The use of autologous platelet-leukocyte-enriched plasma to minimize drain burden and prevent seroma formation in latissimus dorsi breast reconstruction.

INTRODUCTION: Seromas and drains are major sources of morbidity associated with latissimus dorsi breast reconstruction. Our goal was to look at an autologous platelet-leukocyte-enriched plasma spray and to assess its efficacy in reducing drain burden and seroma formation. METHODS: We performed a single surgeon, patient-controlled, blinded study on bilateral latissimus dorsi breast reconstruction patients in which we applied autologous platelet-leukocyte-enriched plasma to one side and measured drain amounts, time to drain removal, and seroma rate. RESULTS: Twelve patients were included in this study. The average age was 41.1 years, and the average body mass index was 21.6 kg/m. Average volume of drain output showed neither difference (789 mL spray side vs. 790 mL control side) nor average time to drain removal (11.83 days spray side vs. 11.5 days control side). There were 2 complications reported: 1 hematoma (8.33%) and 1 seroma (8.33%) that required aspiration in a postoperative visit. CONCLUSIONS: It appears after 12 patients that there is no demonstrable difference regarding drain output, time to drain removal, or seroma incidence between the study and the control group. We feel a larger study population would add power and confirm these findings.

The independent plastic surgery match: an in-depth analysis of the applicants and process.

BACKGROUND: The independent plastic surgery match is an extremely competitive process that remains the most common training model for residents. The purpose of this study was to analyze the candidates and the overall process, both quantitative and qualitatively. METHODS: Between 2006 and 2008, an anonymous 25-question online survey was sent to all applicants of the match. Questions regarding demographics, the match process, financial burden, and qualitative issues were all included. Information from the American Board of Plastic Surgery and The San Francisco Match was also used to evaluate the application and distribution process. RESULTS: A total of 137 applicants responded (29.2% response rate). Of the responders, 62.5% were aged 30 to 34 years, 77.2% male, 66.2% white, 94.1% in general surgery residencies, and 66.2% at an academic setting, with 39.7% at an institution that also had a plastic surgery residency program. For successful matchers, an average of 13.6 invitations were awarded, 10.02 interviews were attended, and they matched to number 2.52 on their list. Of all, 64.5% spent more than $4000 on the process, whereas 9.2% spent more than $10,000. Applicants receiving 1 to 4, 5 to 9, and 10 or more interviews had successful match rates of 47.2%, 62.9%, and 92.9%, respectively. In all, 45% of unsuccessful applicants stated that the stress on themselves and their family was the number one reason to not reapply. CONCLUSIONS: Candidates applying to the independent plastic surgery match need to be aware of the competitiveness and financial commitment the process requires.

Overview and management of sternal wound infection.

Sternal wound infection is a life-threatening complication after cardiac surgery associated with high morbidity and mortality. Past treatment options have included closed suction and continuous irrigation. Current paradigms in the management of sternal wound infection include surgical debridement, vacuum-assisted closure therapy, flap coverage, and sternal plating. We provide a general overview of sternal wound infection and treatment options for the plastic surgeon.

Laparoscopic treatment of simultaneously occurring pyloric stenosis and malrotation.

Hypertrophic pyloric stenosis (HPS) is a common cause of nonbilious vomiting in the neonatal period with an incidence of approximately 1 to 3 per 1000 live births. The Ramstedt pyloromyotomy has been the standard treatment since 1912. In 1991, Alain et al. reported a novel approach to HPS using laparoscopy. Since this original description, the laparoscopic pyloromyotomy has become progressively more popular and, in many institutions, has replaced the open approach. Similarly, malrotation is a condition affecting the neonatal population, resulting from incomplete intestinal rotation about the superior mesenteric artery during weeks 10 through 11 of development. If left untreated, it can lead to abnormal mesenteric attachments and a narrowed mesenteric base, placing the patient at risk for midgut volvulus. The standard surgical treatment has been the open Ladd procedure first described in 1932. In 1996, Gross described a minimally invasive procedure to address malrotation. The association of concurrent pyloric stenosis and malrotation has rarely been reported in the pediatric literature. This is the first published report of a laparoscopic treatment of HPS and malrotation simultaneously.

