Non-plastic Surgeons Research Articles

Energy-Based Medical Devices in Plastic Surgery: A Comparison of FDA-Approved Indications to Advertised Claims.

Lasers and energy-based devices are commonly employed in aesthetic medicine. In the United States, the FDA regulates lasers as medical devices, restricting marketing to approved indications and making off-label claims illegal. Despite this, no comprehensive analysis of off-label marketing prevalence exists. The authors of this study aim to compare the FDA-approved indications for 2 popular aesthetic lasers to their online advertising claims. Additionally, they seek to educate aesthetic providers on the current regulatory restrictions surrounding off-label advertising. FDA-approved indications for 2 lasers-helium plasma dermal resurfacing and 2940 nm fractional erbium-doped yttrium aluminum garnet-were obtained from the publicly available Establishment Registration & Device Listings Database. Online advertisements regarding the capabilities of each laser were collected from practice websites in the United States. Our analysis of 100 online claims for each laser revealed that more than half of the websites advertising helium plasma (n = 59) and 44 websites advertising fractional lasers made at least 1 off-label claim. Both plastic surgeons and nonplastic surgeons made at least 1 off-label claim, with no statistically significant difference between the groups. Despite FDA regulation of medical devices, online advertising regarding the indications and capabilities of popular medical lasers varies widely. Patients who seek information regarding aesthetic laser treatments may encounter inaccurate and differing claims for these treatments, potentially leading to false expectations and poor patient outcomes.

Microsurgical breast reconstruction in the United States: a narrative review of the current state.

Breast reconstruction with microsurgical techniques allows for autologous reconstruction after mastectomy without the complications associated with alloplastic reconstruction. Autologous reconstruction has undergone significant improvement and now offers patients a variety of options depending on patient specific factors and aesthetic outcomes. This review aims to focus on the history of autologous reconstruction, operative considerations, general surgical techniques for flaps, and indications for choosing the ideal free tissue transfer for all medical specialties and not only plastic surgeons. A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to history of microsurgical options, surgical techniques, patient considerations, and contraindications were utilized for this review with the objective to simplify data for all non-plastic surgeon readers. In this study, we find that patient selection is critical in successful outcomes for microsurgical breast reconstruction. We find that abdominal free flaps are now considered gold standard for autologous reconstruction. However, reliable alternatives exist for patients who are not considered ideal candidates for this reconstruction. These include thigh-based flaps such as gracilis myocutaneous flaps, profunda artery perforator flaps, lateral thigh perforator flaps and trunk-based flaps such as lumbar artery perforator flap. Postoperative considerations involve clinical monitoring and enhanced recovery after surgery. The rate of reconstructive success and flap viability is greater that 95%, even in high-risk populations, and therefore risk stratification should be performed based on an individual basis. While there are no absolute contraindications to autologous reconstruction, relative contraindications do exist including obesity and elderly populations due to the increased surgical and medical complications. While implant-based reconstruction remains the predominant method of breast reconstruction in the United States, there have been many exciting advancements in autologous reconstruction that offers high aesthetic outcomes and patient satisfaction.

Influenced: Exploring the Effect of Social Media on Medical Students' Perceptions of Plastic Surgery.

Medical students rarely receive dedicated education in plastic surgery, exposing them to influence from the internet or television programming that is frequently skewed toward cosmetic procedures. Additionally, social media posts from board-certified plastic surgeons make up a small portion of available content. These biased representations may impact students' perceptions, narrowing the scope of referrals and limiting career exploration. Medical students at two academic medical centers were surveyed. Blinded data were collected on exposure to plastic surgery, social media usage, observed content, and perceptions of the specialty. Students' understanding of plastic surgery was evaluated using clinical scenarios. The response rate was 24.3%. Social media and television were the primary contributors to understanding of plastic surgery in 51.6% of students, especially for those who had not completed a surgical clerkship (P < 0.026). Students most frequently viewed plastic surgery content posted by influencers (28.1%), followed by board-certified plastic surgeons (24.1%), patients (21.2%), and nonplastic surgeon physicians (19.7%). Posts relating to cosmetic procedures (44.3%) were viewed most frequently. Students who followed board-certified plastic surgeons performed better when answering clinical vignettes (64.8% versus 50.9%). Social media and television play a significant role in medical students' perceptions of plastic surgery. Students are also more likely to see posts from influencers than board-certified plastic surgeons, furthering potential bias. Quality content from board-certified surgeons and professional societies may improve scope of practice creep and student interest.

