EDITORIAL So, You Want to Improve Your Plastic Surgery Papers? Introducing PRS’ Friendly EQUATOR Reporting Guidelines Rod J. Rohrich, M.D. Aaron Weinstein, M.S. Dallas, Texas
I get by with a little help from my friends. —John Lennon, Paul McCartney
B
y now, I think all of us involved in biomedical publishing have heard of the EQUATOR network (Enhancing the QUAlity and Transparency Of health Research), the provider of universal access to endorsed reporting guidelines. Reporting guidelines are: • Documents that help authors to report research methods and findings. • Usually presented as checklists or flow charts. • A fail-safe that studies contain required elements. • Created to lay out the “core reporting criteria required to give a clear account of a study’s methods and results.”1
FRIENDS FOR AUTHORS, REVIEWERS, AND EDITORS These checklists, based on type of research and article, allow authors and reviewers to readily assess the quality of the study and identify any missing information. As academics, perfectionists, and published authors, I think we all understand the clarion call for more quality checks and support the mission of the EQUATOR network, to “improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines.”2 The group is, by From the Plastic and Reconstructive Surgery Editorial Office. Received for publication March 6, 2015; accepted March 9, 2015. Copyright © 2015 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000001393
most accounts, the first major, coordinated, global effort to “tackle the problems of inadequate reporting systematically.”2 That is something anyone who has ever published or peer-reviewed a paper can surely embrace as a worthwhile cause. If the connection to the larger academic publishing community doesn’t prove to make a case for the network, our connection as potential patients should do the trick: Even if we are not involved in the research as participants we are all its potential consumers. As patients, we want to be treated according to the best evidence from well-designed and well-conducted research. However, in order to identify the “best” evidence, research studies need to be published in an accurate, complete and timely way.3
As busy plastic surgeons, though, I know the feeling of being one more pile of paperwork away from needing a serious vacation. Another set of checklists—no matter how honorable the intentions—seems like extra work in an already overloaded day. But, as we at Plastic and Reconstructive Surgery (PRS) venture into implementing many of these EQUATOR protocols into the authoring and reviewing process, I do not Disclosure: Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Quality Medical Publishing and Taylor and Francis Publishing. Mr. Weinstein has no financial interest to declare. No funding was received for this Editorial. Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).
www.PRSJournal.com
205
Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Plastic and Reconstructive Surgery • July 2015 want you to think of the EQUATOR checklists as paperwork: “Reporting guidelines should not be seen as an administrative burden; rather they are a template by which authors can construct their articles more completely.”1 I want you to think of them as friends. And, as per the Beatles lyric above, we all get by with a little help from our friends. Many have written similar sentiments about these guidelines helping many stakeholders: “Following the reporting guidelines helps in preparing high quality research papers, facilitates peer review, and increases the chances of paper acceptance by a suitable journal.”3 A 2012 study found that of 116 health research journals, only 35 percent provided any online instructions to their peer reviewers.4 Although PRS has long had a list of “tips” for reviewer instructions on our peer-review Web site and recently publicly published a reviewer handbook, we want to do even more to help our reviewers. The study showed that even instructions, tips, and handbooks on reviewer protocols could be insufficient on how to grade the manuscript content. The authors write, “Journals have a responsibility to support peer reviewers.”4 We wholeheartedly agree. To help authors write better evidence-based research, and to help reviewers more systematically and easily review the content of the papers, the Editorial Board of PRS and I officially endorse and announce our adoption and implementation of EQUATOR reporting guidelines to both the authorship and peer-review process. Until further notice, submitting these checklists is purely optional for authors and reviewers, but it is highly recommended.