Do medical students respond empathetically to a virtual patient?

BACKGROUND: Significant information exchange occurs between a doctor and patient through nonverbal communication such as gestures, body position, and eye gaze. In addition, empathy is an important trust-building element in a physician: patient relationship. Previous work validates the use of virtual patients (VP) to teach and assess content items related to history-taking and basic communication skills. The purpose of this study was to determine whether more complex communication skills, such as nonverbal behaviors and empathy, were similar when students interacted with a VP or standardized patient (SP). METHODS: Medical students (n = 84) at the University of Florida (UF) and the Medical College of Georgia (MCG) underwent a videotaped interview with either a SP or a highly interactive VP with abdominal pain. In the scenario, a life-sized VP was projected on the wall of an exam room in SP teaching and testing centers at both institutions. VP and SP scripted responses to student questions were identical. To prompt an empathetic response (ie, acknowledging the patients' feelings), during the interview the VP or SP stated "I am scared; can you help me?" Clinicians (n = 4) rated student videotapes with respect to nonverbal communication skills and empathetic behaviors using a Likert-type scale with anchored descriptors. RESULTS: Clinicians rated students interacting with SPs higher with respect to the nonverbal communication skills such as head nod (2.78 +/- .79 vs 1.94 +/- .44, P < .05), and body lean (2.97 +/- .94 vs 1.93 +/- .58, P < .05), level of immersion in the scenario (3.31 +/- .49 vs 2.26 +/- .52, P < .05), anxiety (1.16 +/- .31 vs 1.45 +/- .33, P < .05), attitude toward the patient (3.24 +/- .43 vs 2.89 +/- .36, P < .05), and asking clearer questions (3.06 +/- .32 vs 2.51 +/- .32, P < .05) compared to the VP group. The students in the SP group also had a higher empathy rating (2.75 +/- .86 vs 2.16 +/- .83, P < .05) and better overall rating (4.29 +/- 1.32 vs 3.24 +/- 1.06, P < .05) than the VP group. Empathy was positively correlated with the observed nonverbal communication behaviors. Eye contact was the most strongly correlated with empathy (r = .57, P < .001), followed by head nod (r = .55, P < .001) and body lean (r = .49, P < .001). CONCLUSIONS: Medical students demonstrate nonverbal communication behaviors and respond empathetically to a VP, although the quantity and quality of these behaviors were less than those exhibited in a similar SP scenario. Student empathy in response to the VP was less genuine and not as sincere as compared to the SP scenario. While we will never duplicate a real physician/patient interaction, virtual clinical scenarios could augment existing SP programs by providing a controllable, secure, and safe learning environment with the opportunity for repetitive practice.

A simple and inexpensive method of preoperative computer imaging for rhinoplasty.

UNLABELLED: GOALS/PURPOSE: Despite concerns of legal liability, preoperative computer imaging has become a popular tool for the plastic surgeon. The ability to project possible surgical outcomes can facilitate communication between the patient and surgeon. It can be an effective tool in the education and training of residents. Unfortunately, these imaging programs are expensive and have a steep learning curve. The purpose of this paper is to present a relatively inexpensive method of preoperative computer imaging with a reasonable learning curve. MATERIALS AND METHODS: The price of currently available imaging programs was acquired through an online search, and inquiries were made to the software distributors. Their prices were compared to Adobe PhotoShop, which has special filters called "liquify" and "photocopy." It was used in the preoperative computer planning of 2 patients who presented for rhinoplasty at our institution. Projected images were created based on harmonious discussions between the patient and physician. Importantly, these images were presented to the patient as potential results, with no guarantees as to actual outcomes. RESULTS: Adobe PhotoShop can be purchased for 900-5800 dollars less than the leading computer imaging software for cosmetic rhinoplasty. Effective projected images were created using the "liquify" and "photocopy" filters in PhotoShop. Both patients had surgical planning and operations based on these images. They were satisfied with the results. CONCLUSIONS: Preoperative computer imaging can be a very effective tool for the plastic surgeon by providing improved physician-patient communication, increased patient confidence, and enhanced surgical planning. Adobe PhotoShop is a relatively inexpensive program that can provide these benefits using only 1 or 2 features.