Can J Plast Surg
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While studies have compared aesthetic outcomes following wide local excision of head and neck melanoma, none have evaluated this important outcome from the patient's perspective. Indeed, one could argue that the psychosocial impact of head and neck melanoma excision and reconstruction is more accurately assessed by deriving patient-based as opposed to surgeon-based outcome measures. ⋯ The degree of emotional impairment following reconstruction of head and neck melanoma excision defects was correlated with the patient's perception of appearance alteration. From the patient's perspective, primary closure and local tissue transfer appeared to result in the highest aesthetic satisfaction.
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The infiltration of local anesthetics can be painful, which is likely due, in part, to their acidity. In spite of a Cochrane study that recommended neutralizing lidocaine with bicarbonate to decrease the pain of injection, not many surgeons have adopted the practice, and there are many 'recipes' for how much bicarbonate one should add. ⋯ Lidocaine with epinephrine was approximately 1000 times more acidic than subcutaneous tissue. The addition of bicarbonate to the local anesthetic solution is simple to perform and is inexpensive. The proper volume ratio of 8.4% sodium bicarbonate to 1% lidocaine with 1:100,000 epinephrine is approximately 1 mL:10 mL. Surgeons should be more aware of the simplicity and value of buffering with bicarbonate to decrease the pain of injection.
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Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada. ⋯ The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.
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Advancements in clinical decision-making are influenced by presentations made at scientific conferences or publications in journals with extensive readership. However, many ideas shared at annual conferences fail to be published, and most surgeons attend these meetings only sporadically. ⋯ From the three North American annual general meetings reviewed, there was a modest conversion rate of mainly reconstructive case series published predominantly in a single journal, Plastic and Reconstructive Surgery. Several years often pass from the genesis of a research hypothesis to final publication, and because the majority of presentations fail to be published, presentations should be observed with a critical eye given the more stringent peer review process and time required for final publication. In an effort to improve conversion rates, departments and faculty members must foster a culture that prioritizes publication.
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The objective of the present study was to determine whether it is possible to consistently and reliably teach medical students and resident learners how to administer local anesthetics in an almost painless manner. Using the published technique, 25 consecutive medical students and residents were taught how to inject local anesthetics for carpal tunnel release by watching the senior author perform the technique once. The learner then independently administered the anesthesia to the next patient who then scored the learner's ability to inject the local anesthetic from a pain perspective. ⋯ All 25 patients rated the entire pain experience to be less than 2/10. Eighty-four per cent of the patients indicated that the experience was better than local anesthetic given at the dentist's office. Medical students and residents can quickly and reliably learn how to administer local anesthesia for carpal tunnel release with minimal pain to the patient.