WHICH LISTS? There are a wide variety of checklists for a staggering array of article types. Consult the EQUATOR network (www.equator-network.org) to learn more, and access a user-friendly, constantly updated list of guidelines. Many of these checklists do not apply to the type of work that plastic surgeons typically conduct and publish. For these reasons, we are recommending the following four checklists as our go-to reporting guidelines: • For randomized controlled trials, we officially endorse and will use the CONSORT (Consolidated Standards of Reporting Trials) guidelines. (See Document, Supplemental
Digital Content 1, which shows the CONSORT checklist, http://links.lww.com/ PRS/B340.) • For systematic reviews and meta-analyses, we endorse the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) statement. (See Document, Supplemental Digital Content 2, which shows the PRISMA checklist, http://links. lww.com/PRS/B341.) • For strengthening observational studies (including cohort studies, case-control studies, cross-sectional studies, and others), we will use the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklists. (See Document, Supplemental Digital Content 3, which shows the STROBE checklist, http://links. lww.com/PRS/B342.) • For basic statistical reporting, we adopt the SAMPL (Statistical Analyses and Methods in the Published Literature) Guidelines. (See Document, Supplemental Digital Content 4, which shows the SAMPL checklist, http://links.lww.com/PRS/B343.) There are other checklists that you may wish to use, and should feel free to use if applicable to your study: • STARD (STAndards for the Reporting of Diagnostic accuracy studies) for diagnostic accuracy studies. • MOOSE (Meta-analysis Of Observational Studies in Epidemiology) for meta-analyses of observational studies. • SQUIRE (Standards for Quality Improvement Reporting Excellence) for quality improvement reports. • COREQ (Consolidated Criteria for Reporting Qualitative Research) for qualitative research. • CARE (CAse REport) guidelines for case series and case reports. That said, the aforementioned four guidelines (Table 1),5–8 will likely be the most useful for submissions to PRS, and are the items that our Editorial Board members and reviewers will be most familiar with at the early onset of this new protocol.
IMPLEMENTING EQUATOR The EQUATOR network is “helping authors, editors and peer reviewers to improve the clarity
206 Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Volume 136, Number 1 • Editorial Table 1. The Main EQUATOR Reporting Guidelines Adopted by PRS as of July of 2015 Study Type Randomized controlled trials Systematic reviews, meta-analyses Cohort studies, casecontrol studies, cross-sectional studies Statistical reporting: methods and analyses
PRS-Adopted Guideline CONSORT* PRISMA† STROBE‡
SAMPL§
Latest Version
Full Name Consolidated Standards of Reporting Trials Preferred Reporting Items for Systematic Reviews and Meta-Analyses Strengthening the Reporting of Observational Studies in Epidemiology
2010
Statistical Analyses and Methods in the Published Literature
2013
2009 2007
Web Site
Resources Available
http://www.consortstatement.org http://www.prismastatement.org
• Checklist • Flow diagram • Checklist • Flow diagram
http://www.strobestatement.org
• Checklist
—
• Guidelines • PRS-customized checklist
*From Equator Network. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomized trials. Available at: http:// www.equator-network.org/reporting-guidelines/consort/. Accessed February 26, 2015. †From Equator Network. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRSIMA Statement. Available at: http:// www.equator-network.org/reporting-guidelines/prisma/. Accessed February 26, 2015. ‡From Equator Network. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Available at: http://www.equator-network.org/reporting-guidelines/strobe/. Accessed February 26, 2015. §From Equator Network. Basic Statistical Reporting for Articles Published in Biomedical Journals: The “Statistical Analyses and Methods in the Published Literature” or the “SAMPL Guidelines.” Available at: http://www.equator-network.org/reporting-guidelines/sampl/. Accessed February 26, 2015.
and completeness of research reports”9; we want to help authors and reviewers as well. In the end, the Journal and plastic surgery literature at large would be the main beneficiary, through improved content and research. As of the publication of this article, you will have already noticed additional steps engrained in the PRS article submission and review process by means of Editorial Manager. At the submission stage, you will note a new required step: we will ask that you identify your manuscript as being an article type that either does or does not have an associated endorsed reporting guideline. When you get to the “attach files” portion of the submission-building process, you will find an optional item called “Reporting Guideline Checklist”; you can upload the appropriate checklist to your manuscript at that point. At this introductory stage, we will not be requiring that you then submit that checklist. It is strictly optional at this point; that said, I do not believe it is too bold to state that our peer reviewers would find the inclusion of such a checklist favorable and helpful when conducting a peer review. Peer reviewers will have access to the checklists filled out by the authors if provided. Independent of the author’s submission of a reporting guideline, reviewers will have the opportunity to download a “blank” checklist to aid in their review and upload as a supporting document to their peer review, if they so choose. All PRS-endorsed checklists will be provided under “Files and Resources” on the home page of
our Editorial Manager Web site: www.editorialmanager.com/prs. They are also included as Supplemental Digital Content within this Editorial.
