{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T11:37:07Z","timestamp":1770896227534,"version":"3.50.1"},"reference-count":12,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>AI, especially ChatGPT, is impacting healthcare through applications in research, patient communication, and training. To our knowledge, this is the first study to examine ChatGPT-4\u2019s ability to analyze images of lower leg defects and assesses its understanding of complex case reports in comparison to the performance of board-certified surgeons and residents. We conducted a cross-sectional survey in Switzerland, Germany, and Austria, where 52 participants reviewed images depicting lower leg defects within fictitious patient profiles and selected the optimal reconstruction techniques. The questionnaire included cases with varied difficulty, and answer options did not always include the most obvious choices. Findings highlight that ChatGPT-4 successfully evaluated various reconstruction methods but struggled to determine the optimal solution based on the available information in visual and written forms. A chi-squared test of independence was performed to investigate the overall association between answer options (A, B, C, and D) and rater group (board-certified surgeons, ChatGPT-4, and resident). Inter-group rater associations showed significant overall test results (p &lt; 0.001), with high agreement among board-certified surgeons. Our results suggest that board-certified plastic surgeons remain essential for patient-specific treatment planning, while AI can support decision-making. This reaffirms the role of AI as a supportive tool, rather than a replacement, in reconstructive surgery.<\/jats:p>","DOI":"10.3390\/life15010066","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T09:30:45Z","timestamp":1736328645000},"page":"66","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pilot Study on AI Image Analysis for Lower-Limb Reconstruction\u2014Assessing ChatGPT-4\u2019s Recommendations in Comparison to Board-Certified Plastic Surgeons and Resident Physicians"],"prefix":"10.3390","volume":"15","author":[{"given":"Silke","family":"Graul","sequence":"first","affiliation":[{"name":"Department of Hand and Plastic Surgery, Thurgau Hospital Group, 8501 Frauenfeld, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Pais","sequence":"additional","affiliation":[{"name":"Department of Hand and Plastic Surgery, Thurgau Hospital Group, 8501 Frauenfeld, Switzerland"},{"name":"Department for BioMedical Research, University of Bern, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael","family":"Loucas","sequence":"additional","affiliation":[{"name":"Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Rohrbach","sequence":"additional","affiliation":[{"name":"Australian Centre of Health Engagement, Evidence and Values (ACHEEV), University of Wollongong, Wollongong 2500, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elias","family":"Volkmer","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Helios Klinikum Munich West, 81241 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Leitsch","sequence":"additional","affiliation":[{"name":"Department of Hand and Plastic Surgery, Thurgau Hospital Group, 8501 Frauenfeld, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2324-9813","authenticated-orcid":false,"given":"Thomas","family":"Holzbach","sequence":"additional","affiliation":[{"name":"Department of Hand and Plastic Surgery, Thurgau Hospital Group, 8501 Frauenfeld, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1056\/NEJMsr2214184","article-title":"Benefits, Limits, and Risks of GPT-4 as an AI Chatbot for Medicine","volume":"388","author":"Lee","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Liu, J. (2024). ChatGPT: Perspectives from human\u2013computer interaction and psychology. Front. Artif. Intell., 7.","DOI":"10.3389\/frai.2024.1418869"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1093\/jamia\/ocad072","article-title":"Using AI-generated suggestions from ChatGPT to optimize clinical decision support","volume":"30","author":"Liu","year":"2023","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9375","DOI":"10.1109\/ACCESS.2017.2788044","article-title":"Deep learning applications in medical image analysis","volume":"6","author":"Ker","year":"2017","journal-title":"IEEE Access"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1055\/s-0043-1771514","article-title":"ChatGPT in Plastic and Reconstructive Surgery","volume":"56","author":"Sharma","year":"2023","journal-title":"Indian J. Plast. Surg."},{"key":"ref_6","unstructured":"Metz, C., and Collins, K. (2024, October 07). 10 Ways GPT-4 Is Impressive but Still Flawed, The New York Times, Available online: https:\/\/www.nytimes.com\/2023\/03\/14\/technology\/openai-new-gpt4.html."},{"key":"ref_7","unstructured":"Bubeck, S., Chandrasekaran, V., Eldan, R., Gehrke, J., Horvitz, E., Kamar, E., Lee, P., Lee, Y.T., Li, Y., and Lundberg, S. (2023). Sparks of Artificial General Intelligence: Early experiments with GPT-4. arXiv."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Copeland-Halperin, L.R., O\u2019Brien, L., and Copeland, M. (2023). Evaluation of Artificial Intelligence\u2013generated Responses to Common Plastic Surgery Questions. Plast. Reconstr. Surg. Glob. Open, 11.","DOI":"10.1097\/GOX.0000000000005226"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Leypold, T., Sch\u00e4fer, B., Boos, A., and Beier, J.P. (2023). Can AI Think Like a Plastic Surgeon? Evaluating GPT-4\u2019s Clinical Judgment in Reconstructive Procedures of the Upper Extremity. Plast. Reconstr. Surg. Glob. Open, 11.","DOI":"10.1097\/GOX.0000000000005471"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.medj.2023.02.008","article-title":"On the cusp: Considering the impact of artificial intelligence language models in healthcare","volume":"4","author":"Goodman","year":"2023","journal-title":"Med"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Johnson, D., Goodman, R., Patrinely, J., Stone, C., Zimmerman, E., Donald, R., Chang, S., Berkowitz, S., Finn, A., and Jahangir, E. (2023). Assessing the Accuracy and Reliability of AI-Generated Medical Responses: An Evaluation of the Chat-GPT Model. Res. Sq.","DOI":"10.21203\/rs.3.rs-2566942\/v1"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0749-3797(00)00258-0","article-title":"Physician response to surveys A review of the literature","volume":"20","author":"Kellerman","year":"2001","journal-title":"Am. J. Prev. Med."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/1\/66\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:24:37Z","timestamp":1759919077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/1\/66"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,8]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["life15010066"],"URL":"https:\/\/doi.org\/10.3390\/life15010066","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,8]]}}}