The 100 Most-disruptive Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014) (2024)

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The 100 Most-disruptive Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014) (1)

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Plast Reconstr Surg Glob Open. 2021 Mar; 9(3): e3446.

Published online 2021 Mar 26. doi:10.1097/GOX.0000000000003446

PMCID: PMC7997101

PMID: 33786257

Marek A. Hansdorfer, MD,* Sydney R. Horen, BA,* Brandon E. Alba, MD,* Jennifer N. Akin, , BA,* Amir H. Dorafshar, MD,The 100 Most-disruptive Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014) (2)* and Adan Z. Becerra, PhDThe 100 Most-disruptive Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014) (3)

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Alternative bibliometrics have recently been the subject of significantly increased interest. The disruption index is a new bibliometric that was recently applied to surgery and urology and identifies papers that shift paradigms and eclipse previous research in a given field.


The 100 most-disruptive publications in the 14 most prominent plastic and reconstructive surgery and subspecialty journals were identified.


We present the 100 most-disruptive studies as well as the 100 most-cited studies for comparison in n=14 of the most popular plastic and reconstructive surgery (and subspecialty) journals between 1954 and 2014. The 100 most-disruptive publications in these journals were more disruptive than 99.8% of all PubMed papers. Plastic and Reconstructive Surgery (PRS) had the most papers in the top 100 (n=64) followed by British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery, n=15), and Journal of Oral and Maxillofacial Surgery (n=7). PRS had 9 of the top 10 papers. However, Clinics in Plastic Surgery had the highest average disruption score for all its published papers (0.0029). The correlation coefficient linking disruption scores and citation counts was 0.01 and 0.11, respectively. The most common decade represented in the top 100 was the 1980's (n=31) and the least common was the 2000's (n=9).


This is the first application of the disruption index to plastic and reconstructive surgery. The disruption score provides a unique ability to identify research that has shifted paradigms and driven the innovation that defines our specialty.


The field of plastic and reconstructive surgery has significantly evolved over the past several decades. The innovation that is part and parcel to the DNA of our specialty has driven constant progress in both clinical and basic science research. Research publications are an important aspect of academic productivity and can also influence professional accomplishments such as promotion, tenure, and respect of peers.1 Many different metrics have been utilized to quantify the impact of publications. Both historically and currently, the most commonly-utilized metric remains citation count.2,3 However, citation count has notable limitations and problems that prevent it from optimally identifying impactful work; for example, not all citations are positive and equal and it is a purely quantitative metric. In addition, older publications will inherently accumulate more citations over time than newer publications, skewing the true significance of citation count.

In response to the shortcomings of traditional measures of research impact, bibliometricians have developed new metrics to better capture the influence and impact of publications.4 One such metric is the “disruption index,” which seeks to measure the degree to which an article disrupts its field and induces a paradigm shift by “introducing something new that eclipses attention to previous work upon which it has built.”5,6 In other words, a disruptive article displaces the literature that it cited. Disruption scores range from −1 to +1, with positive scores (>0) corresponding to disruptive articles and negative (<0) corresponding to developmental articles (1.0 is a maximally disruptive article). Disruptive articles tend to change established principles, whereas developmental studies tend to build upon those existing principles.5,6

As the volume of research within the field of plastic surgery continues to explode, quantifying the impact of various publications is critical to identify shifting paradigms and prioritize research and funding. Previous studies have identified impactful publications in plastic surgery using metrics such as citation count7,8 or the Altmetric score recently seen in Plastic and Reconstructive Surgery.9,10 Although recently applied to both surgery11 and urology,12 no studies have applied the disruption score (DS) metric to the plastic and reconstructive (and subspecialty) literature. The purpose of this study was to identify the most-disruptive publications, compare the disruption metric to citation count, and to quantify the most-disruptive journals in plastic and reconstructive surgery.


A search of PubMed-indexed literature was performed in March 2020 to identify PubMed Identifiers (PMIDs) of all articles published in Plastic and Reconstructive Surgery (PRS), Annals of Plastic Surgery, British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery), Journal of Oral and Maxillofacial Surgery, Journal of Craniomaxillofacial Surgery, Journal of Craniofacial Surgery Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, Clinics in Plastic Surgery, Journal of Hand Surgery (American), Journal of Hand Surgery (European/British), Journal of Reconstructive Microsurgery, JAMA Facial Plastic Surgery, Aesthetic Surgery Journal, and Aesthetic Plastic Surgery. The PMIDs were then merged with a validated database of DSs ( for all articles indexed in PubMed published between 1954 and 2014.5

The DS for a focal article is the ratio of 2 numbers5 and is represented by the equation DS = (A−B)/(C+D). The numerator is the number of future publications that cited the focal article without also citing any of its references (A) minus the number of future publications that cited the focal article and at least one of its references (B). The denominator is the total number of times the focal article was cited (C) plus the number of future publications that cited at least one of the references of the focal article, but not the focal article itself (D).5 To illustrate the calculation of a figurative study’s DS, we present here a sample calculation. Assuming this study was later cited a total of 50 times, and that 40 of these citations did not also cite one of the citations of the index article but 10 studies did, the numerator would be 40−10 = 30. Assuming then that 30 future studies cited at least one of the references of the focal study but not the focal study itself, the denominator would be 50 + 30 = 80, resulting in a DS of 30/80 = 0.375.

After calculating the DS and identifying the most-disruptive articles, we then utilized the publicly available iCite tool ( developed by National Institute of Health to obtain the number of times each article was cited. We ranked the articles in order of DS and selected out the top 100 for inclusion in this study. We also ranked all articles published by the included journals in the time period studied by the number of citations and selected out the top 100. A kernel density plot of all literature indexed in PubMed (1954–2014) was generated to characterize the distribution of DSs in the entire PubMed universe. We limited the study period up to the year 2014 for 2 reasons: first, a period of several years after publication date is needed to allow for future studies to cite a focal article and to calculate a DS, and second, the time period 1954–2014 were the years that were available in the publicly-available database utilized.5 Statistical analysis was performed utilizing R Statistical Software (version 4.0.0, Auckland, New Zealand). Figures and plots were created using the ggplot2 package available in R.14


A kernel plot for the DSs of the 12,742,382 PubMed-indexed articles (1954–2014) across all specialties is shown in Figure ​Figure1.1. For our analysis, a total of n = 53,507 articles were identified, n = 15,759 in PRS, n = 6,276 in Annals of Plastic Surgery, n = 5467 in British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery), n = 7843 in Journal of Oral and Maxillofacial Surgery, n = 1770 in Journal of Craniomaxillofacial Surgery, n = 3496 in Journal of Craniofacial Surgery, n = 1937 in Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, n = 1104 in Clinics in Plastic Surgery, n = 3691 in Journal of Hand Surgery (American), n = 2463 in Journal of Hand Surgery (European/British), n = 406 in Aesthetic Surgery Journal, n = 450 in JAMA Facial Plastic Surgery, n = 1225 in Journal of Reconstructive Microsurgery, and n = 1620 in Aesthetic Plastic Surgery. The 100 most-disruptive articles in plastic and reconstructive surgery and sub-specialties are presented in Table ​Table1.1. For comparison, the top 100 most-cited articles in these journals is presented in Table ​Table2.2. The top five including nine of the top 10 most-disruptive articles were published in PRS. Additionally 21 of the top 30, and 64 of the total list of 100 appeared in the same journal. The second-most articles on the list appeared in British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery) (n = 15), third-most in Journal of Oral and Maxillofacial Surgery (n = 7), fourth-most in Annals of Plastic Surgery (n = 6), followed by Journal of Hand Surgery (American) (n = 3), Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery (n = 2), Journal of Hand Surgery (European/British) (n = 1), Clinics in Plastic Surgery (n = 1), and Journal of Craniomaxillofacial Surgery (n = 1) (Table ​(Table3).3). There were no articles from either Journal of Reconstructive Microsurgery,Journal of Craniofacial Surgery, JAMA Facial Plastic Surgery, Aesthetic Plastic Surgery or Aesthetic Surgery Journal in the top 100. The top 100 most-disruptive publications in these journals were more disruptive than 99.8% of all PubMed articles. Citation counts of the 100 most-disruptive articles ranged from 1 to 502 (mean = 44.9 citations). The correlation coefficient linking DSs and citation counts was 0.01 and 0.11 among all articles, and the 100 most-disruptive articles, respectively.

