Critical Appraisal in Plastic Surgery: Nullius in Verba

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At conferences, many new techniques are introduced to many audience members, often including myself. Sometimes a new technique with dramatic postoperative results may be especially intriguing. The presenter says that all the patients were satisfied and that no complications occurred. In such cases, we are prone to incorporate at least a part of the method into our routines, or even to change our previous operative method. Of course, the famous surgeon giving the presentation has already published his methods in a journal article or a book chapter. Some surgeons develop new surgical nomenclature or propose names for a purportedly new anatomical structure because they think that they were the first to innovate the technique or to find the anatomical structure.
Several years later, a modified technique can be introduced by the same surgeon. At this time, the presenter insists that the new modified method obtained better results. He publishes again, this time with modified methods. Usually he does not mention why he modified the previous method or express regret for the shortcomings of the previous method. He may introduce a new name for a structure similar to one that he previously named.
Since the famous surgeon says that this new method is better or even best, we are put in the position of having to follow this “virtuoso,” without knowing whether he will change the method once more. We have to use the new terminology as an indicator of being up to date. If we do not use the new term for a method or anatomical structure, we seem out of date and lose the ability to communicate each other.
With the ever-increasing quantity of medical literature, it is impossible for plastic surgeons to read every article, even in their subspecialties. Thus, the critical appraisal of scientific papers is an important skill for plastic surgeons to master. We must start from a position of skepticism because it is the true starting point of science.1
It is difficult to distinguish papers written just to meet publication requirements from true gems, and we should have our eyes wide open to distinguish trustworthy papers from theses published for their own sake.
If all the patients are satisfied and no complications occurred, the follow-up period should be checked. If new surgical nomenclature or a name for a purportedly new anatomical structure appears in a paper, we must review previous techniques or go back to the anatomy textbook we used in medical school. Papers that do not cite previous papers on similar topics and insist on their originality should be disregarded. If a paper provokes a letter to the editor, and the authors do not respond to this letter, it can be concluded that the authors are attempting to avoid criticism.2,3
We should not be “conclusion-of-the-abstract readers.” In a systematic review containing a meta-analysis, the data are contained in the few articles that are included in the meta-analysis. Such “evidence-based medicine” is intrinsically dependent on both the direction of the available research and the selection criteria used.1 Thereafter, when reading a review article, we should consult the guidelines presented in PRISMA (Preferred Statement for Meta-Analytical Studies and Systematic Reviews: or CONSORT (Consolidated Standard for Reporting Trial 2010 for Randomised Trials:
Nullius in verba (don’t take anyone's word for it) was the motto adopted by the Royal Society of London for Improving Natural Knowledge in 1660 (Fig. 1). I strongly suggest that this motto should also be applied in the field of plastic surgery.
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