Plastic and reconstructive surgery
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New developments in primary tendon repair in recent decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening and gap formation between tendon ends. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, although marked bulkiness should always be avoided. ⋯ A wide-awake surgical setting allows patient to actively move the digits. After surgery, surgeons and therapists protect patients with a short splint and flexible wrist positioning, and are now moving toward out-of-splint freer early active motion. Improved outcomes have been reported over the past decade with minimal or no rupture during postoperative active motion, along with lower rates of tenolysis.
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Plast. Reconstr. Surg. · Jun 2018
Pathways to Academic Leadership in Plastic Surgery: A Nationwide Survey of Program Directors, Division Chiefs, and Department Chairs of Plastic Surgery.
Many aspire to leadership in academic plastic surgery yet there is no well-documented pathway. ⋯ Program directors and academic heads serve nonoverlapping roles. Few program directors will advance to the role of academic head. Successful applicants to the program director position often serve as an associate program director and are seen as motivated resident educators. In contrast, those faculty members selected for the academic head role are academically accomplished administrators with business acumen.
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Plast. Reconstr. Surg. · May 2018
Comparative StudyThe Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer.
Contralateral prophylactic mastectomy may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of contralateral prophylactic mastectomy in women with early-stage unilateral breast cancer. Given finite health care resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction. ⋯ In women with unilateral breast cancer, contralateral prophylactic mastectomy with reconstruction is more costly. The increased monetary cost of contralateral prophylactic mastectomy may be offset by improved quality of life. However, this financial reality is an important consideration when ongoing efforts toward reimbursement reform may not pay for contralateral prophylactic mastectomy if outcomes data are not presented to justify this procedure.
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Plast. Reconstr. Surg. · May 2018
ReviewAddressing the Opioid Epidemic: A Review of the Role of Plastic Surgery.
The opioid epidemic has been a growing public health threat in the United States and Canada for the past 30 years, with alarming and steadily increasing opioid-related mortality rates. Originating with well-intentioned efforts by physicians to relieve pain and suffering in their patients, the source of the opioid epidemic and much of its ammunition continues to be the sales of legally produced pharmaceutical opioids. ⋯ The authors identified several aspects of plastic surgery that make judicious prescription of opioids in this field uniquely complex, including high variability of cases managed, large volume of ambulatory procedures, and frequent involvement in collaborative care with other surgical specialties. Additional research in plastic surgery is needed to both increase current knowledge of opioid prescribing practices and provide evidence for recommendations that can successfully combat the opioid epidemic.
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Plast. Reconstr. Surg. · May 2018
A Prospective Comparison of Short-Term Outcomes of Subpectoral and Prepectoral Strattice-Based Immediate Breast Reconstruction.
Prepectoral acellular dermal matrix-assisted immediate implant-based breast reconstruction is gaining popularity, involving complete implant coverage with acellular dermal matrix. The authors aimed to compare pain, patient-reported outcome measures (including implant rippling), and safety of prepectoral and subpectoral Strattice-assisted implant-based breast reconstruction. ⋯ Therapeutic, II.