Table 1.

Details of the 100 Most-disruptive Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014)

RankTitleFirst AuthorSenior AuthorYearAffiliationJournalDisruption
Study Design
1Minimally invasive, limited incision breast surgery: passing fad or emerging trend?Rod J. Rohrich2002University of Texas Southwestern Medical Center, Dallas, Tex.Plastic and Reconstructive Surgery0.9090909097Viewpoint
2The ultimate fate of freeze dried fascia: experience with its use in the correction of facial paralysis.R. K. SnydermanT. E. Starzynski1966Memorial Hospital for Cancer and Allied Diseases, New York, N.Y.Plastic and Reconstructive Surgery0.8888888898Case study
3A suction curette for removal of excessive local deposits of subcutaneous fat.U. K. KesselringR. Meyer1978Lausanne, SwitzerlandPlastic and Reconstructive Surgery0.85714285743Methodologies
4A new and reliable method of securing skin grafts to the difficult recipient bed.A. M. SchneiderL. C. Argenta1998Wake Forest University School of Medicine, Winston-Salem, N.C.Plastic and Reconstructive Surgery0.85714285798Ideas and innovations/methodologies
5Body contouring by lipolysis: a 5-year experience with over 3000 cases.Y. G. Illouz1983Paris, FrancePlastic and Reconstructive Surgery0.823741007263Review
6The zig-zag volar-digital incision for flexor-tendon surgery.J. M. Bruner1967Des Moines, IowaPlastic and Reconstructive Surgery0.81355932261Methodologies
7Palatal fistulae following cleft palate surgery.F. E. AbyholmG. Eskeland1979Oslo, NorwayScandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery0.81333333352Review
8Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty.J. H. Sheen1984UCLA, Los Angeles, Calif.Plastic and Reconstructive Surgery0.760869565267Case study
9Reduction mammaplasty with a vertical dermal flap.P. K. McKissock1972Torrance, Calif.Plastic and Reconstructive Surgery0.743842365138Methodologies/review
10Internal fixation of certain fractures of the mandible by bone plating.J. A. SnellW. A. Dott1969Melbourne, AustraliaPlastic and Reconstructive Surgery0.71428571423Review
11“Outbreak” of hand injuries during Hajj festivities in Saudi Arabia.M. M. RahmanM. M. Al-Qattan1999King Saud University and King Fahad National Guard Hospital, Riyadh, Saudi ArabiaAnnals of Plastic Surgery0.71428571412Review
12The use of lingual flaps in repair of fistulas of the hard palate.J. Guerrer-SantosJ. T. Altamirano1966Guadalajara, MexicoPlastic and Reconstructive Surgery0.6992481275Case study
13A new technique for reduction mammaplasty.L. Ribeiro1975Rio de Janeiro, BrazilPlastic and Reconstructive Surgery0.692913386104Methodologies
14Abnormal anatomy of the muscles of palatopharyngeal closure in cleft palates: anatomical and surgical considerations based on the autopsies of 18 unoperated cleft palatesM. FáraJ. Dvorák1970Prague, CzechPlastic and Reconstructive Surgery0.6862745114Case study
15Microsurgical reconstruction of the lingual nerve.P. G. MozsaryR. A. Middleton1984Department of Oral Surgery, University of the Pacific School of Dentistry, San Francisco, Calif.Journal of Oral Maxillofacial Surgery0.6851Case study
16Analysis of 200 free flaps.T. Harashina1988Keio University Hospital, TokyoBritish Journal of Plastic Surgery0.672043011100Review
17The salutary effects of the bed on the survival of experimental flaps.T. KaufmanJ. W. Futrell1985?Annals of Plastic Surgery0.66666666728?
18Anesthesia for tongue flaps in infants.L. NaikP. Sawant1993Bombay, IndiaPlastic and Reconstructive Surgery0.6666666672Comment/methodologies
19Intraoperative K-wire protection.R. ThangarajS. Singh2010Birmingham, UKBritish Journal of Plastic Surgery0.6666666673Methodologies
20Minimizing the pain of local anesthesia.K. A. ArndtJ. M. Noe2013Beth Israel Hospital/Harvard Medical School, Boston, Mass.Plastic and Reconstructive Surgery0.66176470665Methodologies/prospective cohort
21Meralgia paresthetica: a complication of iliac bone procurement.A. M. WeikelM. B. Habal1977University of Florida/Boston, Mass.Plastic and Reconstructive Surgery0.6657Case report
22A simple technique for locating the umbilicus in abdominoplasty.S. Hoffman1989Mount Sinai School of Medicine, City University of New YorkPlastic and Reconstructive Surgery0.6428571438Ideas and innovations/methodologies
23The endoscopic breast augmentation: the transumbilical insertion of saline-filled breast implants.G. W. JohnsonJ. E. Christ1993Houston, Tex.Plastic and Reconstructive Surgery0.64197530941Methodologies/case series
24Use of off-label and non-approved drugs and devices in plastic surgery.Rod J. RohrichNeal R. Reisman2003University of Texas Southwestern Medical School, Dallas, Tex.Plastic and Reconstructive Surgery0.63157894714Viewpoint
25vagin*l reconstruction with gracilis myocutaneous flaps.J. B. McCrawC. E. Horton1976Lackland Airforce Base, Tex./Eastern Virginia Medical School, Norfolk, Va.Plastic and Reconstructive Surgery0.627071823234Case report
26Anatomy and arteriography of cleft lips in stillborn children.M. Fára1968Prague, CzechPlastic and Reconstructive Surgery0.61538461530Cadaveric study
27Public attitudes toward oral surgery: results of a Gallup poll.J. Delfino1997St. John’s Mercy Hospital, St. Louis, Mo.Journal of Oral Maxillofacial Surgery0.61538461513Survey
28Cell size and growth characteristics of cultured fibroblasts isolated from normal and keloid tissue.J. D. RussellW. S. Witt1976Mcharry Medical College, Nashville, Tenn.Plastic and Reconstructive Surgery0.61333333340Basic science
29Unilateral galactocele following augmentation mammoplasty.E. D. DeloachL. E. Ruf1994Memorial Medical Center, Savannah, Ga.Annals of Plastic Surgery0.61111111115Case report
30A retrospective study of 1,521 mandibular fractures.P. N. Bochlogyros1985University of Miinster, Waldeyerstrasse, Miinster, West GermanyJournal of Oral Maxillofacial Surgery0.6172Review
31Johann Friedrich Dieffenbach (1794–1847).R. M. Goldwyn1968Harvard Medical School, Boston, Mass.Plastic and Reconstructive Surgery0.67Historical review
32The role of cosmetic surgery in criminal rehabilitation.A. G. SchuringR. E. Dodge Jr1967New Orleans, La.Plastic and Reconstructive Surgery0.62Case-control study
33A plea for reducing the number of positions for residency training in plastic surgery.R. A. Young1994Chesterfield, MissouriPlastic and Reconstructive Surgery0.62Comment
