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Background Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap. Methods A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps. Results The median age of the patients at surgery was 10.5 days (range, 1–369 days) and the average defect size was 22.5 cm2 (range, 7.1–55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45–120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects. Conclusions All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.

Background Applicants to integrated plastic and reconstructive surgery (PRS) residency in the United States spend exorbitant amounts of time and money throughout the interview process. Outside of first-hand experience through a visiting rotation, applicants utilize various resources in learning about a program. Today’s applicants are “Millennials,” the demographic cohort raised during the information age and proficient with digital technology. The authors evaluated whether programs have a presence on social media, and whether applicants are following these accounts. Methods An online survey was sent to applicants to a single integrated plastic surgery program evaluating basic demographics, social media utilization, and sources of information accessed throughout the residency application process. A manual search of popular social media platforms (Instagram, Facebook, and Twitter) was performed in October 2019. Accounts affiliated with integrated PRS programs were identified and analyzed. Results Eighty-four of 222 applicants (37.8%) completed the survey. Ninety-six percent of applicants were within the Millennial demographic. Ninety-six percent of applicants had some form of social media presence, with Facebook (90%) and Instagram (87%) being the most popular platforms. Seventy-three percent of applicants reported following a PRS residency social media account. As of October 2019, 59 integrated residency programs (73%) have active Instagram accounts. Conclusions Applicants still rely on the program website when researching potential residencies, but social media is being rapidly adopted by programs. Program social media accounts should be used as a dynamic form of communication to better inform applicants of program strengths and weaknesses.

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ZusammenfassungIn Deutschland wurde der erste Patient mit SARS-Cov-2 Virus Infektion am 27. Januar 2020 in München bestätigt. Für uns als Plastische Chirurgen und Handchirurgen ist es von zentralerBedeutung, dass wir uns als verantwortungsbewusste Menschen und Ärzte dafür einsetzen, die Übertragung von Viren zu verringern und die Ressourcen zur Behandlung von Patienten, die an der Krankheit schwer erkrankt sind, frei geben. Die vorliegende Arbeit gibt einer Übersicht zu aktuellen Entwicklungen und Erkenntnissen für das Fachgebiet Plastische Chirurgie und für die Handchirurgie.Gleichzeitig müssen wir über unsere Fachgesellschaften aktiv Kriterien und Regularien zur Versorgung von an COVID-19 erkrankten Patienten mitgestalten, den Erhalt unserer Notfallversorgung sichern und sinnvolle Exit-Strategien erarbeiten. Naturgemäß kann dabei gerade bei der rasanten Entwicklung der Erkenntnisse in der aktuellen Pandemie nur eine Momentaufnahme gegeben werden.

Background Since the initial Research and Reconstruction Forum (R&R Forum) in 2011, the R&R Forum, Korean Society for Aesthetic Plastic Surgery (KSAPS), and Korean Society of Plastic and Reconstructive Surgeons (KSPRS) have held annual meetings. This study was conducted to provide updated information on the publication rate of presentations at those meetings. Methods Plastic surgery–related abstracts presented at the R&R Forum, KSAPS, and KSPRS between 2011 and 2015 were collected. The sessions were divided into free papers, posters, and e-presentations (or e-posters) for each annual meeting. Abstract publication status was confirmed through PubMed, Google Scholar, the KCI-Korean Journal Database, and the KMbase database. Results In total, 2,335 abstracts were presented in the free paper, poster, and e-presentation sessions. Of these, 622 (26.6%) were published. The overall publication rates were 240 of 684 abstracts (35.1%) presented at the R&R Forum, 56 of 216 abstracts (25.9%) presented at the KSAPS meetings, and 326 of 1,435 abstracts (22.7%) presented at the KSPRS meetings. In terms of specific annual meetings, the 2014 R&R Forum had the highest publication rate (39.9%), followed by the 2015 KSAPS (31.0%) and the 2015 KSPRS (28.8%). Conclusions Scientific researchers present diverse results at these professional meetings, with a focus on innovative surgical techniques and improved surgical outcomes. This is our second study on this topic. Despite its limitations, this study indirectly shows that the recognition of Korean plastic surgeons and the quality of the annual meetings of Korean societies of plastic surgery have risen to the global level.

