Wendell L. Hughes' life and contributions to plastic surgery

Wendell L. Hughes was a pioneer in ophthalmic plastic surgery and best known for the "Hughes flap," a tarsoconjunctival flap used for lower eyelid reconstruction. In 1937, Wendell L. Hughes sought to achieve the criterion standard of replacing "like with like" in his development of the tarsoconjunctival flap for lower lid reconstruction. This work was published in his ground-breaking thesis, Reconstructive Surgery of the Eyelids, the most comprehensive book on ophthalmic plastic surgery of its time. Although this flap has undergone many modifications, it has stood the test of time and is still used today. In addition, Dr. Hughes was heavily involved in surgical education, a founding member of the American Board of Plastic Surgery, and a leader in the development of sutures and microneedles. More importantly, he was a gracious humanitarian and inspiring mentor loved by peers and patients alike. Other authors have reviewed the intricacies of the Hughes flap; however, little attention has been given to the contributions of its creator.     

Vilray P. Blair, his surgical descendants, and their roles in plastic surgical development.

Perhaps one of the most historically well-known plastic surgeons is Vilray P. Blair. As commander of the U.S. Army corps of head and neck surgeons during World War I, he became well known for his work in posttraumatic reconstruction. Blair's efforts in the early part of this century helped to develop plastic surgery as a distinct surgical subspecialty in the United States. His prowess as a surgeon allowed him to build one of the largest plastic surgery centers in the country and to train many of the top young American surgeons. Blair excelled as a teacher. He produced academic surgeons such as James Barrett Brown and Bradford Cannon, who took the lead in the care of wartime injuries during World War II. At Valley Forge General Hospital, Blair's trainees dedicated themselves to the reconstruction of injured patients and trained other young plastic surgeons in the care of postwar trauma. This exceptional level of patient care resulted in the U.S. government recognizing plastic surgery as a subspecialty following World War II. Since that time, Blair's surgical descendants at Washington University have led the country in the development of new training concepts and ideals and have gone on to become leaders in plastic surgery worldwide.     

History offhand: a golfer's needleholder

Sir Harold D. Gillies was the father of modern plastic surgery. Apart from being an extraordinary surgeon, he was an innovator of surgical instruments and an outstanding golfer. He adopted Kocher's suture scissors and converted them for needleholding. The authors believe that the surgeon Gillies adapted this needleholder to fit his golfer's hand.     

Safety and efficacy in an accredited outpatient plastic surgery facility: a review of 5316 consecutive cases

Advances in medicine have improved the delivery of health care, making it more technologically superior than ever and, at the same time, more complex. Nowhere is this more evident than in the surgical arena. Plastic surgeons are able to perform procedures safely in office-based facilities that were once reserved only for hospital operating rooms or ambulatory surgery centers. Performing procedures in the office is a convenience to both the surgeon and the patient. Some groups have challenged that performing plastic surgery procedures in an office-based facility compromises patient safety. Our study was done to determine whether outcomes are adversely affected by performing plastic surgery procedures in an accredited outpatient surgical center. A retrospective review was performed on 5316 consecutive cases completed between 1995 and 2000 at Dallas Day Surgical Center, Dallas, Texas, an outpatient surgical facility. Most cases were cosmetic procedures. All cases were analyzed for any potential morbidity or mortality. Complications requiring a return to the operating room were determined, as were infection rates. Events leading to inpatient hospitalization were also included. During this 6-year period, 35 complications (0.7 percent) and no deaths were reported. Most complications were secondary to hematoma formation (77 percent). The postoperative infection rate for patients requiring a return to the operating room was 0.11 percent. Seven patients required inpatient hospitalization following their procedure secondary to arrhythmias, angina, and pulmonary emboli. Patient safety must take precedence over cost and convenience. Any monetary savings or time gained is quickly lost if safety is compromised and complications are incurred. The safety profile of the outpatient facility must meet and even exceed that of the traditional hospital-based or ambulatory care facility. After reviewing our experience over the last 6 years that indicated few complications and no deaths, we continue to support the judicious use of accredited outpatient surgical facilities by board-certified plastic surgeons in the management of plastic surgery patients.     