34Frank Hastings Hamilton: a pioneer American plastic surgeon.Germania S. BauxJoseph G. McCarthy2004University of California, San Francisco, Calif. /New York University Medical CenterPlastic and Reconstructive Surgery0.64Historical review
35A radial forearm flap based on an extended dissection of the cephalic vein. The longest venous pedicle? Case report.Y. NakayamaT. Iino1986University of Tsukuba, Sakura-mura, Niihari-gun, Ibaraki, JapanBritish Journal of Plastic Surgery0.59259259316Case report
36Congenital claw-like fingers and toes. Case report of two siblings.T. Egawa1977?Plastic and Reconstructive Surgery0.59090909130Case report
37Geometric considerations in the design of rotation flaps in the scalp and forehead region.R. B. Ahuja1988New Delhi, IndiaPlastic and Reconstructive Surgery0.58064516122Methodologies
38Hooked forceps.I. J. Peled1984?Annals of Plastic Surgery0.5714285713Methodologies
39Some characteristics of endoscopic and radiological systems used in elaboration of the diagnosis of velopharyngeal incompetence.R. W. PigottA. P. Makepeace1982Frenchay Hospital, Bristol and The University of Bristol, EnglandBritish Journal of Plastic Surgery0.57142857123Methodologies/comparative study
40The wrestler’s ear.J. C. KelleherR. K. Dean1967Toledo, OhioPlastic and Reconstructive Surgery0.56521739134Case study
41“Gate flap” for the total reconstruction of the lower lip.R. Fujimori1980?British Journal of Plastic Surgery0.55434782650Longitudinal study
42Longitudinal study of growth in bilateral cleft lip and palate, from infancy to adolescence.H. FriedeS. Pruzansky1972University of Chicago, Ill.Plastic and Reconstructive Surgery0.54651162836Review
43Review of long-term results in supportive treatment of facial paralysis.B. S. Freeman1979Houston, Tex.Plastic and Reconstructive Surgery0.54166666717Review/comparative study
44Replantation of the lower extremity.Z. W. ChenB. F. Zeng1983Shanghai, People’s Republic of ChinaClinics in Plastic Surgery0.53846153822?
45The stretched scar: a clinical and histological study.B. C. SommerladJ. M. Creasey1978Canniesburn Hospital, Bearsden, Glasgow England / Porton Down, Wiltshire, EnglandBritish Journal of Plastic Surgery0.53703703728Clinical trial
46Comparative reliability of nasal pharyngoscopy and videofluorography in the assessment of velopharyngeal incompetence.S. W. SinclairA. Bracka1982Frenchay Hospital, Bristol, EnglandBritish Journal of Plastic Surgery0.5312517Review/comparative study
47A study of the supraorbital nerve.D. M. Knize1995University of Colorado, Denver, Colo.Plastic and Reconstructive Surgery0.52475247579Cadaveric study/case study
48An island flap from the first web space of the foot to cover plantar ulcers.H. J. Buncke JrL. B. Colen1980San Francisco, Calif.British Journal of Plastic Surgery0.5217391315Case report
49The four-flap Z-plasty.R. M. WoolfT. R. Broadbent1972Salt Lake City, UtahPlastic and Reconstructive Surgery0.50746268743Methodologies
50Facial injuries from automobile accidents: a study of 400 consecutive cases.R. C. Schultz1967Des Plaines, Ill.Plastic and Reconstructive Surgery0.50476190534Review
51A swallowing characteristic noted in a glossectomy patient. Case report.R. Massengill JrK. Pickrell1970Duke University, Durham, N.C.Plastic and Reconstructive Surgery0.512Case report
52Chondritis in the burned ear.J. A. DowlingJ. A. Moncrief1968Brooke Army Medical Center, Fort Sam Houston, Tex.Plastic and Reconstructive Surgery0.524Review/retrospective study
53The sonic digitizer: a rapid and accurate method to assess the size of experimental flaps.T. KaufmanM. I. Siegel1984?Annals of Plastic Surgery0.53Comparative study
54A simple means of maintaining light handle sterility.R. S. SingerA. L. Sisk1984Medical College of Georgia, Augusta, Ga.Journal of Oral Maxillofacial Surgery0.51Methodologies
55A study of the outcome of the American Society for Aesthetic Plastic Surgery research grant program.B. L. CunninghamG. H. Landis1993University of Minnesota Medical School, Minn.Plastic and Reconstructive Surgery0.53Survey
56What age(s) for face lifts?V. S. Lambros1998Newport Beach, Calif.Plastic and Reconstructive Surgery0.53Comment
57Who decides the breast augmentation parameters?Richard V. Dowden2003Cleveland, OhioPlastic and Reconstructive Surgery0.56Editorial
58“Sandwich” dressing for pediatric hand surgery.Nikesh K. PatelJames G. Hoehn2009Albany Medical Center; Albany, N.Y.Plastic and Reconstructive Surgery0.51Viewpoint/methodologies
59Cleft lip-cleft palate closure: the unknown contributions of Harvey Cushing.Amir H. DorafsharRichard J. Redett2010The Johns Hopkins Medical Institute, Baltimore, Md.Plastic and Reconstructive Surgery0.52Case study
60Maxillary arch alignment in the bilateral cleft lip and palate infant, using pinned coaxial screw appliance.N. G. GeorgiadeR. A. Latham1975Duke University, Durham, N.C.Plastic and Reconstructive Surgery0.49206349262Methodologies/case study
61How soon may the axial vessels of a surviving free flap be safely ligated: a study in pigs.M. J. BlackL. A. Sharzer1978Melbourne, AustraliaBritish Journal of Plastic Surgery0.48837209360Animal study
62A rectus abdominis myocutaneous flap to reconstruct abdominal wall defects.S. J. MathesJ. Bostwick III1977Emory University School of Medicine, Atlanta, Ga.British Journal of Plastic Surgery0.48437590Case report
63A simplified stent dressing technique using elastic rubber bands.F. PrunésH. Asbun1989Kern Medical Center, Bakersfield, Calif.Annals of Plastic Surgery0.48275862110Methodologies
64Nasendoscopy: significant refinements of a direct-viewing technique of the velopharyngeal sphincter.D. J. DavidA. Bagnall1982North Adelaide, AustraliaPlastic and Reconstructive Surgery0.4814814817Methodologies
65A comparison of absorbable and nonabsorbable suture materials for skin repair.B. GuyuronC. Vaughan1992Mt. Sinai Medical Center, Cleveland, OhioPlastic and Reconstructive Surgery0.48076923135Comparative study
66Hidradenitis suppurativa–A clinical review.J. D. Watson1985Cannies-burn Hospital, Bearsden, Glasgow, UK/Frenchay Hospital, Bristol, UKBritish Journal of Plastic Surgery0.47916666760Retrospective review
67Mandibular lengthening by gradual distraction. Preliminary report.C. C. SnyderE. Z. Browne Jr1973Veterans Administration Hospital, Salt Lake City, UtahPlastic and Reconstructive Surgery0.474725275290Methodologies/animal study