ZusammenfassungDie Plastische Chirurgie ist stärker als viele andere Fachgebiete durch ein hohes Maß an multidisziplinärer Vernetzung geprägt. Trotz des breiten fachlichen Spektrums der Plastischen Chirurgie ist das Fachgebiet nicht an jedem Universitätsklinikum oder Haus der Maximalversorgung als eigenständige Abteilung oder Klinik vertreten. Auch haben selbstständige Einrichtungen nicht selten mit einem niedrig angesetzten Stellenschlüssel zu kämpfen. Außer Frage steht, dass das Fachgebiet durch die stetige Entwicklung der rekonstruktiven Mikrochirurgie zu einer deutlich verbesserten und schnelleren Versorgung von Patienten mit komplexen Defektwunden beigetragen hat. Der Zustrom der Patienten erfolgt hierbei zum größten Teil über andere Fachabteilungen. Die Einbindung der zuführenden Abteilung in die Erstellung des rekonstruktiven Planes ist von entscheidender Bedeutung für den qualitativen Erfolg der Behandlung und die Funktionswiederherstellung. Der Schlüssel in der weiteren Entwicklung des Fachgebietes liegt dabei in hohem Maße bei der stärkeren Vernetzung mit unterschiedlichen Fachdisziplinen, um die Behandlung komplexer Fälle zu gewährleisten und stärker in den allgemeinen Fokus der Krankenhausmedizin zu rücken. Im Interesse der Versorgungsqualität ist hierbei die professionelle Implementierung von multidisziplinären Boards, bei denen die Plastisch-rekonstruktive Chirurgie eine wichtige Rolle einnehmen kann, von größter Relevanz.Im Rahmen des Workshops „Der interdisziplinäre Mikrochirurg“ wurde auf der 39. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße das Thema des Stellenwertes, der Initiierung und der Umsetzung von interdisziplinären Boards diskutiert und gemeinsame Empfehlungen konsentiert. Die gemeinsamen Ergebnisse und Erfahrungen werden im vorliegenden Artikel dargestellt und an drei konkreten Beispielen verdeutlicht.

Background Dermatologists don’t have a good knowledge of the surgical treatment for ingrown toenails and there is no consensus on which is the best approach. Objective To develop an easy and effective surgical approach to solve the problem of ingrown toenails. Methods We identified 67 patients with ingrown toenails in varying degrees of severity which were treated with the standardized approach. Results All the patients had a completely recovery from the disease and none complained about the cosmetic result. Study limitations The number of cases is limited. Conclusion The standardized surgical approach is easily learned and very effective. The recurrence rate is lower than with other treatments.

Aging leads to marked changes in the face and important aspects of the anatomy, including danger zones, importance of the superficial musculoaponeurotic system (SMAS), and existing surgical techniques, and the main complications are essential for indication and for surgical success. The increasing demand of patients for better results poses challenges. The use of adjuvant techniques such as fat graft and platelet-rich plasma (PRP) on the whole face represents a complementary strategic value approach. Methods – ten rhytidectomies were performed between November 2017 and December 2018 at the Santa Casa de Misericordia Hospital in Goiânia and analyzed the results obtained with the proposed surgical tactics demonstrated here. Results – the patients presented good satisfaction, low complications index, and better skin quality with the surgical tactic used. Conclusion – the rhytidoplasty complemented at the end of the surgical procedure with fat and platelet-rich plasma in a panfacial manner is effective, safe, and reproducible, presenting excellent results in terms of skin quality, being an option in the treatment of aging facial.

Background The type of content that influences plastic and reconstructive surgery (PRS) residency program selection and attracts applicants is everchanging and not clearly understood. Further, the COVID-19 pandemic had a major impact on residency selection that is undetermined. Objectives The purpose of this study was to determine to what degree and the type of PRS SM content that drives prospective applicants’ interest of a residency program, especially in the context of COVID-19. Methods Prospective PRS residency applicants were surveyed anonymously. Results An average of 60% of respondents reported that PRS social media (SM) content influenced their perception of a program. Fifty-eight percent reported that resident lifestyle content made them gain interest in a program. Separately, 32% reported that resident lifestyle content influenced them to rank a program higher. Seventy-two percent of respondents claimed SM content did not make them lose interest in a program. Rarely posting, outdated content, and lack of engagement were cited as factors for loss of interest in a program. A majority of respondents (53%) reported wanting to see more resident life and culture content on SM. Of the existing PRS SM content, respondents were most interested in resident lifestyle, followed by clinical and program-specific content. Conclusions The COVID-19 pandemic amplified the importance of SM PRS residency selection. Resident lifestyle content was consistently indicated as more likely to make respondents gain interest in a program, rank a program higher, and as the most desired content. PRS programs will benefit from highlighting resident camaraderie, quality of life, hobbies, and lifestyle to attract applicants.

Summary In this piece of correspondence, the authors set out the challenges and opportunities presented by the SARS-CoV-2 (COVID-19) pandemic to junior surgical trainees embarking on a career in plastic surgery.