Sir William Jardine and the Ichnology of Annandale

ABSTRACT

Sir William Jardine was a polymath; he was one of the world's foremost ornithologists, and ichthyologists, as well as a knowledgeable geologist, entomologist and botanist. He was a talented and skilled artist and engraver and a keen hunter and fisherman. He was also the author of the book The Ichnology of Annandale that represents the first book ever published on the subject of ichnology. It was here in this volume that Jardine coined the word ichnology. It is also one of the rarest ichnology publications, as it is believed that only 135–140 copies were ever printed. This volume remains the most lavishly illustrated book in vertebrate ichnology literature. This paper discusses the work of Jardine, the finds from his estate and his role in defining ichnology as a science.     

Autotransfusion in elective plastic surgical operations

One-hundred and eight patients undergoing elective major plastic surgical procedures, primarily reduction mammaplasties, have been autotransfused. Units of blood were harvested 1 and/or 2 weeks before the operation. At the time of the surgery, the patient's hematocrit and hemoglobin had almost returned to predonation level and active reticulocytosis was occurring. No patients in this group had any problems from phlebotomy or autotransfusion. These autotransfused patients felt better, were less anxious about acquiring a transmitted disease, and returned to work or school activities earlier than those in the control groups. Autotransfusions are safe and effective and this pilot study indicates that they should be considered for patients undergoing major elective procedures.     

Gustav Senn(1875–1945): The pioneer of chloroplast movement research

Gustav Senn analyzed for the first time light-induced movement and arrangement of chloroplasts. Using many plant species he performed physiological analyses of chloroplast migration in response to exte...     

The integral role of the plastic surgeon at a level I trauma center

The role of plastic surgery in urban level I trauma centers in the United States has been largely undefined, despite the undeniable historical involvement of plastic surgery in reconstruction of posttraumatic defects. To explore and define this role, case data were prospectively collected during a 29-month period following initiation of a full-time plastic surgery position at an established urban level I trauma center. Referring and/or interacting surgical service, anatomical area of interest, and procedure data were tabulated. A total of 1009 operative reports comprising 1104 procedures were recorded. The most common interacting surgical services were orthopedics and general/trauma surgery; however, interaction occurred with a total of 10 surgical specialties. The upper extremity was the most common anatomical area operated on followed by head and neck, lower extremity, trunk, urogenital, and breast. A wide variety of procedures were performed in each anatomical area, demonstrating the broad scope of reconstructive surgery practiced in a trauma setting. Three hundred and twenty-four procedures involved expertise in microsurgery, flaps, and burn or frostbite care. Additional procedures commonly performed demonstrated considerable overlap with other fields of surgical specialization. This overlap in skills proved advantageous in distribution of facial trauma call and hand surgery coverage. Data presented in this study reinforce the idea that plastic surgery is a specialty defined by concept rather than anatomical area, and also demonstrate a significant role for plastic surgeons in a level I trauma center.     

Biological adaptabilities and quantum entropies.

The entropy-based theory of adaptability set forth by Michael Conrad in the early 1970s continued to appear in his work for over two decades, and was the subject of the only book he published in his lifetime. He applied this theory to a host of subjects ranging from enzyme dynamics to sociology. This paper reviews the formalism of adaptability theory, clarifying some of its mathematical and interpretive difficulties. The theory frames the computational tradeoff principle, a thesis that was the most frequently recurring claim in his work. The formulation of adaptability theory presented here allows the introduction of quantum entropy functions into the theory, revealing an interesting relationship between adaptability and another one of Conrad's deep preoccupations, the role of quantum processes in life.     