Multidisciplinary Experience for Gluteal Fat Grafting.

Gluteal fat grafting, colloquially known as Brazilian Butt Lift, has experienced a significant rise in popularity in recent years. Despite this increase, potential complications associated with the procedure have also been observed, necessitating a thorough examination of the current practices and outcomes. This study collected experiences of a multidisciplinary group of surgeons through a detailed survey sent in April 2022. This study aimed to shed light on the practices employed by these surgeons, the frequency and types of complications they encounter, and the overall outcomes of their procedures. Of the 100 surgeons surveyed, 86 responded. The study identified that pulmonary fat embolism (PFE) was the most serious complication, with fatality due to PFE recorded at a rate of 1:23,878. Liposuction site seromas were the most common complications, with an overall rate of 2.45%. Although there were no overall differences in complications between plastic and non-plastic surgeons, plastic surgeons were found to have a sixfold increase in the odds of experiencing a liposuction seroma. The survey also revealed substantial practice variations, particularly regarding fat preparation methods, recipient-site preparation, antibiotic use, and postoperative care protocols. Despite known complications, a strong tendency to continue performing these procedures was observed among surgeons, demonstrating the sustained demand and acceptance of the procedure. This study underscores the need for continued surveillance and research to enhance the safety and effectiveness of gluteal fat grafts. The experiences and data gathered from practicing surgeons provide valuable insights, paving the way for refining techniques, building consensus, and facilitating informed discussions with patients about the risks and benefits of the procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Plastic surgery market share of breast reconstructive procedures: An analysis of two nationwide databases.

Given advances that streamline breast reconstruction (e.g., prepectoral placement, acellular dermal matrix [ADM], oncoplastic surgery), there is concern that nonplastic surgeons are performing a growing proportion of breast reconstructive procedures. The purpose of this study was to evaluate US trends in the market share of breast reconstruction performed by plastic compared to general surgeons. IBM® MarketScan® Commercial Claims 2006-2017 and NSQIP 2005-2020 were queried to identify women who underwent mastectomy with alloplastic (tissue expander or implant-based) or free flap reconstruction, or lumpectomy with oncoplastic reconstruction (breast reduction, mastopexy, or local/regional flap). MarketScan included immediate and delayed reconstructions, while all NSQIP reconstructions were immediate. Poisson regression with incident rate ratios (IRRs) modeled trends in surgeon type over time. The cohort included 65 168 encounters from MarketScan and 73 351 from NSQIP. Plastic surgeons performed 95.8% of free flap, 93.8% of alloplastic, and 64.9% of oncoplastic reconstructions. Plastic surgeons performed an increasing proportion of immediate oncoplastic reduction and mastopexy (MarketScan IRR: 1.077, 95% confidence interval [CI]: 1.060-1.094, p < 0.001; NSQIP IRR: 1.041, 95% CI: 1.030-1.052, p < 0.001). There were no clinically significant trends for delayed oncoplastic, alloplastic, or free flap reconstructions. Plastic surgeons were more likely to use ADM compared to general surgeons in NSQIP (p < 0.001). Plastic surgeons gained market share in immediate oncoplastic breast reduction and mastopexy over the past two decades without any loss in alloplastic or free flap breast reconstruction. Plastic surgeons should continue collaboration with breast surgical oncologists to reinforce the shared surgeon model for management of breast cancer.