The worldwide outbreak of coronavirus disease 2019 (COVID-19) has forced health care systems across the United States to undertake broad restructuring to address the ongoing crisis. The framework of crisis management can assist plastic surgeons navigate the dynamic environment of the COVID-19 pandemic. This article outlines crisis management tools at a number of different levels, from hospital-wide to plastic surgeon-specific, and it offers a practical discussion of the coronavirus situation as it affects plastic surgeons. Although there are innumerable ways that this virus is currently changing plastic surgeons' practices, it is crucial to remember that these changes are temporary, and they will be best met by being confronted head-on.

It is noteworthy the range of facial treatments, with aesthetic purpose, with which we can preserve the balance of the shape or beauty of our patients. Fillers, botulinum toxin, laser, and other technologies are widely used in dermatology. Eyelids can also be treated with these and other therapeutic resources. However, herniation of the fat pockets of the upper eyelids does not present significant results with these methods. The advancement of techniques known as minimally invasive and other technologies does not satisfy the treatment of this facial aesthetic unit. Thinking about the global rejuvenation of the face, it is unlikely that we will achieve a result of excellence without acting on the eyelids. Upper blepharoplasty remains irreplaceable, and it is the treatment of choice for skin redundancy and herniation of fat pockets. This surgery, with a long history in Dermatology, has a unique and fundamental role in facial rejuvenation. In this study, we tried to demonstrate the surgical technique of superior blepharoplasty educationally and to prove its efficacy and safety, with good aesthetic and functional results. With full knowledge of this anatomical region and technical precepts, we recognize that we can perform it safely

Background Differences in approach to repair a specified defect after Mohs micrographic surgery (MMS) between specialties have not been previously examined. Objective To assess the difference in frequency of which reconstruction repairs are selected after MMS, among Mohs surgeons and facial plastic surgeons (FPS), and evaluate whether the level of satisfaction with the final repair outcome differed between specialties. Materials and methods The study was approved by the Saint Louis University Institutional Review Board. A link to the survey was distributed to members of American College of Mohs Surgery (ACMS) and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), between January and May 2016. Results The reconstructive procedure selected most often ("top choice") was not significantly different between Mohs surgeons and FPS for the majority of the images. There was no material difference in how dermatologists and FPS rate the aesthetic outcome of the 3 presented closure types, with the exception of one closure type-nose with graft. Conclusion Mohs surgeons were found to more likely cluster around a single preference for their reconstruction technique compared with FPS, in which a higher percentage of surgeons also selected other options.

Purpose: To discover oculofacial plastic surgeon practice patterns for cautery selection in the setting of implantable electronic devices and present guidelines based on a review of current literature. Methods: A 10-Question web-based survey was sent to the email list serve of the American Society of Ophthalmic Plastic and Reconstructive Surgery to determine surgeon cautery preference in the setting of various implantable electronic devices and comfort level with the guidelines for cautery selection in their practice or institution. The relationship between survey questions was assessed for statistical significance using Pearson’s Chi-square tests. Results: Two hundred ninety-three (41% response rate) surveys were completed and included for analysis. Greater than half of respondents either had no policy (36%) or were unaware of a policy (19%) in their practice or institution regarding cautery selection in patients with a cardiac implantable electronic device. Bipolar cautery was favored for use in patients with a cardiac implantable electronic device (79%–80%) and this number dropped in patients with implantable neurostimulators (30%). Overall, one-third of respondents did not feel comfortable with their practice/institution policy. Conclusion: Choices and comfort level among oculofacial plastic surgeons for cautery selection in patients with implantable electronic devices vary considerably, and some choices may increase the risk for interference-related complications. Practice patterns vary significantly in the setting of a neurostimulator or cochlear implant, where interference can cause thermal injury to the brain and implant damage, respectively. Guidelines are proposed for cautery selection in patients with implantable electronic devices undergoing oculofacial plastic surgery.

The recent rise in women seeking cosmetic surgery of their genitalia (labiaplasty) coincides with the increasing number of surgeons posting videos of these operations on social media accounts and websites. Sociocultural influences significantly contribute to our ideas of what constitutes healthy and pathologic, and surgeons have historically played a role in defining "normal" and "abnormal" anatomy. In the nineteenth century, Saartjie Baartman-a woman with a large posterior and unusually long labia minora-was used by physicians to "educate" the public about these differences. We examine the parallels with the twenty-first century practice of surgeons using social media to educate patients about the operations they perform and discuss ethical and professional hazards associated with this practice.