68Foreign body in the sphenoid sinus.C. DimitriouC. Antoniadis1992Thessaloniki, GreeceJournal of Craniomaxillofacial Surgery0.47368421113Case report
69The surgical face lift—rhytidectomy.H. Conway1970Cornell University, New York, N.Y.Plastic and Reconstructive Surgery0.46575342519Review
70Critical reappraisal of Medical Research Council muscle testing for elbow flexion.Michael C. MacAvoyDavid P. Green2007Permanente Medical Group of South San Francisco, San Francisco, Calif.Journal of Hand Surgery (American)0.46153846225Cadaveric study
71Indentation tonometry of breasts.H. Hayes JrP. McLeod1979University of Arkansas, Little Rock, Ark.Plastic and Reconstructive Surgery0.4545454555Comparative study
72Definition and classification of plastic surgery.R. K. Sandhir1997Delhi, IndiaPlastic and Reconstructive Surgery0.4545454556Editorial
73Nipple or areolar reduction with simultaneous breast augmentation.Richard A. Baxter2003Mountlake Terrace, Wash.Plastic and Reconstructive Surgery0.4545454557Case series/methodologies
74The pocket principle: a new technique for the reattachment of a severed ear part.R. A. MladickB. I. Cohen1971Norfolk General Hospital, Norfolk, Va.Plastic and Reconstructive Surgery0.44954128454Case report
75Hildreth’s test is a reliable clinical sign for the diagnosis of glomus tumours.H. Giele2002The Radcliffe Infirmary, Oxford, UKJournal of Hand Surgery (European/British)0.44827586224Prospective analysis
76A practical guide to surgical loupes.J. M. BakerR. A. Meals1997University of California, Los Angeles School of Medicine, Los Angeles, Calif.Journal of Hand Surgery (American)0.44444444412Methodologies
77Arthroscopy of the human temporomandibular joint.J. P. McCain1988University of Miami, Miami, Fla.Journal of Oral Maxillofacial Surgery0.44339622669Cadaveric study/case study
78Reduction mammaplasty by the “B” technique.P. Regnault1974Montreal, CanadaPlastic and Reconstructive Surgery0.44230769248Methodologies/case series
79The effect of form and dimension on the management of the maxillary arch in unilateral cleft lip and palate conditions.A. G. Huddart1987Wordsley Hospital, Stourbridge, West Midlands, EnglandScandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery0.43759Review
80Precision rhinoplasty. Part I: The role of life-size photographs and soft-tissue cephalometric analysis.B. Guyuron1988Mount Sinai Hospital, Cleveland, OhioPlastic and Reconstructive Surgery0.43518518555Methodologies
81The distribution of lymph nodes in and around the parotid gland: an anatomical study.M. E. McKeanI. A. McGregor1985Royal Infirmary, Glasgow and the Plastic Surgery Unit, Canniesburn Hospital, GlasgowBritish Journal of Plastic Surgery0.43333333356Cadaveric study
82Silastic reconstruction of temporo-mandibular joint meniscus.W. C. HansenB. W. Deshazo1969Los Angeles, Calif.Plastic and Reconstructive Surgery0.42857142938Case study
83The transvestibular approach to the nasal tip and dorsum: a new refinement in rhinoplasty.N. S. Fuleihan1998Boston University Medical Center, Boston, Mass.Plastic and Reconstructive Surgery0.4285714293Methodologies
84Facial width problems associated with rigid fixation of mandibular fractures: case reports.E. Ellis IIIW. Tharanon1992University of Texas, Southwestern Medical Center, Dallas, Tex.Journal of Oral Maxillofacial Surgery0.42424242420Case report/methodologies
85Another method to lengthen the columella in the double cleft patient.R. O. BrauerD. W. Foerster1966Houston, Tex.Plastic and Reconstructive Surgery0.42424242411Methodologies/case study
86Reanimation of lower lip reconstructed by flaps.C. P. Sawhney1986Chandigarh, IndiaBritish Journal of Plastic Surgery0.42307692318Methodologies/case study
87The influence of plastic surgery “reality TV” on cosmetic surgery patient expectations and decision making.Richard J. CrockettJohn A. Persing2007Yale University School of Medicine, New Haven, Conn.Plastic and Reconstructive Surgery0.42222222235Survey
88Reversible, titrated deep sedation for major office surgery.A. J. McDowellD. R. Whitlow1977Burbank, Calif.Plastic and Reconstructive Surgery0.4166666676Consecutive case series
89When to replant a fingertip after its complete amputation.N. I. Elsahy1977Medical College of Georgia, Augusta, Ga.Plastic and Reconstructive Surgery0.41666666731Comparative study
90Use of temporal muscle flap for reconstruction after orbito-maxillary resections for cancer.V. Y. BakamjianS. G. Souther1975Stanford University, California/Roosevelt Park Memorial Hospital, Buffalo, N.Y.Plastic and Reconstructive Surgery0.41538461561Case Study/methodologies
91Inferior epigastric artery skin flaps without rectus abdominis muscle.I. KoshimaS. Soeda1989University of Tsukuba, Ibaraki, JapanBritish Journal of Plastic Surgery0.412451362502Case report
92Bilateral cleft lip and a primary forked flap: a preliminary report.D. R. Millard1967Miami, Fla.Plastic and Reconstructive Surgery0.40983606633Methodologies/case study
93Naso-orbital fractures and traumatic deformities of the medial canthus.J. M. ConverseB. Smith1966New York University, New York, N.Y.Plastic and Reconstructive Surgery0.40909090927Methodologies/case study
94Successful treatment of some fibrous envelope contractures around breast implants.B. S. Freeman1972Houston, Tex.Plastic and Reconstructive Surgery0.40789473714Methodologies/case series
95Surgical skin-marking techniques.M. S. GranickE. W. Jones1987Pittsburg, Pa.Plastic and Reconstructive Surgery0.40579710125Animal Study/methodologies
96Coverage of exposed bone by muscle transposition and skin grafting.L. O. VasconezJ. McCraw1974Emory University, Atlanta, Ga.Plastic and Reconstructive Surgery0.40449438244Review
97Incidence of the Robin Anomalad (Pierre Robin syndrome).P. G. BushA. J. Williams1985Royal Liverpool Children’s Hospital, Liverpool, UKBritish Journal of Plastic Surgery0.40404040493Review/analysis
98Fractures of the mandible: a review of 580 cases.R. A. OlsonD. B. Osbon1982University of Iowa, IowaJournal of Oral Maxillofacial Surgery0.402366864142Review
99The honor and responsibility of teaching in plastic surgery.J. W. May Jr.1991Massachusetts General Hospital, Boston, Mass.Plastic and Reconstructive Surgery0.46Editorial
100A case of an intratendinous ganglion.S. C. YoungA. Freiberg1985University of Toronto, Toronto, Ontario, CanadaJournal of Hand Surgery (American)0.414Case report