The misconception of plastic surgery scope amongst general practitioners in East Nusa Tenggara, Indonesia

The scope of plastic reconstructive and aesthetic surgery is often misunderstood amongst both public and professionals, including the general practitioners (GP) who play vital roles in referring patients. Unlike other subspecialties, which are circumscribed by subgroup patients, specific organs, or diseases, the versatility of plastic surgery is driven by the principle of the surgical technique being malleable to each clinical case. This study aimed to demonstrate how well general practitioners in Kupang City acknowledge the scope of plastic surgery. The 30-Question electronic survey was filled out by GPs in several hospitals, PHCs, and clinics whose certificate of registration is based in Kupang City. Respondents should match the given cases to one subspecialist surgeon that the GPs think fits best. In total, 83 GPs participated; 63.9% (n=53) were female, aged 27.95 (±3.53 years), 77.1% (n=64) practised in a hospital, and 67.5% (n=56) graduated from medical school in Java. Only 2.4% (n=2) chose a plastic surgeon whom they will refer to among three hand cases, 6% (n=5) in four craniomaxillofacial cases, and 10.8% (n=9) in five reconstructive cases. The GPs tend to associate cosmetic procedures with plastic surgeons, while reconstructive surgery cases like hand or craniomaxillofacial cases were correlated with non-plastic surgeons. The scope of plastic surgery needs to be further introduced in the medical student curriculum; thus, GP can be more exposed to the field and refer patients accurately.

Out-of-scope Cosmetic Surgery: A Review of Malpractice Lawsuits against Nonplastic Surgeons.

Our systematic review of the Westlaw legal database from 1979 to 2022 included 64 malpractice cases. Inclusion criteria were cosmetic surgeries or minimally invasive procedures in medical malpractice lawsuits not involving board-certified plastic surgeons. Out-of-scope was defined using the procedural competencies established by the American Council for Graduate Medical Education, the Commission on Dental Accreditation, and the Council of Podiatric Medical Education. Data on legal proceedings, provider credentials and board certification, surgical interventions, and legal outcomes were collected. The majority of malpractice cases involving cosmetic surgeries or minimally invasive procedures occurred when providers were practicing out of scope (N = 34; 55.7%). The verdict was ruled in favor of the plaintiff (patient) in 34.4% of cases. Out-of-scope practice occurred most in family/internal medicine, no board certification, and obstetrics/gynecology (N = 4, N = 4, and N = 3, respectively). The most common allegation was permanent injury or disfigurement (N = 21; 21.4%). Plastic surgeons provided expert testimony 44.0% of the time. Our review of the Westlaw legal database suggests that the majority of nonplastic surgeon cosmetic malpractice cases may occur in the setting of out-of-scope practice.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites.

The website search engines for the top 20 US medical centers according to the US News and World Report's Hospital Rankings from 2020 to 2021 were queried for search terms pertaining to breast reconstruction. Information collected for search results included gender, if they were a physician, medical specialty, medical school and residency attended, and each individual's position within the search results. Across 80 distinct search attempts, 27 searches (34%) produced no results. The search term "breast reconstruction" yielded the most plastic surgeon search results, with plastic surgeons composing 39% of all search results. The search term "mastectomy" generated the least number of plastic surgeon results, with a 16% representation of plastic surgeons. Nearly two-thirds of physicians identified were nonplastic surgeons (67%). Other surgeons represented 47% of search results and obstetricians/gynecologists, 2%. Nonsurgeons represented 18% of queries. On average, plastic surgeons appeared higher on search lists than nonplastic surgeons, 13th to 39th, respectively (P < 0.001). Plastic surgeons composed only a third of physicians identified, and a third of searches produced no results. Patients interested in breast reconstruction may encounter difficulty finding an appropriate plastic surgeon. Inadequate search engines on hospital websites introduce inefficiencies for the entire health care systems and may negatively impact hospital and physician bottom line.

