Outcomes analysis of a resident cosmetic clinic: safety and feasibility after 7 years.

Cosmetic patients have many options when seeking out their surgeons. In midsize and larger cities, these options span not only different specialties but also different levels of experience. Because surgical experience can best be gained first hand, there exists a special and symbiotic relationship between a surgeon-in-training and his or her patient. Benefits stem from the opportunity for a surgeon to gain independent experience while offering cost effective benefits to patients who may or may not otherwise have access to cosmetic surgery. To meet the needs of both patients and the surgeons-in-training, the Wake Forest University Plastic and Reconstructive Surgery Training Program has set up and maintained a chief resident run cosmetic surgery clinic for 17 years. Each chief resident serves as primary surgeon 1 day a week during the chief year. We present a 7-year retrospective outcome analysis of this experience. The authors performed an Institutional Review Board approved retrospective chart review of all patients who received major cosmetic procedures performed in the WFU chief resident clinic over a 7-year span from 2000 to 2007. A total of 210 charts were reviewed. Fourteen charts were excluded because of inadequate records or non esthetic procedures performed concomitantly. All procedures were viewed as independent events. A total of 196 patients underwent 272 procedures. All procedures were evaluated for major and minor complications and revisions. A total number of 272 initial cosmetic procedures were performed in a 7-year span. Adverse events were divided into major and minor complications. There were no major complications for any of the procedures. Overall minor complication rate was 8.0%. Overall revision rate was 14.4%. Procedures with greatest probability of revision were abdominoplasty and reduction mammaplasty. Chief resident clinics provide a unique experience wherein surgeons-in-training are allowed to hone previously developed surgical acumen while providing a safe and expectedly desirable result for their patients. Because many cosmetic patients desire secondary touch up procedures, a rate of 14.4% in this cohort is neither unexpected nor unacceptable. In addition, the postoperative evaluation and the decision to pursue secondary procedures provides a unique perspective to the chief residents. A chief resident run clinic can be an effective and safe learning tool, providing benefit to patient and the surgeon in training.

Surgical treatment for scaphocephaly and a calcified cephalohematoma.

Craniosynostosis is the premature fusion of 1 or more of the cranial sutures, with sagittal synostosis being the most common nonsyndromic single suture synostosis. The pathogenesis of craniosynostosis has been extensively studied and is likely multi-factorial. A complex interaction between the dura and overlying suture via multiple growth factors seems to play the most important role. There have been 3 published studies with patients presenting with scaphocephaly and a cephalohematoma, which raises the question of how the 2 conditions may be related. Cephalohematomas can be seen after trauma and a number of other causative factors but usually resorb over time without sequela. In a small percentage of cases, the hematoma persists and calcifies, leading to significant asymmetry and deformity of the skull. Once it reaches this point, surgical intervention may be required to correct the resulting skull deformity. We present a child with scaphocephaly and a cephalohematoma who underwent surgical correction with resection of the cephalohematoma and sagittal suturectomy with spring-assisted surgery.

Multiple modality treatment regimen in an aggressive resistant fungal hand infection: a case report.

Cutaneous fungal infections are a rare but significant complication associated with immunocompromised states. Lesions allowed to progress to disseminated fungemia are associated with a near 80% mortality rate. Treatment guidelines aimed at local control are vague, centering on wide local excision with systemic antifungal medications. We present the case of a 3-year-old female who, while receiving induction chemotherapy, developed a progressive Aspergillus flavus infection. Involvement included the distal palm and common and proper neurovascular bundles to two fingers. Initial treatments with serial debridement and topical Dakin's solution were unsuccessful in eliminating this fungal infection. A novel treatment using topical voriconazole mixed with Aquaphor® (Beiersdorf AG; Hamburg, Germany) was compounded in the hospital pharmacy to maintain a moist wound healing environment followed by the use of the Vacuum Assisted Closure (VAC®, Kinetic Concepts, San Antonio, TX). Significant improvement was noted within 4 days with this new dressing regimen. Topical voriconazole therapy followed by VAC allowed progressive healing and eventual closure with a split thickness skin graft. The wound was then durably closed, allowing critical chemotherapy to resume. No evidence of systemic fungemia developed, and her clinical recovery preceded laboratory evidence of immune system recovery. Fungal skin infections can be a threat to both life and limb in immunocompromised patients. The armamentarium available to combat this rare but difficult problem is imperfect. In certain infections not responsive to other therapies, the therapeutic regimen described herein should be considered if wide local excision carries significant functional morbidity.