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The authors present an account of the history of surgical treatment of hypertrophic breasts at the Clinic of Plastic Surgery in Prague. They divided the period from 1928 to the present time into stages with regard to the predominating technique. The authors emphasize also the necessity of careful selection of the surgical procedure with regard to the type and extent of the defect.
With the development of various reconstructive and regenerative techniques in the 1980s, mucogingival surgery evolved into periodontal plastic surgery. This article highlights the surgical procedures which currently can be classified under the concept of Periodontal Plastic Surgery. The learning objective of this article is a review and update of these surgical procedures.
Healthcare reform may impact graduate medical education (GME) to reduce both specialty training positions and the length of training in these programs. General Surgery residencies often provide prerequisite training for surgery specialty training and will be affected by these changes. The purpose of this study is to identify the quality, outcome, and differences between PGYI-PGYIII categorical general surgery residents (GS) and matched prerequisite plastic surgery residents (PS). Concurrent comparisons analyzed American Board of Surgery Inservice Training Examinations (ABSITE) data from 1980-1992 as well as the surgery operative logs (SOL) and the curriculum of matched residents from 1989-1992. Outcome was assessed by board performance and from a piloted questionnaire to all PS graduates of the combined (3-year GS and 2-year PS) program. ABSITE analysis demonstrated satisfactory performance for both PS and GS at each PGY level, with significant increases each year for GS, but only between PGYI and PGYII for PS; there was a significant difference between PS and GS at all PGY levels. SOL analysis paralleled the curriculum and demonstrated more plastic surgery for PS compared to GS, with no difference in general surgery or hand surgery. PS program graduate respondents (32/44-72.7%) identified that the GS training/PS training was appropriate (71.9%/93.8%), effective (90.7%/93.8%) and of appropriate duration (87.5%/75.1%). 87.5 per cent of PS graduates completed ABPS certification. Combined PS training in all PS programs would reduce GME payments by over $20 million. Combined PS training is effective, appropriate, resource-efficient, and has an excellent outcome, but it requires a specific curriculum and close coordination between General Surgery and Plastic Surgery programs.
The workload of plastic surgery is often poorly understood by the public and those responsible for financing health care. The authors have used linked statistical data to analyse demographic and epidemiological profiles of workload in plastic surgery in Oxfordshire. The analyses were constructed for residents of the district and for patients treated from other districts. The former provides a profile of workload generated for plastic surgery from a geographically-defined population. The latter complements this by adding information about 'imported' workload. Admission rates for plastic surgery were higher for children and elderly people than for other age groups; higher for males than females; and they increased during the 11 years of the study. Most of the increase represented an increase in people treated by the service, rather than an increase in readmissions, although there was a modest increase in the latter too. Lengths of stay per admission and total time spent in hospital per person declined considerably. The bulk of the workload in plastic surgery is concerned with the treatment of trauma (including burns), cancer and congenital malformations. The main clinical conditions treated by the specialty are documented distinguishing, for each condition, the extent to which the patients came from outside the authority in which the provider unit is cited.
Education in aesthetic plastic surgery involves the dissemination of information at different levels, as to the aims and ideals of this special field of plastic surgical practice. This is particularly important in our time, characterized as it is by increasing government interference in medical practice, social pressures on our patients, and constant professional pressures on us to abandon established methods and adopt new, unproven and sometimes potentially hazardous ways, all this in the face of a growing litigation problem.
The study of historical priorities in plastic surgery must be based on established principles in the field instead of mere chronology. Examples of application of these principles to two landmarks in plastic surgery are given. The reader is commended to adhere to these principles in the study of other developments in plastic surgery.
More than thousand plastic operations were performed in our departments with ROMICRO-set during the last ten years. First we applied it for reconstructive and aesthetic augmentation of the breast. Thereafter, we developed new technique for gynecomastia and reconstruction of diastasis of the m. rectus abdominis sheath. According to our experience, the ROMICRO-set is a useful tool in plastic surgery. The ROMICRO-set can be used through a small incision to achieve three dimensional views with excellent exposure and lighting.
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At most medical schools, students are offered limited or sporadic experiences in plastic surgery. This is unfortunate because all physicians need to possess the knowledge and skills to evaluate skin lesions and participate in wound management. Also, students who are considering a career in plastic surgery do not have adequate information to make informed decisions. With the restructuring of plastic surgery training programs, career decisions of individuals interested in plastic surgery are being made earlier than ever before in the education continuum, and the aforementioned problem assumes greater magnitude both for the students and the faculty. At MCP-Hahnemann School of Medicine, basic plastic surgery experiences have been integrated into the third-year surgery clerkship as a requirement for all students, and a Plastic Surgery Pathway has been designed in conjunction with the school's pathway system for fourth-year students. The Pathway provides a framework for the student to select a combination of rotations that will best provide an appropriate broad-based education in preparation for training in plastic surgery, and it provides extensive guidance by faculty members in the discipline to assist with career decisions, rotation selection, and preparations for the residency application process. Students in the Plastic Surgery Pathway are required to take rotations in medicine, neurology, and plastic surgery. The remaining rotations are selected from a list of options based on the student's individual learning needs, interests, and career aspirations. Early experience with the Plastic Surgery Pathway has shown that it has been well received by students and faculty, has assisted students with their career decisions, and has led to an increased student awareness of the importance and relevance of the specialty.
Plastic surgeons have taken uncommon interest in their past. Systematized approaches toward the collection of historical information have characterized the specialty. Plastic surgery is the only discipline to have compiled a complete bibliography of its world's literature. The Archives maintains an ongoing program of acquisition of the oral, written, and personal memorabilia of the notable leaders and events of plastic surgery.
Standard photographic technique in plastic surgery is an important topic that has been stressed in the discipline over the past several years. Clinical photographs should always be taken with the same camera lens, lens setting, lighting, film, and patient position to ensure reproducibility and to enable valid pre- and postoperative comparisons. A 35-mm single lens reflex camera is highly recommended for this type of photography. Two lenses are suggested, one with a focal length range of 50 to 60 mm and one with a focal length range of 90 to 105 mm. Both should have macro capability. Two or more flash units are recommended, either camera-mounted or a studio system set-up in the office. Using the patient preparation method and technique outlined in the text, the Standards in Clinical Photography achieve consistency from patient to patient and also in the same patient in pre- and postoperative photographs. Henceforth, the information discussed in the article forms the basis for standard views, regardless of the image-capture medium.
The goal of this study was to analyze the publications in the plastic surgery literature for the year 2002. Contents of these articles, authors' information (such as nationality affiliation of the first author), type of institution, presence of grant support, and previous presentation were analyzed. For inclusion in this study, the publications had to be original articles from the three most frequently read general plastic surgery journals: Annals of Plastic Surgery, British Journal of Plastic Surgery, and Plastic and Reconstructive Surgery. With this approach, 533 articles were included in the study. To give a cross-sectional analysis of the content of all articles, 11 distinct categories were created in which all the articles were subsummarized. The categories were based on anatomical regions and specific plastic surgical areas. A summary is given for each of the categories to provide an overview of the field in which most of the research in plastic surgery was taking place in 2002 and which topics were focused on. The authors found that only 7 percent of all articles had grant support, whereas 36 percent of articles were presented previously during a scientific meeting. Most of the articles came from university-based institutions (68 percent), followed by non-university-based institutions (29 percent) and private practice (3 percent). Regarding nationality affiliation, most of the articles came from the United States (n = 229) and Europe (n = 128); in Asia, Turkey (n = 39) and Japan (n = 36) were the countries with the most published articles.
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