New trends and insights in facial fracture treatment in the United States

Aim: Facial fractures have multiple etiologies, including motor vehicle collisions, interpersonal violence, falls, and sports-related accidents. The objectives of this study are to reassess, compare, and expand the epidemiologic analysis and postoperative complication rates of facial fracture treatment. Additionally, we sought to compare the length of stay and operative time outcomes between plastic surgeons and non-plastic surgeons. Methods: NSQIP (National Surgical Quality Improvement Program) participant databases were queried to identify all patients undergoing facial fracture operations. Epidemiological data was divided into two groups and compared by surgeon specialty: patients operated on by a plastic surgeon and patients operated on by a non-plastic surgeon. Our primary outcomes of interest were operation time and length of stay. Postoperative complications included wound complications, mortality, return to the OR, and major bleeding. Results: 3,354 patients underwent facial fracture repair (2012 to 2016). In men, the most common fracture was mandibular (40.9%); in women, the most frequent was orbital (32.4 %). 79.6% had single facial fractures and 20.4 % had multiple facial fractures. Plastic surgeons’ operating time was less than that of non-plastic surgeons (P = 0.0007). The average length of stay was higher for the plastic group (mean = 1.65 days, plastic) (P &lt; 0.00001). Postoperative complication variables showed no statistically significant differences between the plastic and non-plastic groups. Conclusion: Continuous epidemiologic analysis is vital for the proper allocation of healthcare resources to the most affected facial fracture patients in the US. Assessment of complication rates between surgical specialties allows a better understanding of the management of facial fracture patients on a national level. Our data analysis may allow surgeons to better counsel patients preoperatively and improve inter-specialty collaboration.

TikTok: Is It Time to Start Trending with #PlasticSurgery?

TikTok is a short-form video social media platform created in 2016 that has rapidly grown in popularity. The aim of this study was to examine trending plastic surgery videos on TikTok and to understand the dynamics of the #PlasticSurgery conversation on this relatively new social media platform. A prospective analysis of TikTok videos identified by directly querying the platform using #PlasticSurgery was performed during November of 2020. Top trending videos at time of data collection, defined as having more than 100,000 likes, were included. Videos were analyzed for user credentials, video engagement (number of views, likes, shares, and comments), associated hashtags, and video purpose and content. The top 376 trending videos were viewed a total of 1,680,910,700 times at time of analysis. Videos made by board-certified plastic surgeons were, on average, more popular than videos made by non-plastic surgeons [490.4 versus 378.6 million likes ( P = 0.006); 5.1 versus 3.8 billion views ( P = 0.046)]. The most popular procedures featured were augmentation mammaplasty (531,143,800 views; 42,825,400 likes), followed by body contouring procedures such as liposuction and abdominoplasty (276,810,500 views; 22,362,000 likes) and rhinoplasty (243,724,100 views; 27,588,200 likes). Educational videos on average had significantly higher levels of engagement than entertainment-focused videos [549,336 versus 340,163 likes ( P = 0.002); 6.3 versus 2.9 million views ( P < 0.001)]. Videos about plastic surgery, particularly educational videos by board-certified plastic surgeons, perform exceptionally well on the TikTok platform. TikTok presents an opportunity for plastic surgeons to educate patients about plastic surgery procedures and to present themselves as board-certified plastic surgeons.

Coworker Reports about Unprofessional Behavior in Plastic Surgery.

Patient reports of unprofessional conduct by surgeons have been linked to postprocedure complications and increased risk for malpractice claims. Coworkers are also positioned to observe and report unprofessional behaviors, including concerns related to delivery of competent medical care, clear and respectful communication, integrity, and responsibility. This study compared rates of coworker concerns between plastic surgeons and other physicians (other surgical specialists and nonsurgeons), and characterized whether plastic surgery subspecialties differed in their rates of complaints. Coworker concern data from January 1, 2014, to December 31, 2019, were retrieved from the Vanderbilt Center for Patient and Professional Advocacy's Coworker Observation Reporting System database. Specialty was classified as plastic surgery, non-plastic surgical, and nonsurgical. The plastic surgery cohort was further characterized by sex, medical school graduation year, predominant practice type (reconstructive only, aesthetic only, or hybrid), and postresidency training (ie, completion of a fellowship). The study cohort included 34,170 physicians (302 plastic surgeons, 7593 non-plastic surgeons, and 26,275 nonsurgeons). A greater proportion of plastic surgeons (13.6%) had one or more coworker concerns compared with nonsurgeons (10.8%) and non-plastic surgeons (6.1%) ( P < 0.001). The most prevalent concern category reported for plastic surgeons was clear and respectful communication. Among plastic surgeons who had no concerns versus those who had at least one concern, there was no significant difference when comparing sex, medical school graduation year, predominant practice type, or postresidency training. Plastic surgeons in this cohort study received more coworker reports than other surgeons and nonsurgical physicians. These data may be used by institutions to identify plastic surgeons at risk for preventable postprocedure complications and intervene with peer feedback intended to promote self-regulation.

