title: A systematic review of ethical principles in the plastic surgery literature.
abstract: BACKGROUND
  This purpose of this study was to perform a systematic review to identify articles that discuss ethical issues relating to the field of plastic and reconstructive surgery and to evaluate whether ethical issues are underrepresented in the plastic surgery literature.
  
  
  METHODS
  Four medical databases were selected to search through the medical literature with specific inclusion criteria to disqualify irrelevant articles from the study. Appropriate articles were extracted, and their quality and validity were assessed by multiple investigators to maximize reproducibility. The data were then synthesized and analyzed for associations among the ethical principles.
  
  
  RESULTS
  Of a total library search of more than 100,000 plastic surgery-oriented articles, only 110 clearly focused on ethical principles. Autonomy (53 percent) was the most common major theme, whereas distributive justice (15 percent) represented the least frequently emphasized ethical principle. The proportions of each ethical principle were tested against each other for equality using Cochran's Q test; the Q test reached statistical significance (Q = 67.04, df = 3, p < 0.0001), indicating that the ethical principles were not discussed equally in plastic surgery literature, which was expected because autonomy represented 53 percent of the articles, whereas distributive justice represented only 15 percent of articles. When examining both major and minor themes, more than half of the articles (61 percent) addressed two or more ethical principles. Beneficence and nonmaleficence were strongly associated (Pearson's chi = 55.38, df = 1,p < 0.0001).
  
  
  CONCLUSIONS
  Despite the extensive number of ethical issues that plastic surgeons face, a relatively small proportion of plastic surgery literature was dedicated to discussing ethical principles.
authors.affiliation: Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Allison G
authors.initials: AG
authors.lastname: Pushman
authors.forename: Lillian T
authors.initials: LT
authors.lastname: Bellfi
mesh_terms: D026686:Beneficence; D015706:Bibliometrics; D026690:Ethics, Clinical; D004992:Ethics, Medical; D006801:Humans; D026684:Personal Autonomy; D028662:Principle-Based Ethics; D019651:Plastic Surgery Procedures / Q000941:ethics*; D015203:Reproducibility of Results; D012107:Research Design; D012935:Social Justice; D013518:Surgery, Plastic / Q000941:ethics*