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Table 2.

Details of the 100 Most-cited Articles in Plastic and Reconstructive Surgery and Sub-specialties (1954–2014)

RankTitleFirst AuthorSenior AuthorYearAffiliationJournalDSCitation Count
1Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.J. B. MullikenJ. Glowacki1982Harvard Medical School, Boston, Mass.Plastic and Reconstructive Surgery0.1664802391447
2Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic.Robert E. Marx2003Miami, Fla.Journal of Oral Maxillofacial Surgery0.3012646791228
3Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.L. C. ArgentaM. J. Morykwas1997Bowman Gray School of Medicine, Winston-Salem, N.C.Annals of Plastic Surgery−0.082813151037
4Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases.Salvatore L. RuggieroStephen L. Engroff2004Division of Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New Hyde Park, N.Y.Journal of Oral Maxillofacial Surgery0.0143901321024
5Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation.M. J. MorykwasW. McGuirt1997Bowman Gray School of Medicine, Winston-Salem, N.C.Annals of Plastic Surgery0.0971102151005
6Lengthening the human mandible by gradual distraction.J. G. McCarthyB. H. Grayson1992New York University Medical Center Institute of Reconstructive Plastic Surgery, N.Y.Plastic and Reconstructive Surgery0.046428571979
7Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatmentRobert E. MarxVishtasb Broumand2005Miller School of Medicine, Division of Oral and Maxillofacial Surgery, University of Miami, Miami, Fla.Journal of Oral Maxillofacial Surgery−0.039070613794
8Platelet-rich plasma: evidence to support its use.Robert E. Marx2004University of Miami School of Medicine and Jackson Memorial Hospital, Miami, Fla.Journal of Oral Maxillofacial Surgery−0.06700702754
9Fibula free flap: a new method of mandible reconstruction.D. A. Hidalgo1989Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.Plastic and Reconstructive Surgery−0.016783974694
10The vascular territories (angiosomes) of the body: experimental study and clinical applications.G. I. TaylorJ. H. Palmer1987Royal Melbourne Hospital, and Department of Anatomy, University of Melbourne AustraliaBritish Journal of Plastic Surgery0.021912351687
11Functional evaluation of complete sciatic, peroneal, and posterior tibial nerve lesions in the rat.J. R. BainD. A. Hunter1989University of Toronto, Ontario, CanadaPlastic and Reconstructive Surgery−0.0101983649
12The free vascularized bone graft. A clinical extension of microvascular techniques.G. I. TaylorF. J. Ham1975Melbourne, AustraliaPlastic and Reconstructive Surgery0.246969697622
13The free thigh flap: a new free flap concept based on the septocutaneous artery.Y. G. SongY. L. Song1984Beijing, People’s Republic of ChinaBritish Journal of Plastic Surgery0.14574
14Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps.Fu-Chan WeiChih-Hung Lin2002Chang Gung Memorial Hospital, Taipei, TaiwanPlastic and Reconstructive Surgery−0.13681592543
15“Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study.O. M. RamirezA. L. Dellon1990Johns Hopkins University School of Medicine, Baltimore, Md.Plastic and Reconstructive Surgery0.260773481536
16Breast reconstruction with a transverse abdominal island flap.C. R. HartrampfP. W. Black1982Atlanta, Ga. + Medical College of Virginia, Richmond, Va.Plastic and Reconstructive Surgery0.270416025526
17Deep inferior epigastric perforator flap for breast reconstruction.R. J. AllenP. Treece1994Louisiana State University Medical Center, Stanley S. Scott Cancer Center, New OrleansAnnals of Plastic Surgery−0.101567398520
18American Association of Oral and Maxillofacial Surgeons position article on bisphosphonate-related osteonecrosis of the jaws—2009 update.Salvatore L. RuggieroBhoomi Mehrotra2009Division of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Long Island Jewish Medical Center, New Hyde Park, N.Y.Journal of Oral Maxillofacial Surgery−0.035806452517
19Inferior epigastric artery skin flaps without rectus abdominis muscle.I. KoshimaS. Soeda1989University of Tsukuba, Ibaraki, JapanBritish Journal of Plastic Surgery0.412451362502
20Osteoradionecrosis: a new concept of its pathophysiology.R. E. Marx1983Wilford Hall USAF Medical Center, San Antonio, Tex.Journal of Oral Maxillofacial Surgery0.267496112497
21American Association of Oral and Maxillofacial Surgeons position article on medication-related osteonecrosis of the jaw—2014 update.Salvatore L. Ruggiero2014Stony Brook School of Dental Medicine, Hofstra North Shore-LIJ School of Medicine, New York Center for Orthognathic and Maxillofacial Surgery, Lake Success, N.Y.Journal of Oral Maxillofacial Surgery−0.000134372487
22Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing.Barry L. EppleyJoel Higgins2004Indiana University School of Medicine, IndianapolisPlastic and Reconstructive Surgery0.019706499464
23Facial recontouring with lipostructure.S. R. Coleman1997New York, N.Y.Clinics in Plastic Surgery−0.040733198460
24Structural fat grafting: more than a permanent filler.Sydney R. Coleman2006New York University School of Medicine, New YorkPlastic and Reconstructive Surgery−0.008598131456
25The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck.S. Ariyan1979Yale University, New Haven, Conn.Plastic and Reconstructive Surgery0.321628093450
26Healing of bone defects by guided tissue regeneration.C. DahlinS. Nyman1988Gothenburg University, SwedenPlastic and Reconstructive Surgery0.037960123442
27Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells.Gino RigottiAndrea Sbarbati2007Ospedale Maggiore di Verona, Verona, ItalyPlastic and Reconstructive Surgery0.001683164441
28International clinical recommendations on scar management.Thomas A. MustoeUlrich E. Ziegler2002Northwestern University School of Medicine, Chicago, Ill.Plastic and Reconstructive Surgery−0.043637387427
29Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q.Andrea L. PusicStefan J. Cano2009Memorial Sloan-Kettering Cancer Center, New York, N.Y.Plastic and Reconstructive Surgery0.041296061415
30The radial forearm flap: a versatile method for intra-oral reconstruction.D. S. SoutarI. A. McGregor1983Glasgow, ScotlandBritish Journal of Plastic Surgery0.294749403411
31On the nature of hypertrophic scars and keloids: a review.F. B. NiessenM. Kon1999University Hospital of Groningen, The NetherlandsPlastic and Reconstructive Surgery−0.008386118409
32Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.K. C. ChungR. A. Hayward1998University of Michigan Medical Center, Ann ArborJournal of Hand Surgery (American)−0.000243694399
33Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells.Kotaro YoshimuraKiyonori Harii2008University of Tokyo School of Medicine, Tokyo, JapanAesthetic Plastic Surgery−0.029148409397
34The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation.Lieneke J. DraaijersPaul P. M. van Zuijlen2004Beverwijk, the NetherlandsPlastic and Reconstructive Surgery0.008187687369
35Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment.Robert E. MarxJuan J. Ulloa2007Division of Oral and Maxillofacial Surgery, University of Miami Miller School of Medicine, Miami, Fla.Journal of Oral Maxillofacial Surgery−0.035548686362
36Donor-site morbidity after harvesting rib and iliac bone.S. W. LaurieJ. E. Murray1984Harvard Medical School, Boston, Ma.Plastic and Reconstructive Surgery0.350591716361
37The osteocutaneous scapular flap for mandibular and maxillary reconstruction.W. M. SwartzR. Acland1986University of Pittsburg, Pittsburg, Pa.Plastic and Reconstructive Surgery0339
38The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.N. BlondeelG. Matton1997University Hospital Gent, BelgiumBritish Journal of Plastic Surgery−0.059577677337
39Membranous versus endochondral bone: implications for craniofacial reconstruction.J. E. ZinsL. A. Whitaker1983Philadelphia, Pa.Plastic and Reconstructive Surgery0.117415976333
40Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia.Tony MavrokokkiAlastair Goss2007Adelaide Dental Hospital and University of Adelaide, Adelaide, South Australia.Journal of Oral Maxillofacial Surgery−0.044290449327
41Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery.D. H. WhitmanD. M. Green1997David Grant Medical Center, Travis Air Force Base, Calif.Journal of Oral Maxillofacial Surgery0.163679809323
42Cranio-maxillofacial trauma: a 10-year review of 9543 cases with 21,067 injuries.Robert GassnerHanno Ulmer2003Department of Oral and Maxillofacial Surgery, University of Innsbruck, AustriaJournal of Craniomaxillofacial Surgery−0.007759457319
43Autologous stem cells (adipose) and fibrin glue used to treat widespread traumatic calvarial defects: case reportStefan LendeckelHans-Peter Howaldt2004Justus-Liebig-University Medical School, Giessen, GermanyJournal of Craniomaxillofacial Surgery−0.008742911315
44A paradigm shift in U.S. Breast reconstruction: increasing implant rates.Claudia R. AlbornozEvan Matros2013Memorial Sloan-Kettering Cancer Center, New York, N.Y.Plastic and Reconstructive Surgery−0.004150526310
45Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases.M. ChinB. A. Toth1996California Pacific Medical Center, San Francisco, Calif.Journal of Oral Maxillofacial Surgery−0.035775128307
46Transplantation of chondrocytes utilizing a polymer-cell construct to produce tissue-engineered cartilage in the shape of a human ear.Y. CaoC. A. Vacanti1997Department of Surgery, Children’s Hospital, Boston, Mass.Plastic and Reconstructive Surgery0.088682432302
47Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg.A. C. MasqueletG. Wolf1992Hôpital Avicenne, Paris, FrancePlastic and Reconstructive Surgery−0.004977876300
48Breast reconstruction after mastectomy using the temporary expander.C. Radovan1982Encino, CaliforniaPlastic and Reconstructive Surgery0.398921833298
49Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report.K. HariiS. Torii1976Tokyo, JapanPlastic and Reconstructive Surgery0.240137221296
50Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction.Amy K. AldermanJulie C. Lowery2002The University of Michigan Medical Center, Ann Arbor, Mich.Plastic and Reconstructive Surgery0.019320453296
51One hundred free DIEP flap breast reconstructions: a personal experience.P. N. Blondeel1999University Hospital Gent, BelgiumBritish Journal of Plastic Surgery−0.081786942296
52A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance.G. Lundborg2000Malmö University Hospital, SwedenJournal of Hand Surgery (American)−0.005474551293
53A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.Paul S. GillRobert J. Allen2004Louisiana State University Health Sciences Center, New Orleans, La.Plastic and Reconstructive Surgery−0.058704453292
54Mandibular lengthening by gradual distraction. Preliminary report.C. C. SnyderE. Z. Browne Jr1973Veterans Administration Hospital, Salt Lake City, UtahPlastic and Reconstructive Surgery0.474725275290
55Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube.S. E. MackinnonA. L. Dellon1990University of Toronto Sunnybrook Medical Center, OntarioPlastic and Reconstructive Surgery−0.04289
56The subunit principle in nasal reconstruction.G. C. BurgetF. J. Menick1985Chicago, Ill.Plastic and Reconstructive Surgery0.244604317288
57Synthetic polymers seeded with chondrocytes provide a template for new cartilage formation.C. A. VacantiJ. P. Vacanti1991Massachusetts General Hospital, BostonPlastic and Reconstructive Surgery0.006523499287
58Structural fat grafts: the ideal filler?S. R. Coleman2001Manhattan Eye, Ear, and Throat Hospital, New York, N.Y.Clinics in Plastic Surgery−0.028795812287
59Mandibular elongation and remodeling by distraction: a farewell to major osteotomies.F. MolinaF. Ortiz Monasterio1995Universidad Nacional Autónoma de Mexico, Mexico CityPlastic and Reconstructive Surgery−0.119821542286
60A prospective study of microvascular free-flap surgery and outcome.R. K. KhouriC. Wallemark1998Miami Hand Center, Fla.Plastic and Reconstructive Surgery0.001478561283
61Vacuum-assisted closure: microdeformations of wounds and cell proliferation.Vishal SaxenaDennis P. Orgill2004Massachusetts Institute of Technology, Cambridge, Mass.Plastic and Reconstructive Surgery−0.020012129279
62Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count.Gernot WeibrichWalter E. Hitzler2002Johannes Gutenberg University Mainz, GermanyJournal of Craniomaxillofacial Surgery−0.01010101278
63Fat grafting to the breast revisited: safety and efficacy.Sydney R. ColemanAlesia P. Saboeiro2007New York University School of Medicine, New York, N.Y.Plastic and Reconstructive Surgery−0.006464884274
64Foreign body reactions to resorbable poly(L-lactide) bone plates and screws used for the fixation of unstable zygomatic fractures.E. J. BergsmaW. C. de Bruijn1993University Hospital, Groningen, the NetherlandsJournal of Oral Maxillofacial Surgery0.023038157271
65Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty.J. H. Sheen1984UCLA, Los Angeles, Calif.Plastic and Reconstructive Surgery0.760869565267
66Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases.Y. KimataK. Harii1998National Cancer Center Hospital East, Kashiwa, Chiba, JapanPlastic and Reconstructive Surgery−0.18245614267
67Functional wrist motion: a biomechanical study.A. K. PalmerR. Glisson1985Upstate Medical Center, Syracuse, N.Y.Journal of Hand Surgery (American)0.184087363266
68Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report.Jorge L. OrbayDiego L. Fernandez2002Miami Hand Center, Miami, Fla.Journal of Hand Surgery (American)−0.072820513266
69The vascular territories of the superior epigastric and the deep inferior epigastric systems.J. B. BoydR. Corlett1984Melbourne, AustraliaPlastic and Reconstructive Surgery−0.048589342264
70Body contouring by lipolysis: a 5-year experience with over 3000 cases.Y. G. Illouz1983Paris, FrancePlastic and Reconstructive Surgery0.823741007263
71Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings.Karl H. BreuingStephen M. Warren2005Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.Annals of Plastic Surgery0.002224694259
72A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans.R. A. WeberD. P. Mass2000Scott & White Memorial Hospital and Clinic, Temple, Tex.Plastic and Reconstructive Surgery−0.037142857259
73Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery.E. Billings JrJ. W. May Jr1989Massachusetts General Hospital, BostonPlastic and Reconstructive Surgery0.010935252253
74Keloid pathogenesis and treatment.Ali Al-AttarSteven P. Davison2006Georgetown University Medical Center, Washington, D.C.Plastic and Reconstructive Surgery−0.01314012252
75A new concept in the treatment of osteoradionecrosis.R. E. Marx1983Wilford Hall USAF Medical Center, Lackland AFB, Tex.Journal of Oral Maxillofacial Surgery−0.039757995250
76Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications.Yoon S. ChunElof Eriksson2010Harvard Medical School, Brigham and Women’s Hospital/Faulkner Hospital, Boston, Mass.Plastic and Reconstructive Surgery−0.176151762248
77Distant transfer of an island flap by microvascular anastomoses. A clinical technique.R. K. DanielG. I. Taylor1973Melbourne, AustraliaPlastic and Reconstructive Surgery0.147027027244
78The frequency and epidemiology of hand and forearm fractures in the United States.K. C. ChungS. V. Spilson2001The University of Michigan Medical Center, Ann Arbor, Mich.Journal of Hand Surgery (American)0.135831382241
79Free anterolateral thigh flaps for reconstruction of head and neck defects.I. KoshimaS. Ohta1993Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, Okayama, Japan.Plastic and Reconstructive Surgery−0.088673621241
80Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient.Jorge L. OrbayDiego L. Fernandez2004Miami Hand Center, Miami, Fla.Journal of Hand Surgery (American)−0.098630137240
81Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.B. A. TothP. Lappert1991Pacific Presbyterian Medical Center, San Francisco, Calif.Plastic and Reconstructive Surgery0.134067952239
82Human histology and persistence of various injectable filler substances for soft tissue augmentation.Gottfried LemperleUlrich Charrier2003University of California, San Diego, Calif.Aesthetic Plastic Surgery−0.012070006239
83Fibular osteoseptocutaneous flap: anatomic study and clinical application.F. C. WeiM. S. Noordhoff1986Taipei, TaiwanPlastic and Reconstructive Surgery−0.003925967238
84Myogenic differentiation by human processed lipoaspirate cells.Hiroshi MizunoMarc H. Hedrick2002University of California-Los Angeles School of MedicinePlastic and Reconstructive Surgery−0.008084971238
85Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening.D. W. NitzanG. A. Martinez1991Hebrew University-Hadassah School of Dental Medicine, Jerusalem, IsraelJournal of Oral Maxillofacial Surgery−0.007383479238
86vagin*l reconstruction with gracilis myocutaneous flaps.J. B. McCrawC. E. Horton1976Norfolk, Va.Plastic and Reconstructive Surgery0.627071823234
87Relative antigenicity of components of a vascularized limb allograft.W. P. LeeA. J. Weiland1991Johns Hopkins University School of Medicine, Baltimore, Md.Plastic and Reconstructive Surgery−0.001562907233
88Cleft palate repair by double opposing Z-plasty.L. T. Furlow Jr1986Gainesville, Fla.Plastic and Reconstructive Surgery−0.017902813232
89Acellular dermis-assisted breast reconstruction.S. L. SpearN. G. Menon2008Georgetown University, Washington, DCAesthetic Plastic Surgery−0.127725857230
90Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome.Maurice Y. NahabedianPaul N. Manson2002Johns Hopkins Medical Institutions, Baltimore, Md.Plastic and Reconstructive Surgery−0.088586031229
91Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan reconstruction outcome study.E. G. WilkinsK. W. Shaheen2000University of Michigan Health System, Ann ArborPlastic and Reconstructive Surgery−0.000883246227
92The definitive plastic surgical treatment of the severe facial deformities of craniofacial dysostosis. Crouzon’s and Apert’s diseases.P. Tessier1971Paris, FrancePlastic and Reconstructive Surgery0.071197411226
93Bone regeneration within a coralline hydroxyapatite implant.R. E. Holmes1979University of Texas, Dallas, Tex.Plastic and Reconstructive Surgery0.078222778224
94Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture.J. C. MacDermidJ. H. Roth2000St. Joseph’s Health Centre, London, Ontario, CanadaJournal of Hand Surgery (American)−0.012585812223
95The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone.A. J. DeFranzoR. G. Teasdall2001Wake Forest University School of Medicine, Winston-Salem, N.C.Plastic and Reconstructive Surgery−0.062587904223
96The levels of evidence and their role in evidence-based medicine.Patricia B. BurnsKevin C. Chung2011University of Michigan Health System, Ann Arbor, Mich.Plastic and Reconstructive Surgery0.000240154222
97Keloids and hypertrophic scars: a comprehensive review.W. B. RockwellH. P. Ehrlich1989Massachusetts General Hospital, Boston, Mass.Plastic and Reconstructive Surgery−0.012576687222
98The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system.H. K. MoonG. I. Taylor1988Cleveland Clinic Foundation, OhioPlastic and Reconstructive Surgery−0.063380282222
99Transplantation of purified autologous fat: a 3-year follow-up is disappointing.R. A. Ersek1991Southwest Texas State UniversityPlastic and Reconstructive Surgery0.134969325221
100Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients.P. G. CordeiroQ. Y. Hu1999Memorial Sloan-Kettering Cancer Center, New York, N.Y.Plastic and Reconstructive Surgery−0.031496063215