Resume Introduction Le pectus excavatum est la malformation congenitale thoracique la plus frequente et constitue un motif de consultation courant en chirurgie plastique. Notre attitude consiste le plus souvent en un comblement de la depression par une prothese sur mesure en silicone. L’objectif de ce travail etait d’evaluer les gains apportes par la conception assistee par ordinateur (CAO) dans la fabrication des implants en comparaison de la methode classique de moulage plâtre. Patients et methode Nous avons collige l’ensemble des cas ayant beneficie de la mise en place d’implants sur mesure en silicone au sein du service de chirurgie plastique du CHU de Nantes. Les criteres de jugement etaient la qualite des resultats evaluee par le patient, et par l’equipe chirurgicale en aveugle sur photographies et par questionnaires standardises. Les delais pre-operatoires, les durees d’interventions et d’hospitalisation, le nombre de reprises chirurgicales a visee cosmetique, les suites et complications postoperatoires, etaient releves. Resultats Entre 1990 et 2016, 29 implants thoraciques en silicone ont ete poses dans notre service. Avant 2012, les implants etaient concus par moulage plâtre (n = 13). Apres cette date, les implants etaient concus par CAO (n = 16). Les patients jugeaient leurs resultats « bons » ou « excellents » dans 77 % et 86 % des cas respectivement dans les groupes Plâtre et CAO. Les notes attribuees par l’equipe chirurgicale aux reconstructions par implants CAO etaient meilleures que dans le groupe Plâtre : 8,17 versus 6,96 (p = 0,001). Les implants CAO etaient significativement moins perceptibles que les implants du groupe Plâtre. La duree operatoire etait reduite dans le groupe CAO : 60,2 versus 74,7 minutes dans le groupe Plâtre (p = 0,04), de meme que la duree d’hospitalisation : 3,5 versus 5,3 jours (p = 0,01). Il n’y avait pas de differences significatives entre les deux groupes en termes de complications postoperatoires. Conclusion La prise en charge des pectus excavatum par pose d’un implant en silicone sur mesure constitue une methode peu invasive et pourvoyeuse de bons resultats cosmetiques. La conception de ces implants est facilitee et amelioree qualitativement par la CAO.

Item does not contain fulltext BACKGROUND: Previous research has highlighted the gender-based disparities present throughout the field of surgery. This study aims to evaluate the breadth of the issues facing women in plastic surgery, worldwide. METHODS: A systematic scoping review was undertaken from October of 2016 to January of 2017, with no restrictions on date or language. A narrative synthesis of the literature according to themed issues was developed, together with a summary of relevant numeric data. RESULTS: From the 2247 articles identified, 55 articles were included in the analysis. The majority of articles were published from the United States. Eight themes were identified, as follows: (1) workforce figures; (2) gender bias and discrimination; (3) leadership and academia; (4) mentorship and role models; (5) pregnancy, parenting, and childcare; (6) relationships, work-life balance, and professional satisfaction; (7) patient/public preference; and (8) retirement and financial planning. Despite improvement in numbers over time, women plastic surgeons continue to be underrepresented in the United States, Canada, and Europe, with prevalence ranging from 14 to 25.7 percent. Academic plastic surgeons are less frequently female than male, and women academic plastic surgeons score less favorably when outcomes of academic success are evaluated. Finally, there has been a shift away from overt discrimination toward a more ingrained, implicit bias, and most published cases of bias and discrimination are in association with pregnancy. CONCLUSIONS: The first step toward addressing the issues facing women plastic surgeons is recognition and articulation of the issues. Further research may focus on analyzing geographic variation in the issues and developing appropriate interventions.

The First World War and the number of facial injuries made specialized trauma centers necessary. Alberic Pont was trained both in medicine and dentistry. He founded in Lyon one of the first French specialized wards, which received more than 7000 soldiers overall. Through his charisma, his skills, his creativity and his generosity, he must be considered as a symbol among the pioneers of maxillo-facial surgery, which was then at its early stage. The centenary of World War I is the occasion to shed light on this man who dedicated his career to those who were renamed "broken faces".