26. Heavy Rotation: Changing Consensus in Integrated Residency Training Program Rotation Schedules

Background: As plastic surgery training evolves, ongoing appraisal of the 6-year integrated curriculum is warranted. We performed the current study to describe inter-program variance in structured US plastic surgery curricula. Methods: In August 2021, we obtained rotation schedules from plastic surgery training program websites. When unavailable, we requested schedules from program coordinators. Individual blocks were each recorded as one of 52 rotations and sorted as follows: led by plastics faculty (“Core Plastics”), hosted by non-plastic surgeons within the scope of plastic surgery (“Off-Service”), and rotations outside the scope of plastic surgery (“General Surgery”). Within these categories further characterization was performed using descriptive statistics. Results: Of 84 US programs, rotation schedules were obtained for 71.4% (n=60): 50.0% (n=42) listed complete data on their websites, 3.6% (n=3) listed partial data on their websites and provided additional data upon request, 17.9% (n=15) listed no data on their websites and provided data upon request, and 28.6% (n=24) provided no data online or upon request. The most common program structure was the “2 + 4” model (n=29, 48.3%) followed by the “1 + 5” (n=16, 26.7%), the combined “3 + 3” (n=13, 21.7%), and the “0 + 6” (n=2, 3.3%) models. Overall, programs offered 51.3 (SD±5.5) months of core plastic surgery, 12.4 (SD±4.1) months of general surgery, and 7.8 (SD±2.7) months off-service. All programs offered mixed plastic surgery [mean=28.5 (SD±14.2) months] followed by ENT and dermatology. The most common plastic surgery rotations were hand, mixed cosmetics, and craniofacial/pediatrics. Most programs offered either electives [n=31, 2.3 (SD±1.2) months] or research time [n=22, 2.0 (SD±0.9) months]. Many programs offered experience in areas beyond ACGME requirements such as neurosurgery [n=19, 1.0 (SD±0.1) months], thoracic surgery [n=14, 1.0 (SD±0.3) months], and/or urology [n=6, 1.0 (SD±0) months]. Conclusion: Our findings show that >75% of integrated plastic surgery training programs featured a majority (?4 years) of specialty-specific training with only 21.7% continuing the “3 + 3” model. While many programs provided data upon request, more than half did not include rotation schedules on their websites, potentially influencing competitive candidates’ decisions to apply. Continued transparency around plastic surgery training curricula can help program directors further refine their programs.

A Survey of Factors Influencing Specialization in Plastic Surgery Among Chinese Surgeons.

:In recent years, more Chinese surgeons have left other fields to enter plastic surgery. The factors influencing this respe-cialization have not been elicited. The authors aim to elucidate Chinese surgeons’ experience and career satisfaction in this specialty change. Between July and September 2020, the authors conducted an online survey of nonplastic surgeons who received plastic surgery training at an academic center. The survey evaluated their motivation for pursuing their field, practice patterns, and career satisfaction. Responses were compared those who respecialized in plastic surgery with those who did not. A total of 251 nonplastic surgeons completed the survey. The most frequent reasons for pursuing plastic surgery were lifestyle (61.1%), desire to help others (44.4%), and higher compensation (37.3%). Among those who changed fields, employment in academic centers declined from 85% to 51.7%, 70% devoted at least half of their practice to aesthetic surgery, and the median nights on call decreased from 1.54 to 0.38 per week after specializing in plastic surgery. Overall career satisfaction in plastic surgery was significantly higher compared with their former specialties (78.3% versus 28.3%, P 0.05). The authors’ study showed that outflow of surgeons from other specialties to plastic surgery is mainly due to burnout, which erodes physicians’ satisfaction level and the quality of care they are able to provide. The authors highlight the need for reducing burnout in other surgical fields as well as rigorous plastic and aesthetic surgery training for those changing fields to ensure high-quality patient care.