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Fig. 1.

Kernel density distribution plot of all PubMed-indexed plastic surgery articles (1954–2014). Negative values indicate developmental articles, and positive values indicate disruptive articles.

Table 3.

Number of Articles in the Top 100 Most-disruptive Articles by Journal

JournalNo. Articles in Top 100
1. Plastic and Reconstructive Surgery64
2. British Journal of Plastic Surgery15
3. Journal of Oral and Maxillofacial Surgery7
4. Annals of Plastic Surgery6
5. Journal of Hand Surgery (American)3
6. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery2
7. Journal of Hand Surgery (European/British)1
8. Clinics in Plastic Surgery1
9. Journal of Craniomaxillofacial Surgery1
10. Aesthetic Surgery Journal0
11. Aesthetic Plastic Surgery0
12. Journal of Craniofacial Surgery0
13. JAMA Facial Plastic Surgery0
14. Journal of Reconstructive Microsurgery0

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Figure ​Figure22 displays a scatterplot of DSs by citation count for all plastic surgery articles, and Figure ​Figure33 displays a kernel density plot of DSs by journal. Mean DSs by journal are presented in Table ​Table4.4. The highest mean DS was in Clinics in Plastic Surgery and PRS. The average PRS, Annals of Plastic Surgery, British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery), Journal of Oral and Maxillofacial Surgery, Journal of Craniomaxillofacial Surgery, Journal of Craniofacial Surgery, Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, Clinics in Plastic Surgery, Journal of Hand Surgery (American), Journal of Hand Surgery (European/British), Aesthetic Surgery Journal, JAMA Facial Plastic Surgery, Journal of Reconstructive Microsurgery, and Aesthetic Plastic Surgery article was more disruptive than 81%, 33%, 42%, 22%, 36%, 38%, 77%, 88%, 10%, 12%, 38%, 26%, 34%, and 23% of all PubMed articles, respectively.

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Fig. 2.

Scatterplot of citation counts by DSs for all plastic surgery articles.

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Fig. 3.

Distribution of disruption scores by individual journal (1954–2014). Negative values indicate developmental articles, and positive values indicate disruptive articles. Note: British Journal of Plastic Surgery is currently Journal of Plastic, Reconstructive & Aesthetic Surgery.

Table 4.

Mean DSs by Journal

JournalMean DSs
1. Clinics in Plastic Surgery0.0029
2. Plastic and Reconstructive Surgery0.0005
3. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery0.00003
4. British Journal of Plastic Surgery−0.0015
5. Aesthetic Surgery Journal−0.0018
6. Journal of Craniofacial Surgery−0.0018
7. Journal of Craniomaxillofacial Surgery−0.0021
8. Journal of Reconstructive Microsurgery−0.0023
9. Annals of Plastic Surgery−0.0025
10. JAMA Facial Plastic Surgery−0.0039
11. Aesthetic Plastic Surgery−0.0048
12. Journal of Oral and Maxillofacial Surgery−0.0049
13. Journal of Hand Surgery (European/British)−0.010
14. Journal of Hand Surgery (American)−0.0124

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Figure ​Figure44 displays publication year histogram for the top 100 most-disruptive articles. The most common decade represented was the 1980s (n = 31), and the least common was 2000s (n = 9). The mean DS for the 1960s, 1970s, 1980s, 1990s, and the 2000s was 0.59, 0.55, 0.53, 0.55, and 0.55, respectively. With respect to study types, there are notable differences between the focus of the most-disruptive and the most-cited articles. The most common study types in the most-disruptive list were methodological studies (n = 32), case reports/series (n = 31), and reviews (n = 19), whereas for the most-cited list, they were case reports/series (n = 33), reviews (n = 17), and novel surgical techniques (n = 9).

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Fig. 4.

Histogram of publication year among the top 100 most-disruptive articles.


This is the first study to apply the disruption index to the field of plastic and reconstructive surgery. We present in the current study a list of the top 100 most-disruptive studies appearing in 14 of the most popular journals in plastic surgery (1954–2014). In our analysis, we found that DSs correlated poorly with citation count. This findings underscores that the disruption metric may capture unique characteristics of paradigm-shifting studies that may be overlooked when favoring citation count. This list contains some of the most infamous and practice-altering articles in the history of our specialty.

The most-disruptive article appearing on the list, “Minimally Invasive, Limited Incision Breast Surgery: Passing Fad or Emerging Trend?” was published by Rod J. Rohrich in PRS in 2002.15 This “Cosmetic Viewpoint” starts by quoting Albert Einstein: “Problems cannot be solved at the same level of awareness that created them” and discusses what were at the time recent trends in minimally invasive breast surgery, breast liposuction, and limited incision mastopexy/breast reduction.

The second-most disruptive article published in 1966 in PRS was “The Ultimate Fate of Freeze Dried Fascia: Experience with its Use in the Correction of Facial Paralysis.”16 In this report, Snyderman et al discussed their positive experience in 15 patients treated with freeze-dried fascia for facial palsy. To that point, the use of fresh autologous fascia was standard until the authors benefited from the advent of a tissue bank in 1953 at the Memorial Sloan Kettering Cancer Center.

