Plastic Surgical Intervention Research Articles

Assessing adolescents and young adults for plastic surgical intervention: pre-surgical appearance ratings and appearance-related burdens as reported by adolescents and young adults, parents and surgeons

Currently available research on psychological aspects of plastic surgery offers little basis for clinical decision making in the plastic surgeon's assessment of adolescents and young adults applying for surgery. Therefore, the research aims were to study: first, how these adolescents and young adults estimate their appearance as compared to their parents and plastic surgeons to determine the reality of their own appearance perception; second, what appearance-related burdens they experience to determine the urgency of their request for surgery; and third, the surgeons' considerations for the operation. Data were obtained from 184 plastic surgical patients aged 12-22 years (71.2% girls), 172 of their parents and 37 surgeons from 16 hospitals in The Netherlands, using appearance rating scales and to surgeons and parents, and reported substantial appearance-related suffering. There was a moderate to large overlap between the adolescent- and parent-reported burdens. In their assessment, surgeons took psychological and social impediments into consideration. In conclusion, plastic surgeons may rightfully assume that adolescents and young adults have a realistic view of their appearance and that they suffer from significant appearance-related burdens. Parents prove to be an important additional source of information.

Complex forefoot injuries in motorcycle couriers

We reviewed all the severe forefoot injuries admitted to two urban hospitals over a 12-month period. These included 13 tarsometatarsal injuries, of which nine occurred in motorcycle couriers. Analysis of these nine patients suggests a combination of direct trauma leading to open multifragmented metatarsal fractures, and indirect force with dorsiflexion and rotation leading to midfoot disruption. In two cases there was significant other trauma which led to delayed treatment. In six of the nine cases, inadequate footwear was noted. All the patients underwent operative reduction and stabilization, and two necessitated later plastic surgical intervention. Our review suggests that motorcycle couriers are at significant risk of severe forefoot and midfoot trauma. A high index of suspicion is necessary when such patients are admitted with multisystem injuries. Education regarding correct footwear is also warranted.

Wound Management in Spinal Infection

Wound management in the spine-infected patient is a complex problem. Treatment is determined by the primary diagnosis, which may have bearing on wound healing. The most common site of wounds requiring plastic surgical intervention in the neurologically intact patient is in the posterior thoracic area. In spinal cord-injured patients, the most common site is in the lumbosacral area. The cause of these wounds are iatrogenic because of infection after attempted thoracic fusion in the first case. In the spinal cord-injured patient it is caused either by postoperative infection or extension of a pressure ulcer in the area of insensate skin. Preoperative preparation is a prerequisite before wound closure. Muscle and myocutaneous flaps represent the best options in managing these complex wounds.

Initial management of severe facial injuries

Severe facial injuries may be treated within the first 12-h-period or delayed for several days while the patient is transferred to an appropriate hospital. The goal of treatment should be optimal primary reconstruction of all the damaged structures. Specialized experience, instruments and a well-equipped operative theatre are necessary. Adequate primary treatment may so prevent functional losses or deficits and mutilations and reduce secondary plastic surgical interventions to a minimum. Typical case examples are demonstrated.

PLASTIC SURGERY, 1939

Plastic and reconstructive surgery will be extended in its applications by the development of a skin grafting knife by Padgett for the precision cutting of large calibrated skin grafts and by the researches of O'Connor proving the feasibility of using stored refrigerated human cartilage as grafts. The educational and professional requirements for designation as a specialist in this branch of surgery are being formulated by the American Board of Plastic Surgery. Recommendations concerning preliminary training have been made to the young physicians wishing advice as to the best way to approach the specialized studies. Examinations leading to certification by the board will be undertaken soon. The literature in plastic surgery for 1939 has been divided according to the following subjects: ( 1 ) nature, scope and limitations of plastic surgical intervention; ( 2 ) results of clinical and laboratory research—general principles; ( 3 ) plastic operations on the face; ( 4 ) plastic operations on the nose;

PLASTIC SURGERY, 1938

Plastic surgery has its roots in general surgical practice and is modified to meet local needs in various parts of the body. Its literature originates in several main channels, particularly general surgery, military surgery, and ophthalmologic, otolaryngologic and oral surgery. This summary is based on the literature of 1938 derived from these sources, arranged under topical or regional anatomic headings. SCOPE OF, INDICATIONS FOR AND LIMITATIONS OF PLASTIC SURGICAL INTERVENTIONS Straith and DeKleine l studied the role of plastic operations on childen particularly from a psychologic point of view. Congenital defects such as harelip, cleft palate, lop ears and webbed fingers and various acquired deformities not only carry with them functional disabilities and cosmetic peculiarities but may have a retarding and deleterious effect on the child's mental and social development. These considerations suggest that plastic correction should be undertaken as soon as it is possible in children. Wodak 2 contributes a detailed