CONCLUSIONS In recent years, there have been public calls for improving reporting standards of statistical analyses and more in plastic surgery.10 We at PRS have always striven to publish the best, evidencebased plastic surgery literature possible. By adopting these four reporting guidelines by means of the EQUATOR network, and allowing them to help our authors and reviewers be better critical appraisers of the merits of each applicable study, we believe that we will all be better suited to be grading our work on the same page. If other journals were to adopt these checklists, we could uniformly appraise the literature in our field as part of study design, peer review, and revision. It will take some effort—by each author, by each reviewer, by each editorial board member—to adopt and implement these guidelines. However, if we rely on our peers as our friends, and allow these checklists the opportunity we would afford to a friend to simply help us make studies better, we truly will be able to “try with a little help from [our] friends” and get better “with a little help from [our] friends.” Rod J. Rohrich, M.D. Plastic and Reconstructive Surgery Editorial Office Brookriver Executive Center 8150 Brookriver Drive, Suite S-415 Dallas, Texas 75247
207 Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Plastic and Reconstructive Surgery • July 2015 REFERENCES 1. Chan L, Heinemann AW, Roberts J. Elevating the quality of disability and rehabilitation research: Mandatory use of the reporting guidelines. Arch Phys Med Rehabil. 2014;95:415–417. 2. Equator Network. About us. Available at: http://www.equator-network.org/about-us/. Accessed February 3, 2015. 3. Simera I, Altman, DG. Reporting medical research. Int J Clin Pract. 2013;67:710–716. 4. Hirst A, Altman DG. Are peer reviewers encouraged to use reporting guidelines? A survey of 116 health research journals. PLoS One 2012;7:e35621. 5. Equator Network. CONSORT2010 Statement: Updated guidelines for reporting parallel group randomized trials. Available at: http://www.equator-network.org/reportingguidelines/consort/. Accessed February 26, 2015. 6. Equator Network. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRSIMA Statement. Available at: http://www.equator-network.org/reportingguidelines/prisma/. Accessed February 26, 2015.
7. Equator Network. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Available at: http://www.equator-network.org/reportingguidelines/strobe/. Accessed February 26, 2015. 8. Equator Network. Basic Statistical Reporting for Articles Published in Biomedical Journals: The “Statistical Analyses and Methods in the Published Literature” or the “SAMPL Guidelines.” Available at: http://www.equator-network.org/ reporting-guidelines/sampl/. Accessed February 26, 2015. 9. Simera I, Hirst A, Moher D. EQUATOR Network: Enhancing the QUAlity and Transparency of health Research. Presented at Cochrane Collaboration UK and Ireland Contributors Meeting, Cardiff, March 2010. Available at: http://www. equator-network.org/wp-content/uploads/2013/09/3529_ EQUATOR+poster+March2010.pdf. Accessed February 26, 2015. 10. Freshwater MF. A plea to improve statistical analyses and methods in plastic surgery. J Plast Reconstr Aesthet Surg. 2013;66:1447–1448.
208 Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
I get by with a little help from my friends. —John Lennon, Paul McCartney
B
y now, I think all of us involved in biomedical publishing have heard of the EQUATOR network (Enhancing the QUAlity and Transparency Of health Research), the provider of universal access to endorsed reporting guidelines. Reporting guidelines are: • Documents that help authors to report research methods and findings. • Usually presented as checklists or flow charts. • A fail-safe that studies contain required elements. • Created to lay out the “core reporting criteria required to give a clear account of a study’s methods and results.”1
FRIENDS FOR AUTHORS, REVIEWERS, AND EDITORS These checklists, based on type of research and article, allow authors and reviewers to readily assess the quality of the study and identify any missing information. As academics, perfectionists, and published authors, I think we all understand the clarion call for more quality checks and support the mission of the EQUATOR network, to “improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines.”2 The group is, by From the Plastic and Reconstructive Surgery Editorial Office. Received for publication March 6, 2015; accepted March 9, 2015. Copyright © 2015 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000001393
most accounts, the first major, coordinated, global effort to “tackle the problems of inadequate reporting systematically.”2 That is something anyone who has ever published or peer-reviewed a paper can surely embrace as a worthwhile cause. If the connection to the larger academic publishing community doesn’t prove to make a case for the network, our connection as potential patients should do the trick: Even if we are not involved in the research as participants we are all its potential consumers. As patients, we want to be treated according to the best evidence from well-designed and well-conducted research. However, in order to identify the “best” evidence, research studies need to be published in an accurate, complete and timely way.3
As busy plastic surgeons, though, I know the feeling of being one more pile of paperwork away from needing a serious vacation. Another set of checklists—no matter how honorable the intentions—seems like extra work in an already overloaded day. But, as we at Plastic and Reconstructive Surgery (PRS) venture into implementing many of these EQUATOR protocols into the authoring and reviewing process, I do not Disclosure: Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Quality Medical Publishing and Taylor and Francis Publishing. Mr. Weinstein has no financial interest to declare. No funding was received for this Editorial. Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).
