title: Levels of Evidence in the Plastic Surgery Literature: A Citation Analysis of the Top 50 'Classic' Papers.
abstract: BACKGROUND
  The plastic surgery literature is vast, consisting of a plethora of diverse articles written by a myriad of illustrious authors. Despite this considerable archive of published material, it remains nebulous as to which precise papers have had the greatest impact on our specialty. The aim of this study was to identify the most cited papers in the plastic surgery literature and perform a citation analysis paying particular attention to the evidence levels of the clinical studies.
  
  
  METHODS
  We identified the 50 most cited papers published in the 20 highest impact plastic surgery journals through the Web of Science. The articles were ranked in order of number of citations acquired and level of evidence assessed.
  
  
  RESULTS
  The top 50 cited papers were published in six different journals between the years 1957 and 2007. Forty-two of the papers in the top 50 were considered as level IV or V evidence. No level I or II evidence was present in the top 50 list. The average level of evidence of the top 50 papers was 4.28.
  
  
  CONCLUSIONS
  In the plastic surgery literature, no positive correlation exists between a high number of citations and a high level of evidence. Anatomical reconstructive challenges tend to be the main focus of plastic surgery rather than pathologic diseases and consequently, papers with lower levels of evidence are relatively more valuable in plastic surgery than many other specialties.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Joyce
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland.
authors.forename: Cormac W
authors.initials: CW
authors.lastname: Joyce
authors.affiliation: Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: John C
authors.initials: JC
authors.lastname: Kelly
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland.
authors.forename: Jack L
authors.initials: JL
authors.lastname: Kelly
authors.affiliation: Department of Plastic and Reconstructive Surgery, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Carroll
keywords: Bibliometrics; Classical article; Plastic surgery