title: Fifty Years of Innovation in Plastic Surgery.
abstract: BACKGROUND
  Innovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years.
  
  
  METHODS
  Patents and publications related to plastic surgery (1960 to 2010) were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expert-derived technologies outside of the top performing patents areas were additionally explored.
  
  
  RESULTS
  Between 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, non-invasive techniques, and tissue engineering. Of these areas and other expert-derived technologies, those currently undergoing growth include surgical instruments, implants, non-invasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued.
  
  
  CONCLUSIONS
  The application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Kwasnicki
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
authors.forename: Archie
authors.initials: A
authors.lastname: Hughes-Hallett
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
authors.forename: Hani J
authors.initials: HJ
authors.lastname: Marcus
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK.
authors.forename: Shehan
authors.initials: S
authors.lastname: Hettiaratchy
keywords: Diffusion of innovation; History; Surgery, plastic; Technology