www.PRSJournal.com
205
Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Plastic and Reconstructive Surgery • July 2015 want you to think of the EQUATOR checklists as paperwork: “Reporting guidelines should not be seen as an administrative burden; rather they are a template by which authors can construct their articles more completely.”1 I want you to think of them as friends. And, as per the Beatles lyric above, we all get by with a little help from our friends. Many have written similar sentiments about these guidelines helping many stakeholders: “Following the reporting guidelines helps in preparing high quality research papers, facilitates peer review, and increases the chances of paper acceptance by a suitable journal.”3 A 2012 study found that of 116 health research journals, only 35 percent provided any online instructions to their peer reviewers.4 Although PRS has long had a list of “tips” for reviewer instructions on our peer-review Web site and recently publicly published a reviewer handbook, we want to do even more to help our reviewers. The study showed that even instructions, tips, and handbooks on reviewer protocols could be insufficient on how to grade the manuscript content. The authors write, “Journals have a responsibility to support peer reviewers.”4 We wholeheartedly agree. To help authors write better evidence-based research, and to help reviewers more systematically and easily review the content of the papers, the Editorial Board of PRS and I officially endorse and announce our adoption and implementation of EQUATOR reporting guidelines to both the authorship and peer-review process. Until further notice, submitting these checklists is purely optional for authors and reviewers, but it is highly recommended.
WHICH LISTS? There are a wide variety of checklists for a staggering array of article types. Consult the EQUATOR network (www.equator-network.org) to learn more, and access a user-friendly, constantly updated list of guidelines. Many of these checklists do not apply to the type of work that plastic surgeons typically conduct and publish. For these reasons, we are recommending the following four checklists as our go-to reporting guidelines: • For randomized controlled trials, we officially endorse and will use the CONSORT (Consolidated Standards of Reporting Trials) guidelines. (See Document, Supplemental
Digital Content 1, which shows the CONSORT checklist, http://links.lww.com/ PRS/B340.) • For systematic reviews and meta-analyses, we endorse the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) statement. (See Document, Supplemental Digital Content 2, which shows the PRISMA checklist, http://links. lww.com/PRS/B341.) • For strengthening observational studies (including cohort studies, case-control studies, cross-sectional studies, and others), we will use the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklists. (See Document, Supplemental Digital Content 3, which shows the STROBE checklist, http://links. lww.com/PRS/B342.) • For basic statistical reporting, we adopt the SAMPL (Statistical Analyses and Methods in the Published Literature) Guidelines. (See Document, Supplemental Digital Content 4, which shows the SAMPL checklist, http://links.lww.com/PRS/B343.) There are other checklists that you may wish to use, and should feel free to use if applicable to your study: • STARD (STAndards for the Reporting of Diagnostic accuracy studies) for diagnostic accuracy studies. • MOOSE (Meta-analysis Of Observational Studies in Epidemiology) for meta-analyses of observational studies. • SQUIRE (Standards for Quality Improvement Reporting Excellence) for quality improvement reports. • COREQ (Consolidated Criteria for Reporting Qualitative Research) for qualitative research. • CARE (CAse REport) guidelines for case series and case reports. That said, the aforementioned four guidelines (Table 1),5–8 will likely be the most useful for submissions to PRS, and are the items that our Editorial Board members and reviewers will be most familiar with at the early onset of this new protocol.
IMPLEMENTING EQUATOR The EQUATOR network is “helping authors, editors and peer reviewers to improve the clarity
206 Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Volume 136, Number 1 • Editorial Table 1. The Main EQUATOR Reporting Guidelines Adopted by PRS as of July of 2015 Study Type Randomized controlled trials Systematic reviews, meta-analyses Cohort studies, casecontrol studies, cross-sectional studies Statistical reporting: methods and analyses
PRS-Adopted Guideline CONSORT* PRISMA† STROBE‡
SAMPL§
Latest Version
Full Name Consolidated Standards of Reporting Trials Preferred Reporting Items for Systematic Reviews and Meta-Analyses Strengthening the Reporting of Observational Studies in Epidemiology
2010
Statistical Analyses and Methods in the Published Literature
2013
2009 2007
Web Site
Resources Available
http://www.consortstatement.org http://www.prismastatement.org
• Checklist • Flow diagram • Checklist • Flow diagram
http://www.strobestatement.org
• Checklist
—
• Guidelines • PRS-customized checklist
*From Equator Network. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomized trials. Available at: http:// www.equator-network.org/reporting-guidelines/consort/. Accessed February 26, 2015. †From Equator Network. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRSIMA Statement. Available at: http:// www.equator-network.org/reporting-guidelines/prisma/. Accessed February 26, 2015. ‡From Equator Network. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Available at: http://www.equator-network.org/reporting-guidelines/strobe/. Accessed February 26, 2015. §From Equator Network. Basic Statistical Reporting for Articles Published in Biomedical Journals: The “Statistical Analyses and Methods in the Published Literature” or the “SAMPL Guidelines.” Available at: http://www.equator-network.org/reporting-guidelines/sampl/. Accessed February 26, 2015.
