Shock Wave Therapy in Plastic Surgery: A Review of the Current Indications.

BACKGROUND: Extracorporeal shock wave therapy (ESWT) represents a promising, non-invasive management strategy supporting the treatment of a variety of conditions related to plastic surgery. OBJECTIVES: This literature review aimed to give a systematic overview of current applications, its mechanism of action, and its potential to provide tangible therapies in plastic surgery. METHODS: The databases PubMed (National Institute of Health, Bethesda, MD), Embase (via Ovid [Elsevier, Amsterdam, the Netherlands]), and the Cochrane Library (Cochrane, London, UK) were searched for articles published up to June 1, 2021. Clinical studies of any design including ESWT in the context of plastic surgery were included. Two reviewers extracted data, and 46 articles were analyzed after application of the inclusion and exclusion criteria. RESULTS: Forty-six included studies (n = 1496) were categorized into the following broad themes: cellulite/body contouring/skin rejuvenation, burns/scar treatment, diabetic foot ulcers/chronic wound, and future perspectives of ESWT. Overall, applications of ESWT were heterogenous, and the majority of studies reported effectiveness of ESWT as an alternative treatment technique. Flawed methodology and differences in technical standards limit the outcome and conclusion of this review. CONCLUSIONS: There is yet insufficient evidence to support the effectiveness of any specific intervention included in this review; however, all included studies reported improvements in key outcomes. Where reported, ESWT displayed a good safety profile with no serious adverse events. Further research is needed to provide more evidence to delineate the indications of ESWT in plastic surgery.

The treatment of symptomatic fat necrosis: A review and introduction of a new treatment algorithm.

OBJECTIVE: Fat necrosis (FN) is a well-known complication in plastic surgery. Excision of symptomatic FN has been the gold standard, but it often results in contour irregularities that require subsequent treatment. Different alternative surgical and nonsurgical management strategies have been described; however, there are currently no guidelines. This literature review aims to provide an overview of available treatment options and current management standards to support clinical decision making. METHOD: A literature search in the databases PubMed, Embase (via Ovid), and Web Of Science was carried out to identify eligible articles. The search strategy included combinations of the following terms: "Fat necrosis "AND (treatment OR management OR therapy). Six articles discussing or reporting management strategies of FN in a plastic surgery context were included. RESULTS: A variety of techniques were used to manage symptomatic FN. Asymptomatic or small lesions can be treated conservatively. Oil cyst and moderately sized areas of symptomatic FN can effectively be treated by aspiration, ultrasound-assisted liposuction, or needle aeration. Calcified and large areas of FN require excision and debridement of necrotic fat tissue CONCLUSION: At present, there is no consensus on the management of symptomatic FN. The authors propose a new classification system to aid the guidance of management of symptomatic FN.

Dr Jerome Pierce Webster (1888-1974): Surgeon, historian, campaigner, and 'the father of plastic surgery education'.

Dr Jerome Pierce Webster is best remembered as the 'founder of plastic surgery education in the United States' on the basis of developing his nation's first plastic surgery residency programme, his role in the founding of the American Board of Plastic Surgery, and, more generally, his influence in professionalising this subspecialty. He also deserves to be remembered for his extensive missionary work in China, his publications as a successful bibliographer, and as an accomplished historian.