An unusual presentation of presentation of a branchial cleft cyst.

Branchial cleft cysts are congenital anomalies that arise from the aberrant embryological development of the branchial apparatus. The location of a branchial cleft cyst is determined by which branchial cleft failed to obliterate during embryological development, with the second branchial cleft cyst being the most commonly recognized lesion. Although the most common location for branchial cleft cysts is between the external auditory canal and the level of the clavicle, the literature does describe unusual locations. We present a case a 15-year-old boy who had an enlarging lesion on his back that had been present since birth. A presumptive radiologic diagnosis of lymphangioma circumscriptum was made. Upon excision of the lesion and pathologic examination, it was determined to be a branchial cleft cyst. The patient had an uneventful postoperative course, and no recurrence was noted after a 2-year follow-up. Our clinical report demonstrates a lesion on the posterior thorax that proved to be a branchial cleft cyst and should always be part of the differential diagnosis for soft tissue masses of the thorax.

Political Advocacy from Plastic Surgery Trainees in the United States.

Legislature directly impacts the practice of physicians across multiple specialties. The goal of our study is to investigate the political engagement and opinions of plastic surgery trainees, and how they perceive legislation impacts future practice. METHODS: A 24-question survey was designed and distributed to all program directors and Resident Council members within the American Society of Plastic Surgeons. This initiative was driven by the board and directors and supported by the Resident Council. The Resident Council is a trainee-driven committee within the American Society of Plastic Surgeons that communicates with the Board of Directors. RESULTS: This survey generated a 10.3% response rate with 118 responses out of 1143 trainees in ACGME accredited institutions. When asked in an open-ended fashion to list the most important reason why one planned to vote in the 2020 election, only 6.8% listed healthcare as a factor. Eighty-four percent of respondents believe that their vote impacts future legislation and regulation. Ninety-four percent strongly agree or agree that political legislation affects reimbursement. CONCLUSIONS: With only 10.3% of trainees responding, there is a concern that political activity is not a priority for plastic surgery trainees. Plastic surgery trainees are attending summits, meeting with politicians, writing letters, and attending fundraisers. Respondents are overwhelmingly voting and planning to vote in elections, though few list healthcare as a reason. A future goal must be to motivate trainees to consider the intersection between healthcare and plastic surgery.

Cutaneous Cholangiocarcinoma: An Interesting Presentation.

This is a case of a 64-year-old white man with a history of CCA, originally diagnosed in May 2018 and returning in November 2019 with growing cutaneous nodules. These were removed for cosmetic and functional purposes. Pathologic findings of the lesions showed likely metastatic disease from his original CCA. This represents a relatively rare presentation of metastatic disease in the setting of CCA. In cases of CCA with metastatic spread, treatment is not curative and should be focused on measures to improve the patient's quality of life. This includes acceptable cosmesis, as well as factors aiding in completing activities of daily living.

Patient Advocacy in Plastic Surgery: An Underutilized Tool.

Healthcare advocacy is an important tool in the plastic surgeon's arsenal that stands the potential to improve both patient care and the profession. However, many physicians underestimate the importance and influence that healthcare advocacy has on the profession and feel that they lack the leverage and knowledge to advocate on behalf of themselves, their practices, their patients, and their profession, all of which are untrue. Plastic surgeons are uniquely positioned to advocate based on their clinical acumen, personal experiences with patient care, and their position in the healthcare ecosystem value chain. This article aims to equip plastic surgeons with a general framework of knowledge regarding policy and advocacy. Additionally, the article outlines and discusses recent advocacy efforts related to plastic surgery, and efforts that are on the horizon to provide some context to the relevance of advocacy related to plastic surgery. Finally, we aim to empower plastic surgeons to step into the policy advocacy arena for the betterment of our patients and the professional practice of plastic surgery.