. http://www.wordwizard.com/phpbb3/viewtopic.php?fZ5&tZ 4498 [accessed 21.10.13]. 3. http://www.prisma-statement.org/statement.htm [accessed 21.10.13]. 4. http://handbook.cochrane.org/ [accessed 21.10.13].
INVITED COMMENTARY
Reply to: ‘The increased risk of adverse outcomes in bilateral deep inferior epigastric artery perforator flap breast reconstruction compared to unilateral reconstruction’ M. Felix Freshwater Voluntary Professor of Surgery, University of Miami School of Medicine, 9155 S Dadeland Blvd., Suite 1404, Miami, FL 33156-2739, USA Received 28 October 2013; accepted 2 December 2013
Even if you have no interest in breast reconstruction, you should study this paper if you have the slightest interest in evidence-based medicine and plastic surgery.1 There are several major points worth noting and worth applying to future systematic reviews and metaanalyses: 1. The authors eloquently established their reason for expressing the prevalence of adverse events per patient rather than per flap. This is important if our goal is to have informed pre-operative discussions with our patients. Simply put, flaps do not sue; patients do. For that reason, the more information that can be conveyed to the patient pre-operatively, the better. 2. The authors honestly admitted that their findings could be explained by selection bias and more importantly that their findings might be statistically significant, but clinically unimportant.
3. The authors demonstrated how to diligently navigate the morass of low quality studies. Although 43 published studies met the authors’ inclusion criteria, only 14 studies had complete data. Rather than being satisfied with the published data, the authors, in their quest to glean further data, pursued the investigators of the remaining 29 studies. Sadly, only three investigators provided their missing data, while 10 of 29 investigators claimed that any further data was unavailable. 4. Three authors completed this scholarly work. The entire Cherryfield Chowder and Marching Society is not required to perform a thorough systematic review and meta-analysis.2 What is required are few individuals who have no preconceived notions and who are willing to follow the PRISMA guidelines and Cochrane Handbook methodology.3,4
Funding and competing interests E-mail addresses: [email protected], mff@ miamihand.us.
None.
1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.12.007
158
References 1. Wormald JCR, Wade RG, Figus A. The increased risk of adverse outcomes in bilateral deep inferior epigastric artery perforator flap breast reconstruction compared to unilateral reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2013. http://dx.doi.org/10.1016/j.bjps.2013.10.024.
M.F. Freshwater 2. http://www.wordwizard.com/phpbb3/viewtopic.php?fZ5&tZ 4498 [accessed 21.10.13]. 3. http://www.prisma-statement.org/statement.htm [accessed 21.10.13]. 4. http://handbook.cochrane.org/ [accessed 21.10.13].
