The Innovation Press: A Primer on the Anatomy of Digital Design in Plastic Surgery.

ABSTRACT: Three-dimensional (3D) printing continues to revolutionize the field of plastic surgery, allowing surgeons to adapt to the needs of individual patients and innovate, plan, or refine operative techniques. The utility of this manufacturing modality spans from surgical planning, medical education, and effective patient communication to tissue engineering and device prototyping and has valuable implications in every facet of plastic surgery. Three-dimensional printing is more accessible than ever to the surgical community, regardless of previous background in engineering or biotechnology. As such, the onus falls on the surgeon-innovator to have a functional understanding of the fundamental pipeline and processes in actualizing such innovation. We review the broad range of reported uses for 3D printing in plastic surgery, the process from conceptualization to production, and the considerations a physician must make when using 3D printing for clinical applications. We additionally discuss the role of computer-assisted design and manufacturing and virtual and augmented reality, as well as the ability to digitally modify devices using this software. Finally, a discussion of 3D printing logistics, printer types, and materials is included. With innovation and problem solving comprising key tenets of plastic surgery, 3D printing can be a vital tool in the surgeon's intellectual and digital arsenal to span the gap between concept and reality.

Controversies in anesthetic management of liver transplantation.

Controversies in the anesthetic management of liver transplantation (OLT) include the exclusion of patients with pulmonary hypertension, intracranial pressure monitoring in patients with fulminant hepatic failure, preoperative screening for coronary artery disease, perioperative use of anticoagulant medications, and early extubation after surgery. This manuscript discusses these controversies from the perspective of two institutions that possess a long tradition of providing liver transplantations for patients with end-stage liver disease.