Assessing the quality and reliability of patient information regarding aesthetic fat grafting on YouTube

PurposePatients increasingly consult social media regarding aesthetic surgery. Given the popularity of fat transfer operations, this study assesses the quality and reliability of patient information available on YouTube regarding aesthetic fat grafting. MethodsThe terms “fat grafting” and “fat transfer” were searched on YouTube with respect to the terms “face”, “breast”, “buttock”, and “Brazilian butt lift”. Filtered by view count, the top 20 unique, English language, aesthetic surgery-related videos for each search combination were reviewed by three independent reviewers for demographic and descriptive characteristics. Videos were rated for information reliability and quality using the modified DISCERN (MD) tool (1 = low, 5 = high) and global quality scale (GQS) (1 = poor, 5 = excellent). ResultsOut of 80 total videos, 76% were authored by physicians and 24% by laypersons. The overall mean MD score was 1.5 and the mean GQS was 2.6. Videos authored by physicians outscored those by non-medical authors (MD: 1.6 vs. 1.3; GQS 2.7 vs. 2.2). Board-certified plastic surgeon videos (N = 30) scored higher on both the MD (1.7 vs 1.3) and GQS (3.1 vs 2.2) than those of non-medical authors. On the contrary, videos by laypersons and non-plastic surgeons had 40% more views, twice as many “likes” and nearly double as many subscribers. ConclusionThe overall quality of information presented in aesthetic fat grafting procedures videos on YouTube is low and from unreliable sources. Surgeons should educate patients regarding potentially inaccurate information, and professional societies should disseminate high-quality media.

Who is talking about #Facelift on Instagram?

BackgroundThe internet has become a powerful tool for disseminating medical information. Social media platforms have gained popularity among medical professionals to connect with patients and promote their work and practices. We aimed to understand who is posting about facelift procedure on Instagram.MethodsSprinklr, a social listening platform, was used to compile conversations that were posted on Instagram between January 1, 2021, and February 28, 2021, and contained hashtags #facelift, #necklift, #plasticsurgery, #plasticsurgerybeforeandafter, and #platysmabands. English and Spanish language posts were analyzed for positive sentiment. Based on the number of likes, the top 100 English and Spanish posts were selected. Posts were categorized based on primary specialty of the poster as plastic surgeon, non-plastic surgeon, country of active clinical practice, board certification, and members of international plastic surgery societies.ResultsA total of 5099 posts with a total of 11,918 mentions were collected. Of the top 100 English posts, the countries most represented were the USA (59%), followed by Turkey (6%). Physicians made up 48% of the top English posts, of whom 42% were US board-certified plastic surgeons. By contrast, of the top 100 Spanish posts, the countries most represented were Mexico (29%) and Colombia (25%). Physician posters constituted 78%, of whom 38.5% were plastic surgeons certified by their country of practice.ConclusionsPlastic surgeons have become more active in creating popular content related to facelift on Instagram over the past few years. However, a significant percentage of IG content on #facelift, a surgical procedure, was made by non-physicians and non-plastic surgeons in 2021.Level of evidence: Not gradable.

Plastic surgery and specialty creep: an analysis of publication trends.

