Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Oct 2008
Review Case ReportsCommunity-acquired methicillin-resistant staphylococcus aureus: diagnosis and treatment update for plastic surgeons.
: After studying this article, the participant should be able to: 1. Identify risk factors associated with community-acquired methicillin-resistant Staphylococcus aureus. 2. Recognize the clinical presentation of patients with community-acquired methicillin-resistant S. aureus. 3. Understand the treatment and indications for decolonization of patients who have community-acquired methicillin-resistant S. aureus infections. ⋯ : Community-acquired methicillin-resistant Staphylococcus aureus has evolved over the past 10 years as a new health threat seen by plastic surgeons and is an increasing cause of soft-tissue infections. This pathogen has several distinct virulence factors and unique antimicrobial susceptibilities that distinguish methicillin-resistant S. aureus from traditional hospital-acquired methicillin-resistant S. aureus. This article reviews the epidemiology, risk factors, clinical presentation, and treatment of community-acquired methicillin-resistant S. aureus.
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Plast. Reconstr. Surg. · Jun 2008
ReviewOutcome-based residency education: teaching and evaluating the core competencies in plastic surgery.
Through its oversight of residency education in the United States, the Accreditation Council for Graduate Medical Education has mandated new structural changes in resident education with its newly created core competencies and an emphasis on outcomes-based education. These core competencies represent the central areas in which the Accreditation Council for Graduate Medical Education believes a plastic surgery resident should receive adequate and appropriate education and training. In addition, as part of this outcomes-based education, residents are to be evaluated on their level of mastery in these core competencies. ⋯ This shift in residency evaluation initiated by the Outcomes Project by the Accreditation Council for Graduate Medical Education will have a significant impact in how plastic surgery residents are taught and, as importantly, evaluated in the coming years. The objectives of this work were as follows: (1) to outline the different methods available to foster a core competency-based plastic surgery training curriculum and (2) to serve as a primer to help both full-time academic and clinical faculty to further develop their curriculum to successfully teach and constructively evaluate their residents in the core competencies in accordance with the Accreditation Council for Graduate Medical Education guidelines. At the conclusion of this review, the reader should have a better understanding of what is necessary to formulate and help foster a plastic surgery core competency curriculum, particularly with an emphasis on the contemporary methods used for outcomes evaluations.
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After studying this article, the participant should be able to: 1. Describe the pathophysiology of burn injury. 2. Identify patient criteria for transfer to a burn center. 3. Calculate burn size and resuscitation requirements. 4. Treat inhalation injury in the acute setting. 5. Describe treatment options for burn injuries. 6. Describe preoperative selection, intraoperative procedures, and postoperative protocols for patients who require surgical care for their burn injuries. 7. Understand the survival and functional outcomes of burn injury. ⋯ The review article summarizes basic issues in the treatment of acute burn injury as practiced in 2008. The pathophysiology, treatment options, and expected outcomes for an acute burn are described and discussed. Special attention is directed to the nonoperative and surgical management of small to moderate-size burns that might be treated by the practicing plastic surgeon.
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Plast. Reconstr. Surg. · Apr 2008
ReviewMOC-PS(SM) CME article: management considerations in the treatment of craniosynostosis.
After studying this article, the participant should be able to: 1. Recognize the anatomical characteristics of the individual forms of craniosynostosis. 2. Differentiate deformational plagiocephaly from craniosynostosis. 3. Identify the pros and cons of individual types of craniosynostosis operations (i.e., endoscopic craniectomy and open cranioplasty procedures). 4. Understand risks of operative procedure versus the natural history of untreated craniosynostosis. ⋯ The term "craniosynostosis" refers to the premature fusion of one or more cranial vault sutures and its associated skull deformities. The pattern of skull deformities for each of the sutures (metopic, coronal, sagittal, and lambdoid) is characteristic from patient to patient, although variable in the degree of severity. The skull pattern is predictable in that restriction of growth occurs in a plane perpendicular to the plane of the fused vault suture, and compensatory changes occur frequently, parallel to it. When skull deformities are recognized with midfacial and extremity deformities, often the craniosynostosis is referred to as syndromic, implying a genetic basis for the skeletal maldevelopment. Indications for surgery relate to benefits in changing the shape of the skull toward normal and potentially avoiding brain maldevelopment. Brain injury is presumed to be related to local or regional increases in intracranial pressure. A broad range of surgical options to treat craniosynostosis exist, from strip craniectomy to comprehensive, or whole vault, cranioplasty. The optimal surgical timing for these approaches must balance both the desire for early intervention to reduce the effects of bone restriction on brain growth and the ability of a child to withstand the rigors of surgery. Complications of surgery include blood loss, bone defects, and scalp scarring. The most common, significant, postoperative complication, however, is incomplete correction of the skull deformity. Infection in nonsyndromic synostosis surgery is rare. Team management and longitudinal follow-through will aid in determining efficacy and safety of the available surgical approaches.
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Plast. Reconstr. Surg. · Sep 2007
ReviewMeasuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments.
Patient-reported outcomes in cosmetic and reconstructive breast surgery are increasingly important for clinical research endeavors. Traditional surgical outcomes, centered on morbidity and mortality, remain important but are no longer sufficient on their own. Quality of life has become a crucial research topic augmenting traditional concerns focused on complications and survival. Given this, reliable and valid patient questionnaires are essential for aesthetic and reconstructive breast surgeons. ⋯ Valid, reliable, and responsive instruments to measure patient-reported outcomes in cosmetic and reconstructive breast surgery are lacking. To demonstrate the benefits of aesthetic and reconstructive breast surgery, future research to rigorously develop and validate new cosmetic and reconstructive breast surgery-specific instruments is needed.