The third-most disruptive article by Ulrich and Meyer “A Suction Curette for Removal of Excessive Local Deposits of Subcutaneous Fat” appeared in PRS in 1978 and was the first documented report on the use of liposuction.17 This study described the authors’ transition from what was at the point the standard method of removal of localized fat deposits by curette through a small incision in select areas (eg, trochanteric lipodystrophy) to their use of a stainless steel suction curette (devised by Ulrich) to “treat fat deposits elsewhere (eg, stomach, thighs, calves, knees).” This report appeared a few years after Arpad and Giorgio Fischer first started using a blunt suction-assisted cannula to treat fat deposits of the outer thighs.18

The fourth-most disruptive study is the 1998 study by Schneider, Morykwas, and Argenta “A New and Reliable Method of Securing Skin Grafts to the Difficult Recipient Bed.”19 This PRS study described their experience with the Vacuum Assisted Closure device (KCI: San Antonio, Tex.) for skin graft to wound bed apposition in place of the traditional tie-over bolster method.

The fifth-most disruptive study is also the fourth-most cited on the list. This 1985 PRS study by Illouz titled “Body Contouring by Lipolysis: A 5-Year Experience with Over 3000 Cases” presented the author’s experience with liposuction body contouring and subsequent surgical correction of the deformity resulting from overlying skin contraction.20

It is also worth noting that the sixth-most disruptive 1967 study by Brunner describing “The Zig-Zag Volar-Digital Incision for Flexor Tendon Surgery” has for over 50 years been the incision-of-choice for flexor tendon and volar digital exposure.21 Other notable works appearing in the top 10 include a 1979 large-volume review of palatal fistulae by Abyholm et al (“Palatal Fistulae Following Cleft Palate Surgery” in Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery22), the first description in 1984 by Sheen of the now ubiquitous spreader graft in rhinoplasty (“Spreader Graft: A Method of reconstructing the Roof of the Middle Nasal Vault Following Rhinoplasty” in PRS23), McKissock’s 1972 description of his now eponymous breast reduction technique (“Reduction Mammaplasty with a Vertical Dermal Flap” in PRS24), and finally the 1969 Australian study by Snell and Dott advocating for widespread use of plating in mandibular fractures (“Internal Fixation of Certain Fractures of the Mandible by Bone Plating” in PRS25).

The most-cited study (n = 502 citations, 91st on the list of most-disruptive studies) is the 1989 case report by Koshima et al entitled “Inferior Epigastric Artery Skin Flaps Without Rectus Abdominis Muscle” published in the British Journal of Plastic Surgery (currently Journal of Plastic, Reconstructive & Aesthetic Surgery).26 This now infamous article was the first description of the deep inferior epigastric artery perforator (DIEP) flap, which has since become the gold-standard for autologous free flap breast reconstruction at many centers around the world. The current authors would like to stress that all articles in the top 100 are highly disruptive studies. Although, in theory, the number one article on the list is more disruptive than the fifth, which are both more disruptive than all the studies appearing lower, the list is meant to be viewed as a body rather than as a consecutive ranking. The study by Koshima et al26 is one of the most revolutionary studies in the history of plastic surgery, and because it was identified at the top 100, the current authors believe that this is evidence of the merit of this novel bibliometric. Moreover, although many of the articles appearing in the most-disruptive list also carried high citation counts, many did not (n = 25 articles had <10 citations). This finding is similar to the study by Becerra et al investigating disruption in academic surgery, in which 23 of their top 100 also had <10.11

The most common decade of disruption in the top 100 was the 1980s, with 31 articles at the top 100. Although the World Wars and the following decades certainly were integral in the development of plastic surgery,27 the 1980s saw an explosion of innovation in part due to technological advances in plastic surgery and surgery more generally.28 However, notably, the 1980s had the lowest average DS (0.53), with the 1960s having the highest average DS (0.59) of the decades included in our analysis. The 2000s had the fewest appearances on the list of top 100 with 9 articles, although, as previously discussed, the most-disruptive article was published in 2002 by Rohrich.15

The list of the most-disruptive articles also contains a broad diversity of topics and study designs. In fact, the broad range of topics was so variable that it precluded analysis. However, data on study design are presented with the most common type of study on the disruptive list— methodological studies (n = 32), whereas that for the most-cited list was case report/series (n = 33). Although case reports/series were also relatively common on the disruptive list (n = 31), there were very few methodological studies appearing in the most-cited list (n = 6). Although one may expect a list of the most paradigm-shifting studies in plastic surgery to feature a long list of high level of evidence randomized controlled trials, our results are similar to the results of other studies, including the Nature study by Wu et al,5 which initially investigated the disruption bibliometric. They concluded that small teams disrupt, but large teams develop. In both the most-disruptive and most-cited lists in the current study, a large number of case series and case reports seem to highlight this phenomenon: that these types of studies may report on novel concepts that serve to introduce a topic/finding to the wider surgical community and then serves as a foundation for larger, higher level of evidence studies to investigate novel findings. The current authors would also like to stress that the disruption metric is not synonymous with the dictionary definition of the word disruption, which carries its own connotations and may lead to misinterpretation of this bibliometric. Rather, we recommend the reader to focus on the definition of disruption, as outlined in the Methods section and the equation described. Furthermore, although some highly disruptive studies may change clinical practice, many do not. The mean feature of the disruption index is identifying articles that supplant previous literature on a given topic. Moreover, although some of these studies changed clinical practice, all of the highly-disruptive articles share the characteristic that they shifted paradigms in a given topic, as evidenced by shifting citations from previous literature to the index study after publication.

The DS serves as an alternative and complimentary tool to the citation count, which although simple and pragmatic, may not capture all scopes of innovation for quantifying scholarly impact. With the continued explosion of scientific literature, bibliometric measurements have become increasingly important to analyze and rank academic productivity.29 Academic plastic surgery is an exceedingly competitive field and bibliometric measurements are frequently also used for promotion.30 Although citation count or bibliographic indices derived thereof (h-index and g-index) are often used as a proxy for scholarly impact, these metrics have notable limitations.3 Several recent studies9,10 have investigated alternative bibliometrics in plastic surgery, including the Altmetric score. Shiah et al compared the Altmetric score with “traditional” citation-based metrics such as the Hirsch index (H-index) and concluded that the Altmetric score has a weak positive correlation with conventional bibliometrics.9 Another recent study by Ruan et al investigated the relationship among the Altmetric score, Mendeley reader score, citation count, and downloads in PRS, and described the merits of the Altmetric score but discouraged its use as a stand-alone bibliometric.10

This study carries several limitations. Our analysis was conducted in 14 plastic and reconstructive surgery journals. Thus, articles published in other plastic surgery journals, or high-impact journals such as general surgery or medicine are excluded. Additionally, DSs and citation counts, like all bibliometrics, change over time as new scientific literature is published, and this analysis provides a snapshot in time of the current bibliometrics. Additionally, older studies are theoretically favored by this metric (as with other metrics) as they have had more time to aggregate citations. The favoring effect is likely counterbalanced by the fact that outdated studies eventually are less likely to be read or cited due to the dramatic changes that surgery is constantly undergoing. Despite these limitations, this study provides an important contribution to the plastic surgery literature by providing a repository of disruptive plastic surgery articles that may have otherwise been overlooked using traditional bibliometric tools. Future work will focus on comparing the disruption index with other alternative metrics such as Altmetric score, H-index, Mendeley reader score, and download counts.


We present the 100 most-disruptive articles in 14 of the most popular plastic surgery journals published between 1954 and 2014, utilizing a novel bibliometric index. A detailed analysis of these studies, including correlation to citation counts and analysis of publication years, is also presented. To our knowledge, this is the first application of the disruption metric to plastic surgery and its sub-specialties. This review provides a unique perspective on the seminal research studies that shifted paradigms and pushed forward surgical innovations that have made plastic surgery what it is today. We hope this perspective will provide plastic, reconstructive, and subspecialty surgeons an understanding of how current and historical innovations have made a lasting impact on the field of plastic surgery and provide insight into how current and future studies may further shape the field in ways we have yet to observe.


Published online 26 March 2021

Drs. Dorafshar and Becerra contributed equally to this work.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.


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