Deficiencies in soviet medicine

On the eve of the 1984 Summer Olympics, a deranged man drove his car at high speed onto a pedestriancrowded sidewalk in a suburb of Los Angeles. The UCLA Medical Center, located two blocks from the scene, received 17 of 51 casualties. One patient arrived in full cardiac arrest and could not be resuscitated. Six had minor injuries or temporary hysteria and did not require admission to hospital. The mean injury severity score of the 10 patients who were admitted was 13.6 (range 3 to 48). Three patients required immediate surgical procedures, and two had delayed orthopedic operations. Specialty consultations were needed in orthopedics, neurosurgery, plastic surgery, otolaryngology, pediatric surgery, and pediatric intensive care. There were no subsequent deaths, although two patients had substantial residual neurologic disability. This episode of unexpected urban violence underscores the need for dedicated trauma services in university centers. Functions of such services include disaster planning, deploying surgical personnel, managing injured patients, and analyzing outcomes.     

Decision Theory and the Concept of Threshold in Psychophysics

Psychophysics deals basically with how signals are perceived. It is assumed that a signal or stimulus is perceived after it reaches a certain threshold value, called the sensory threshold. Thus, there are two possible states: either a signal is perceived by the neuronal system, or it is not. Fechner deserves most of the credit for the concept of the sensory threshold and for detailing the various techniques for measuring it. A discussion of this cardinal concept may be found in his book Elemente der Psychophysik (1860), although the idea is actually of much earlier origins: Leibnitz and Herbart certainly spoke of it, and indeed it seems to have been considered even by ancient Greek philosophers. Methods for measuring the sensory threshold were known even before Fechner; his contribution was being the first to systematize and perfect them. It is for this reason that his book (Elemente) is considered basic.     

Victor von Bruns (1812-1883) and his contributions to plastic and reconstructive surgery

Victor von Bruns was an active surgeon in Germany during the nineteenth century. His work is accompanied by many illustrations, and a selected few are presented in this survey. His original contributions to plastic and reconstructive surgery are notable, mainly in lip and cheek reconstruction. These are still valid today and have been adopted by many plastic surgeons. His books dealt not only with plastic surgery, but with almost every surgical event, such as amputation, larynx surgery, galvanosurgery, and war surgery. His publications and illustrations give an excellent picture of the advances made by him and other plastic surgeons during the second half of the nineteenth century, thus making him an important contributor to the renaissance of plastic surgery.     

General anesthesia in an office-based plastic surgical facility: a report on more than 23,000 consecutive office-based procedures under general anesthesia with no significant anesthetic complications

The popularity of elective office-based plastic surgery has increased significantly over the past two decades. The continuing demand for improved aesthetic results has stimulated the development of ever more complex plastic surgical techniques. These techniques may require extended periods of operative time spent under anesthesia. Patients have come to expect an almost perfect anesthetic and surgical experience, with safety and comfort being their foremost concerns. Because of increasingly complex and lengthy operations, the authors believe that intravenous sedation, used for many years in their plastic surgery practice, is now suboptimal for most longer and complex surgical procedures. In their experience, under most circumstances, general anesthesia provides the optimal anesthetic experience for the patient, anesthesiologist, and surgeon. The authors present a consecutive 18-year study of general anesthesia in more than 23,000 procedures in an accredited, office-based plastic surgical facility that offers a very safe and uniformly pleasant anesthesia experience for patients. There were no intraoperative or postoperative deaths and no significant complications. The authors' experience differs from the common perception that general anesthesia is too risky for aesthetic surgery procedures.     

Two new procedures for plastic surgical repair, as used in a shotgun injury of the hand.

We report a shotgun injury of the hand, in which two new procedures for plastic surgical repair were carried out. These procedures may be applicable elsewhere in plastic surgery.     

Rectus abdominis myocutaneous free-flap reconstruction following a cranio-orbital-maxillary resection for neurofibrosarcoma

An unusual case of neurofibrosarcoma of the cranio-orbital-maxillary region was resected by a combined neurosurgical and plastic surgical team. The resulting defect was reconstructed in one stage with a free rectus abdominis myocutaneous flap, obviating the need for subsequent prosthetic obturation of the maxillary defect. This reconstructive technique expedited the patient's convalescent period, allowing him to return to work 3 weeks following surgery. Wound healing was uneventful, and the cosmetic result was acceptable to the patient.     

