Faculty Bibliography

Amniotic band sequence (ABS) is a condition in which rupture of the amniotic sac leads to the development of a broad spectrum of fetal anomalies. A newborn male presented at term with multiple craniofacial and skeletal anomalies, including attachment of the placenta to the head, a paramedian facial cleft, and multiple skeletal anomalies. The patient has undergone several operations to date. The initial operation was performed to remove the attached placenta off the underlying dura, which was with a collagen matrix bound to a silicone membrane. The patient subsequently underwent split-thickness skin grafting with complete survival of the graft.

Facial allotransplantation is a clinical reality, proposed to provide improved functional and aesthetic outcomes to conventional methods of facial reconstruction. Multidisciplinary efforts are needed in addressing not just the surgical and immunological issues but the psychological and sociological aspects as well. In view of this, an international survey was designed and conducted to demonstrate that attitudes toward facial allotransplantation are highly influenced by cultural background. Of all countries surveyed, France had the highest percentage of respondents willing to donate their faces (59%) and Iraq had the lowest (19%). A higher percentage of respondents were willing to accepting a face transplant (68%) than donate their face after death (41%). Countries with a dominant Western population show greater percentages of willingness to accept a face transplant, as they exhibit more positive variables, that is, (1) acceptance of plastic surgery for disfigurement and for cosmetic reasons and (2) awareness to the world's first face transplant. Countries with a dominant Western population also show greater percentages of willingness to donate their faces after death, as they exhibit more positive variables, that is, (1) positive attitude to organ donation by being an organ donor themselves, (2) acceptance of plastic surgery if disfigured, and (3) awareness to the world's first face transplant. Although religion was sometimes cited as a reason for not donating their faces, data analysis has shown religion not to be a strong associating factor to willingness to donate a face after death.

BACKGROUND: The authors examined the recent trends in the composition, appointment, and turnover of chairpersons in academic plastic surgery. METHODS: A survey regarding the characteristics of the current and former department chairpersons in plastic surgery was mailed to the 89 existing academic plastic surgery programs. The survey focused on the age, gender, subspecialty, interim tenure, and overall tenure of the two groups. RESULTS: An initial response was received from 60 chairpersons. The majority of current chairpersons are male (81 of 89, 91 percent), which is slightly lower than the group of immediate past chairs, of whom 98 percent (87 of 89) were male. From the questionnaires, it was noted that for both the current and former groups of chairpersons, the 40- to 50-year age range was the most frequent age group at which an individual was appointed to that position. Approximately one-third (35.7 percent) of the current group consider themselves 'general plastic surgeons.' This differs from their predecessors, of whom 56.0 percent reported the same designation. An increase in the promotion of existing faculty to chairpersons was also noted. As compared with 44.2 percent of the previous group, 69.5 percent of the current chairpersons were promoted from within the department. CONCLUSIONS: The population of academic chairpersons in plastic surgery is changing. Today, more chairpersons appear to be younger and specialty trained. Examining the history of academic leadership and identifying trends in any field of medicine can only help to better prepare the specialty for the future

Due to the complex, and often tenuous nature of microsurgical tissue transfer, postoperative monitoring of free tissue flaps plays a vital role in the management of such patients. Some of the more challenging reconstructive problems occur in patients with lower extremity trauma, yet to date, no preferred protocol exists for the postoperative care of lower extremity free flaps. The present study sought to evaluate and assess current preferences in monitoring following lower extremity free tissue transfer. Members of the American Society of Plastic Surgeons (ASPS) were surveyed with regard to their choice for postoperative monitoring and return to dependent positioning ('dangling'). The results demonstrate that there is some agreement among surgeons regarding the optimal means for postoperative monitoring. Most rely on clinical observation in addition to conventional Doppler probe for an average of 4.8 days. Most surgeons follow their own flaps in addition to relying on the residents and nursing staff. The study also notes a wide variety in the times and frequencies at which dangling of the extremity was commenced. Most respondents initiate dangling within 2 weeks of surgery and begin with only 1 to 5 minutes per session

We describe a case of Dabska tumor (DT) occurring within a large congenital lymphangioma circumscriptum on the thigh of a 14-year-old female. Diagnostic biopsy showed numerous intravascular papillary projections lined by atypical endothelial cells within the anastomosing vascular channels of a lymphangioma circumscriptum. DT is regarded as a vascular tumor of intermediate malignant potential, most probably of lymphatic origin. Although it has been described in pre-existing lymphangiomas, to the best of our knowledge this is the first case to be described in a pre-existing lymphangioma circumscriptum. During a follow-up of 9 years, the lymphangioma circumscriptum has recurred, but there has been no evidence of DT recurrence or metastasis

Reconstruction of the lower extremity using free tissue transfer is performed throughout the country by numerous surgical teams. However, no established protocol exists for the use of anticoagulation in the perioperative period. The present study sought to analyze trends in current protocols regarding perioperative anticoagulation for lower-extremity free flap reconstruction. Members of the American Society of Plastic Surgeons were surveyed with regard to their preferences for perioperative anticoagulation in conjunction with lower-extremity free tissue transfer. The results demonstrated tremendous variability in both the agents used and therapeutic periods employed. They highlighted the absence of 1 or more common anticoagulation protocols and tried to establish common trends in the use of such agents

Prior reports have advocated the use of distraction osteogenesis (DO) in the management of neonates with mandibular hypoplasia to avoid early tracheostomy and its associated morbidity. Our center recently reported on the successful use of DO in a neonate with muscular dystrophy, a condition which affects the bone as well as the adjacent skeletal muscle. Herein, we describe the use of neonatal DO for mandibular hypoplasia in the setting of amniotic band sequence (ABS). The child had significant soft tissue contracture in the region of the cheek, associated with bilateral transverse facial clefts. This report highlights the successful utilization of DO for the treatment of mandibular hypoplasia and airway compromise in a patient with ABS

Congenital midline cervical cleft (CMCC) is a rare disorder of the ventral neck that is clinically evident at birth and must be differentiated from the more common thyroglossal duct cyst. The case of CMCC presented here was associated with chromosomes 13/14 de novo Robertsonian translocations as well as midline deformities including a sacral tuft and a minor tongue-tie. The case is presented as well as discussion of histopathology, embryology, and surgical treatment