BackgroundMany surgical specialties have had pioneering influences from plastic surgeons. However, many of these areas of practice have evolved to include surgeons from diverse training backgrounds. This raises the question as to whether the prominence of other specialties in clinical practice translates to greater research productivity in these areas. The objective of this paper is to investigate the publication volumes of plastic surgeons in selected areas of practice compared to surgeons from other disciplines.MethodsPubMed was used to examine publication trends in areas associated with plastic surgery. Searches for the following topics were performed: head and neck reconstruction, hand surgery, breast reconstruction, ventral hernia repair, abdominal component separation, brachial plexus injury, craniofacial surgery, and aesthetic surgery. Affiliation tags were used to examine contributions from nine specialties. Web of Science was used to identify the top cited articles for the last 10 years in each area.ResultsArticles by non-plastic surgeons comprise the majority of the literature for all areas of practice studied except for breast reconstruction and aesthetic surgery. Despite this, plastic surgeons contributed the greatest number of top cited articles over the last 10 years for five of the areas of practice.ConclusionsWhile plastic surgeons do not contribute the greatest proportion of articles published each year in several of the selected areas of practice, they do publish a larger number of articles that are the most cited. Plastic surgeons remain the dominant academic force in terms of volume and citations for both breast and aesthetic surgery.

Expeditionary Plastic Surgery: Reconstruction Pearls for the Non-plastic Surgeon Managing Injured Host Nationals

This review focuses on techniques for reconstructing soft tissue injuries in host nationals that can be performed by non-plastic surgeons in a deployed environment. Advances in wound care technology and techniques have created opportunities to bring world-class care to injured host nationals. Negative pressure wound therapy with instillation can reduce bacterial bioburden, decrease the number of operative debridements, and decrease time to wound closure, saving scarce resources in a deployed setting. Perforator-based pedicle flaps can be utilized to cover large soft tissue defects with minimal donor site morbidity and excellent flap survival. Targeted muscle reinnervation can be performed at the time of an amputation to decrease chronic neuropathic pain. Techniques from simple to complex can be learned and successfully performed by the general, trauma, and orthopedic surgeons in austere locations in order to effectively leverage limited resources for the best outcomes for host nationals.

Update on Liposuction: What All Plastic Surgeons Should Know.

After studying this article, the participant should be able to: 1. Understand the types of tumescence available for liposuction. 2. Explain the various modalities available for liposuction. 3. Describe the patient selection, staging, and complications associated with debulking liposuction. 4. Describe ways to optimize outpatient liposuction. Liposuction is one of the most common procedures performed by board-certified plastic surgeons and is likely greatly underestimated, given underreporting of office procedures and the number of non-plastic surgeons performing these operations. With the ever-increasing popularity of liposuction, various methodologies and technology have been designed to make this task simpler and faster for the surgeon and hasten the recovery for the patient. In the past 10 years, over 50 devices or techniques have been released to assist, refine, or altogether replace liposuction. With the advent of these newer tools, a thorough Continuing Medical Education study was performed to review the available literature.

Factors Associated With Late Admission to Facial Plastic Surgery Among Patients With Long-Standing Facial Paralysis.

Facial plastic surgeons often encounter patients experiencing untreated long-standing facial paralysis who are unaware that their condition can be managed by facial reconstructive procedures. To promote timely admission of patients with facial paralysis for facial plastic surgery, factors associated with late admission should be elucidated. A retrospective chart review was conducted on patients admitted to our facial paralysis clinic. Late admission was defined by an onset-to-admission interval longer than the median value. Multivariable logistic regression analysis was used to assess the odds ratio of late admission with age, sex, etiology, referring physician specialty, and the time of first admission. A total of 199 cases from October 2017 to March 2020 were included. Onset-to-admission interval longer than 21 months (median) was considered late admission. Etiologies involving benign tumors and congenital diseases were significantly associated with late admission (odds ratio [95% confidence interval], 3.9 [1.0-14.4] and 31.7 [4.7-212.6], respectively). Most benign tumor cases were referred from nonplastic surgeons. Benign tumors and congenital diseases were significantly related to late admission of patients with long-standing facial paralysis. As the majority of benign cases were referred from nonplastic surgeons, spreading awareness on facial plastic surgery as a treatment option may be necessary in promoting timely admission.