Plastic Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped plastic surgery practice.

Breast Reconstruction Timing

Immediate becomes the standard

Delayed only → immediate evidence → skin/nipple-sparing → prepectoral → direct-to-implant

From discarded to therapeutic

Discarded → Coleman technique → structural fat grafting → oncological safety → stem cell debates

Beyond the Parkland formula

Parkland (1968) → fluid creep → modified Parkland → goal-directed → colloid adjuncts

Vacuum-assisted healing

Open wound → VAC (1997) → incisional NPWT → RCTs by wound type → cost-effectiveness

Physiological surgical options

Conservative only → LVA → VLNT → combined → supermicrosurgery