and completeness of research reports”9; we want to help authors and reviewers as well. In the end, the Journal and plastic surgery literature at large would be the main beneficiary, through improved content and research. As of the publication of this article, you will have already noticed additional steps engrained in the PRS article submission and review process by means of Editorial Manager. At the submission stage, you will note a new required step: we will ask that you identify your manuscript as being an article type that either does or does not have an associated endorsed reporting guideline. When you get to the “attach files” portion of the submission-building process, you will find an optional item called “Reporting Guideline Checklist”; you can upload the appropriate checklist to your manuscript at that point. At this introductory stage, we will not be requiring that you then submit that checklist. It is strictly optional at this point; that said, I do not believe it is too bold to state that our peer reviewers would find the inclusion of such a checklist favorable and helpful when conducting a peer review. Peer reviewers will have access to the checklists filled out by the authors if provided. Independent of the author’s submission of a reporting guideline, reviewers will have the opportunity to download a “blank” checklist to aid in their review and upload as a supporting document to their peer review, if they so choose. All PRS-endorsed checklists will be provided under “Files and Resources” on the home page of
our Editorial Manager Web site: www.editorialmanager.com/prs. They are also included as Supplemental Digital Content within this Editorial.
CONCLUSIONS In recent years, there have been public calls for improving reporting standards of statistical analyses and more in plastic surgery.10 We at PRS have always striven to publish the best, evidencebased plastic surgery literature possible. By adopting these four reporting guidelines by means of the EQUATOR network, and allowing them to help our authors and reviewers be better critical appraisers of the merits of each applicable study, we believe that we will all be better suited to be grading our work on the same page. If other journals were to adopt these checklists, we could uniformly appraise the literature in our field as part of study design, peer review, and revision. It will take some effort—by each author, by each reviewer, by each editorial board member—to adopt and implement these guidelines. However, if we rely on our peers as our friends, and allow these checklists the opportunity we would afford to a friend to simply help us make studies better, we truly will be able to “try with a little help from [our] friends” and get better “with a little help from [our] friends.” Rod J. Rohrich, M.D. Plastic and Reconstructive Surgery Editorial Office Brookriver Executive Center 8150 Brookriver Drive, Suite S-415 Dallas, Texas 75247
207 Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Plastic and Reconstructive Surgery • July 2015 REFERENCES 1. Chan L, Heinemann AW, Roberts J. Elevating the quality of disability and rehabilitation research: Mandatory use of the reporting guidelines. Arch Phys Med Rehabil. 2014;95:415–417. 2. Equator Network. About us. Available at: http://www.equator-network.org/about-us/. Accessed February 3, 2015. 3. Simera I, Altman, DG. Reporting medical research. Int J Clin Pract. 2013;67:710–716. 4. Hirst A, Altman DG. Are peer reviewers encouraged to use reporting guidelines? A survey of 116 health research journals. PLoS One 2012;7:e35621. 5. Equator Network. CONSORT2010 Statement: Updated guidelines for reporting parallel group randomized trials. Available at: http://www.equator-network.org/reportingguidelines/consort/. Accessed February 26, 2015. 6. Equator Network. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRSIMA Statement. Available at: http://www.equator-network.org/reportingguidelines/prisma/. Accessed February 26, 2015.
7. Equator Network. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Available at: http://www.equator-network.org/reportingguidelines/strobe/. Accessed February 26, 2015. 8. Equator Network. Basic Statistical Reporting for Articles Published in Biomedical Journals: The “Statistical Analyses and Methods in the Published Literature” or the “SAMPL Guidelines.” Available at: http://www.equator-network.org/ reporting-guidelines/sampl/. Accessed February 26, 2015. 9. Simera I, Hirst A, Moher D. EQUATOR Network: Enhancing the QUAlity and Transparency of health Research. Presented at Cochrane Collaboration UK and Ireland Contributors Meeting, Cardiff, March 2010. Available at: http://www. equator-network.org/wp-content/uploads/2013/09/3529_ EQUATOR+poster+March2010.pdf. Accessed February 26, 2015. 10. Freshwater MF. A plea to improve statistical analyses and methods in plastic surgery. J Plast Reconstr Aesthet Surg. 2013;66:1447–1448.
208 Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