Malignant hyperthermia in plastic surgery

Malignant hyperthermia is a seemingly rare genetic myopathy. Hypermetabolic crisis accompanied by a rise in body temperature to as high as 44 degrees C is its hallmark. Malignant hyperthermia is usually triggered by potent inhalated anesthetics and/or depolarizing muscle relaxants. Because of the extraordinary risk of death in patients who are at risk, plastic surgeons may be reluctant to operate on these patients. Five such patients were referred to the Plastic Surgery Service and the UCLA Malignant Hyperthermia Center for anesthetic and surgical management following plastic surgical procedures aborted for first episodes of malignant hyperthermia. They were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants. The patients were not treated prophylactically with dantrolene. Cardiac monitoring, end-tidal pCO2, and rectal temperatures were followed. After completion of their plastic surgical procedures, all five patients had a vastus lateralis muscle biopsy performed and subsequent caffeine/halothane contracture studies completed. The contracture study was positive in all patients studied. No anesthetic or surgical complications were encountered. This study demonstrates that patients at risk of developing malignant hyperthermia crisis can have plastic surgical procedures performed safely while undergoing appropriately selected general anesthesia.     

Ernst Blasius's contributions to plastic surgery

Blasius was a famous teacher and surgeon. Apart from his own writings on surgery and his new methods for reconstructions, such as the replacement of nose, lips, and eyelids, some theses were also inspired by him. His main work is his three-volume Handbuch der Akiurgie, to which he added an excellent atlas, from which a few illustrations are presented here. His books dealt not only with reconstructive problems, but also with almost every surgical event, e.g., amputations, laparotomy, dental extraction, and so on. Blasius's efforts were concerned with overcoming and preventing the worsening of the shape of newly reconstructed noses, lips, and eyelids due to secondarily healed scars, which was the common practice of the great surgeons of his time, such as von Graefe and Dieffenbach. Therefore, his efforts were toward the primary closure of wounds. In rhinoplasty, Blasius extended the forehead flap into three long points, and then extensions were made by infolding them. Furthermore, he mentioned the first use of a nasolabial flap to reconstruct the lower eyelid. Moreover, Blasius laid down basic principles in flap surgery, such as the V-Y plasty and probably the earliest record of the Z-plasty. His publications and illustrations give an excellent picture of the great advances made by him during the first half of the nineteenth century, thus making him an important contributor to the renaissance of plastic surgery.     

The noble enigma: Chagas' nominations for the Nobel prize

Carlos Chagas, a Brazilian physician, discovered the American trypanosomiasis in 1909. Like other remarkable discoveries of those days, his work helped to articulate the insect-vector theory and other theoretical guidelines in tropical medicine. Unlike all other discoveries, all the stages of this work were accomplished in a few months and by a single man. Chagas' discovery was widely recognized at home and abroad. He was twice nominated for the Nobel Prize - in 1913 and in 1921-, but never received the award. Evidence suggests that the reasons for this failure are related to the violent opposition that Chagas faced in Brazil. The contentions towards Chagas were related to a rejection of the meritocratic procedures that gave him prominence, as well as to local petty politics.     

Paul Bert, scientist and politician

Paul Bert worked with Claude Bernard, one of the leading physiologists of the 19th century. In his laboratory at the Collège de France in Paris, Paul Bert carried out fascinating experiments in particular on respiratory processes, leading him to publish "La pression barométrique" in 1878. In this book are recalled his discovery of oxygen pressure decrease with altitude, divers diseases, the improved safety protocols in hyperbaric conditions, and the first development of gas anaesthetics for surgery. He was the third President of the Société de Biologie. Paul Bert was also a politician with strong convictions. Minister of Education under Gambetta's short term government, he initiated the fight for social equality and secular education and became one of the most prestigious figures of the developing socialist party. He received many distinctions and was given a state funeral.