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This and Related “Classic” Articles Appear on Prsjournal.com for Journal Club Discussions.

Patient-reported outcomes in cleft lip and palate treatment are critical for patient care. Traditional surgical outcomes focused on objective measures, such as photographs, anatomic measurements, morbidity, and mortality. Although these remain important, they leave many questions unanswered. Surveys that include aesthetics, speech, functionality, self-image, and quality of life provide more thorough outcomes assessment. It is vital that reliable, valid, and comprehensive questionnaires are available to craniofacial surgeons.

In craniofacial microsomia, patients with severely hypoplastic mandibles (Pruzansky type III) require replacement of the ramus and condyle unit. Autogenous costocartilaginous rib graft and distraction osteogenesis are the most important techniques used, but long-term results need to be looked at to determine optimal management.

After studying this article, the participant should be able to: 1. Recognize the anesthetic choices available to patients undergoing outpatient cosmetic surgery. 2. Identify the various medications selected for use in outpatient cosmetic surgery. 3. Understand the complexities of providing safe anesthesia to patients undergoing outpatient cosmetic surgery.

After studying this article, the participant should be able to: 1. Recognize the various terms used in biostatistics. 2. Describe the choices that are required in designing a particular research study. 3. Understand the different types of data that may be obtained in any given study. 4. Identify which statistical tools are appropriate for evaluating the different types of data.

Defects of the adult skull do not heal spontaneously, producing challenging problems for the craniofacial surgeon. Reconstruction of such defects requires either the placement of alloplastic material or the harvest of autogenous bone. A technique is described for the reconstruction of critical-sized, full-thickness calvarial defects in the adult rat model using specific adult stem cells, namely, multipotent adult stem cells.

The authors examined the recent trends in the composition, appointment, and turnover of chairpersons in academic plastic surgery.

Treatment of midface hypoplasia and forehead retrusion with monobloc advancement is associated with significant complications, including meningitis, prolonged intubation, and frontal bone flap necrosis. To see whether distraction of the monobloc segment offered decreased morbidity, the authors compared clinical outcomes of patients who underwent conventional monobloc advancement with those of patients who underwent monobloc distraction.

The purpose of this study was to identify patients who had previously undergone composite resection of a primary carcinoma of the oral cavity and immediate mandibular reconstruction with an osteocutaneous free flap and subsequently developed a local recurrence or a second metachronous tumor that required a second composite resection and immediate mandibular reconstruction with a second osteocutaneous free flap, in order to evaluate bone-to-bone healing of the two vascularized bone grafts and the long-term survival of these patients.

Plastic surgery residency program directors are frequently interested in predictors of future career direction in their applicants. Many programs strive to train leaders in academic plastic surgery. To determine what factors may predict the ultimate fate of graduating plastic surgery residents, the authors reviewed the application files of 33 former residents from a single, major plastic surgery training program. The data from 29 residents were available for analysis. Nearly half of the residents graduating from the plastic surgery training program went into private practice. Two factors, the number of years taken off for research before entering the plastic surgery residency and the presence of children, were found to be indicative of a candidate's future career path. Of particular note, there was no difference between academic graduates and nonacademic graduates with regard to their intentions in their letters of recommendation and personal statements. This information is useful to both academic program directors and resident applicants. Plast. Reconstr. Surg.111 981, 2003.

The practice of plastic surgery has always remained at the frontier of medical science. Over the past few decades, this frontier has been marked by significant developments in the field of gene therapy. Gene therapy serves to replace, supplement, or manipulate a patient’s genetic makeup to restore function that has been lost or to correct function that is aberrant. Recent technology may allow surgeons to augment the processes of wound healing and angiogenesis by transfecting genes encoding desirable proteins, such as vascular endothelial factor (VEGF), into ischemic tissues. VEGF is a vital growth factor in the development of blood vessels. Although its mechanisms of action are numerous, its sole function seems to be the augmentation of angiogenesis. VEGF is active in growth and development, in wound healing, and in various pathologic conditions, such as psoriasis and rheumatoid arthritis. The role of VEGF in the field of plastic surgery is just beginning to be explored; it may someday prove to be very rewarding.

Microvascular surgery has emerged as an attractive area for recent advances in the field of gene therapy. The present study investigated the survival of ischemic, experimental skin flaps after treatment with the gene encoding vascular endothelial growth factor VEGF. In 30 SpragueDawley rats, anterior abdominal skin flaps supplied by the epigastric artery and vein were created. Ten animals were treated with a mixture of liposomes and the cDNA encoding the 121amino acid isoform of VEGF. Another 10 animals were treated with control plasmid DNA and liposome transfection medium a third group of 10 animals was given physiologic saline. Each solution was injected directly into the femoral artery distal to the origin of the epigastric pedicle supplying the flap. Four days after injection, the pedicle was ligated and blood flow in the flap was approximated using dye fluorescence. Seven days later, the amount of viable tissue within the flap was measured by planimetry. After the animals were killed, specimens from both the operated and nonoperated sides of the abdomen were harvested for immunohistologic evidence of VEGF protein expression. Average dye fluorescence indices of the three groups VEGF cDNA, control plasmid, and saline 2 hours after pedicle ligation were 35.9, 23.9, and 53.9 percent, respectively p< 0.05. Compared with the two control groups, flaps receiving VEGF cDNA had significantly greater tissue viability at the end of 7 days 93.9 versus 28.1 percent for the control plasmid DNA group and 31.9 percent for the saline group p< 0.05. Immunohistochemical staining documented increased deposition of VEGF protein in flaps that were infused with the VEGF cDNA versus saline alone p< 0.05. The results indicated that the survival of ischemic tissues can be enhanced by administration of a cDNA encoding VEGF, a protein known to be important in the process of angiogenesis and wound healing. Plast. Reconstr. Surg.102 2033, 1998.