Zusammenfassung Hintergrund In Deutschland wurden vor nunmehr 13 Jahren Fallpauschalen als medizinisch-ökonomisches Klassifikationssystem eingeführt. Im Folgenden soll die Abbildung plastischer Rekonstruktionen bei malignen Hauttumoren im Kopf-Hals-Bereich durch Diagnosis Related Groups (DRG) analysiert werden. Material und Methoden Vier verschiedene Hauptdiagnosen (Malignes Melanom, Basalzellkarzinom, Plattenepithelkarzinom, Carcinoma in situ) an bis zu 6 unterschiedlichen Lokalisationen im Kopf-Hals-Bereich wurden mit folgenden Prozeduren kombiniert und mittels DRG-Grouper untersucht: Exzision mit Primärnaht, Exzision mit temporärer Weichteildeckung, Plastische Deckung durch Eigenhaut, lokale, freie, gestielte regionale Lappen und Fernlappenplastiken sowie Kombinationsdeckungen. Ergebnisse Durch 5750 verschlüsselte Diagnose-Prozeduren-Kombinationen wurden 10 unterschiedliche DRGs bestimmt. Bei großflächigen temporären Weichteildeckungen und Hauttransplantationen dominiert die DRG J22Z (Erlös 2817 €). In 2017 wurden die häufig durchgeführten lokalen Lappenplastiken hiervon abgewertet und führen aktuell in die DRG J11D (Erlös 1903 €). In diesem Zusammenhang sind Fallzusammenführungen durch ein zweizeitiges stationäres Vorgehen (Sitzung 1: Exzision, Sitzung 2: Plastische Deckung) von besonderer Bedeutung. Malignome an der Lippe ergeben eine eher unruhige DRG-Abbildung ohne klar abzuleitende Gruppierungsregeln. Die hochbewertete Basis-DRG J08 (DRGs J08A, J08B und J08C) kann nahezu ausnahmslos durch einzelne zusätzliche OPS-Ziffern erreicht werden. Schlussfolgerung Die derzeitige Fallpauschalensituation für plastische Rekonstruktionen im Rahmen maligner Hauttumoren bietet etliche potentielle Fehlanreize, welche Einfluss auf die Patientenversorgung haben können. Auf der Suche nach einem diversifizierten DRG-Portfolio bietet sich die Basis-DRG J08 neben der gängigen Kodierpraxis mit entsprechenden Fallpauschalen an. Die Autoren sehen darin die Möglichkeit, bei aktueller Abwertung auch ressourcenintensive Spezialfälle aufwandgerecht abzubilden. Vor einer unbegründeten und inflationären Anwendung wird jedoch aufgrund einer fehlenden nachhaltigen Ausrichtung aufgrund von Verwässerung ausdrücklich gewarnt.

RESUMO Objetivo: relatar a experiência inicial com a terapia por pressão negativa por instilação em feridas complexas infectadas ou contaminadas. Métodos: a terapia por pressão negativa por instilação utilizada foi o V.A.C. Ulta com instilação Veraflo (Kinetic Concepts, Inc). O modo de operação foi contínuo com pressão sub-atmosférica ajustada em 125 mmHg por duas horas e instilação entre as pausas. O tempo de instilação foi de 20 minutos (tempo de contato do agente tópico com a ferida) e a substância instilada foi solução salina padrão a 0,9%. Após obtenção de preparo adequado da ferida, ela foi coberta com enxerto ou retalho. Resultados: foram operados dez pacientes com feridas complexas contaminadas ou infectadas. O número médio de trocas da TPNi foi 1,4, o número médio total de cirurgias foi de 2,4, o intervalo até a cobertura da ferida foi de 6,3 dias e o intervalo até a alta foi de 11,4 dias. Conclusão: a comparação da terapia por pressão negativa por instilação com dois estudos prévios (controle histórico) evidenciou um tempo de internação menor, favorecendo a TPNi. Este estudo teve um caráter inicial, fazendo-se necessário conduzir um trabalho randomizado e controlado para confirmar a eficácia desta terapia e verificar a sua custo-efetividade. ABSTRACT Objective: to report the initial experience with Negative-Pressure Wound Therapy with instillation in infected or contaminated complex wounds. Methods: the negative-pressure wound therapy with instillation used was V.A.C. Ulta with Veraflo instillation (Kinetic Concepts, Inc). The mode of operation was continuous with negative pressure set at 125 mmHg for two hours and instillation between the pauses. The instillation time was 20 minutes (contact time of the topical agent with the wound) and the instilled substance was 0.9% normal saline. After adequate preparation of the wound, it was covered with graft or flap. Results: ten patients with complex or contaminated wounds were operated on. The mean number of NPWTi changes was 1.4, the mean number of surgeries was 2.4, the interval until complete wound coverage was 6.3 days, and the interval up to the time of discharge was 11.4 days. Conclusion: the comparison of the negative-pressure wound therapy with instillation with two previous studies (historical control) evidenced a shorter hospitalization time, favoring TPNi. This study had an initial character, making it necessary to conduct a randomized and controlled trial to confirm the efficacy of this therapy and verify its cost-effectiveness.