Practicing Plastic Surgeon Research Articles

CONTEMPO '87 Crushes Disturbs, Saddens, Amazes, and Disappoints

To the Editor. —As a member of the American Medical Association and a practicing plastic surgeon, I read with great interest the CONTEMPO '87 series of state of the essays.1I am saddened and amazed thatJAMAchose to ignore the specialty of plastic surgery for the second year in a row. This is especially surprising when one considers the important and innovative contributions made by plastic surgeons in the fields of microsurgical free-tissue transfer, skin allografting and skin substituting, care of complex congenital and traumatic craniofacial deformities, and functional muscle transfer. In the same issue, an essay was included about innovations made in the field of otolaryngology, citing tissue expansion and the pectoralis flap as new contributions, referencing 1986 journal articles. The tissue expander was developed by Radovan2and presented to the plastic surgery community more than ten years ago, and modifications and new applications have

Monitoring the Plastic Surgical Patient

Monitoring has now developed to the extent that it is widely accepted if used properly and that it benefits patients at great risk. We must accept the place that monitoring now occupies, as aptly put by the late Myron Laver, "What we once considered appropriate for the academic environment has now become mundane and almost a mandatory maneuver if we are to navigate the ill through their complex physiological and biochemical perturbations. We are no longer limited to the recording of heart sounds and electrical activity." We now have the capabilities of monitoring physiologic parameters that can affect the course of the surgical patient. When applied with logic based on physical and historic information, invasive and noninvasive hemodynamic-pulmonary monitoring can be extremely helpful to the practicing plastic surgeon.