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.     

Factors affecting nausea and vomiting in the plastic surgery patient

In plastic and reconstructive surgery, nausea and vomiting are annoying and often dangerous phenomena, yet attempts to suppress them therapeutically may cause physiological actions of an undesirable nature. Nevertheless, it is possible, through clinical observation and the taking of a careful history, to identify many patients who are at highest risk of suffering undue damage from emetic episodes. Skillful selection of surgical and anesthetic measures that safely limit provocation of the vomiting reflex and the careful use of effective antiemetic drugs in patients particularly at risk can effectively reduce the incidence of what may be our patient's most unpleasant and dangerous perioperative experience.     

McArthur revisited: fluorescence microscopes for field diagnostics

Few scientific instruments become eponymous with their inventors. Among those that have is the 'McArthur'. As a student in the 1930s, John Norris McArthur wanted a portable microscope to take on field trips. His rugged pocket field microscope [Mcarthur, J. (1958) A new concept in microscope design for tropical medicine. Am. J. Trop. Med. Hyg. 7, 382-385] remains a classic of compact design and performance, and has been used for malaria diagnosis over several decades. The 'McArthur' has dimensions of 102x63x51mm (McArthur folded the 160mm path length with a prism) and uses phase-contrast and specialised oil immersion objective lenses. Later, a plastic version was developed and further adapted for the Open University by Kirk & Sons, UK [McArthur J. (1971) The McArthur microscope--open university model. Trans. R. Soc. Trop. Med. Hyg. 65, 438].     

González-Ulloa's Manifesto on aesthetic surgery

The realization that the proper development of aesthetic surgery was hindered by a bias against such practice by departmental heads and editors of medical journals led Dr. Mario González-Ulloa from Mexico to formulate a "Manifesto" on this speciality in the 1960s. This Manifesto has been of utmost importance to our speciality because it served to disseminate responsible opinion concerning aesthetic surgery among specialists. Although the bare text of the Manifesto was published in 1966, its content has so far been lost to future generations of plastic surgeons. Because its place in the history of aesthetic plastic surgery needs to be acknowledged, González-Ulloa's Manifesto is presented and discussed here.     

Plastic surgery in the early nineteenth century: notes on the collections in the University of Pavia's Museum of History

The authors present the documents of plastic surgery preserved in the University of Pavia's History of the University Museum. They include clinical papers, drawings, surgical instruments, and anatomic preparations. Most of these documents relate to the activity of Luigi Porta, who was a general and plastic surgeon and professor in the Medical School of the University of Pavia from 1832 to 1875.     

Introduction to 'picturing eggs, embryos and cells'

Some twenty years ago, the historian of technology Henri Michel, who studied the history of instruments, wanted to draw our attention to the images des sciences (Michel 1977). Obviously, an instrument historian is well trained in dealing with pictorial matter, whether it may be blueprints of instruments, or detailed instructions about how to use and improve them. Further, instruments are extremely well suited media to demonstrate that theoretical knowledge has to be practically acquired, whether by making instruments, or by hand drawings. Also, historians of art have extensively worked, published and communicated on the issue of 'science and art' or 'science in art', and how their relationship shaped intellectual and technical history for several decades. As visualization denotes our ability to perceive, and to conceptualize, philosophy in general, and philosophy of science, in particular reflected about it and tried to grasp the scientists' epistemology. Over the last 25 years, an exceptional body of work was published on pictorial representation, either from a socio-cultural perspective, with an emphasis on the technology, or from the epistemic issue of how to conceptualize an eidon.     

Storytelling: Armenian Family Albums in the Diaspora

Armenians were scattered across the world after experiencing the collective pain of massacres and deportation from Turkey in 1915. They are an example of a people who have lived through loss and the brutalities of history. In this article, I trace one response to enduring loss: the role of photograph albums in capturing such historical ruptures. For scholars concerned with life stories, family photos and records serve both as goads to recollection and as aids to their certification. “Seeing” other pasts obviates somehow our requirement for complete recollection from our interviewees. Yet our sense of other people's pasts involves more than this. At times photos portray only frozen, static moments cut off from their lived experiences. At other times these albums are a verification of presence in history.

All the sorrows of life can be borne if only we can make them into stories. Isak Dinesen (Karen Blixen)     

Bone biology and physiology: Part II. Clinical correlates

The principles of bone biology and physiology permeate all subspecialty practices in plastic and reconstructive surgery, from hand surgery to aesthetic surgery. Despite its importance in our practices, these topics rarely surface within textbooks, literature reviews, or residency curricula. The authors present the second portion of a two-part review of the important concepts of bone biology and bone physiology relevant to plastic surgery, in an effort to ameliorate this educational gap.     

World Models in Authors' Stories

The study of world models is currently in a growth phase as efforts are made to create theoretical frameworks and to refine instruments. At the same time, the empirical body of research is being expanded as more and more objects through which world models emerge are identified. Stories are one such object. It is generally known that this specific product of human culture provides very valuable material both for the analysis of psychological problems at the level of the individual and for the study of the attitudes and motivational determinants of society as a whole. In the modern world, stories function primarily as a special form of representation of existing models of reality and of their transmission to the younger generation. However, there appears to be a certain fundamental difference between author-written stories and folk tales, one having to do with the particular aspect of reality that is modeled in them. Folk tales (including folk tales "retold" by well-known compilers) are characterized by the presentation of the hero as an actor or agent and of the overall situation as one in which some goal is achieved. Authors' stories, on the other hand, as works of fiction, orient the reader mainly in the world of human relationships. Intentionally or not, they incorporate models of relationships that circulate in modern-day society. This allows them to be used as an object of study in the investigation of models of interpersonal relationships.     

Bone biology and physiology: Part I. The fundamentals

The principles of bone biology and physiology permeate all subspecialty practices in plastic and reconstructive surgery from hand surgery to aesthetic surgery. Despite its importance in our practices, the biology of bone healing and bone physiology rarely surfaces within textbooks, literature reviews, or residency curricula. In this article, the authors present the first of a two-part series reviewing the important concepts of bone biology and bone physiology relevant to plastic surgery in an effort to ameliorate this educational gap.     

Children's art as a helpful index of anxiety and self-esteem with plastic surgery

Children often cannot adequately express their feelings about physical issues that may be affecting them emotionally. Nonverbal communication with art has been a time-tested tool in understanding and interpreting the feelings of children under stress. For 27 years, the author has used art as a helpful index of anxiety and self-esteem in children undergoing plastic surgery for congenital, traumatic, and aesthetic problems. A child psychiatrist and an art therapist evaluated 200 drawings. The evaluations corroborated the need to "listen" to our patients no matter what their size.     

Material Poetics of a Malay House

Material objects call to us and structure our being. They are not passive, while we are active—rather, they embroil us in their lives as much as we engage them. Hence, sociality is not solely a human function but necessarily involves environments and artefacts. The notion of material poetics is, in this sense, a mutually shaping matrix that affects social life and thought. This philosophy is explored through an encounter with a Malay house. The house is in many ways liminal—a place in which thought and image dwells. It is traditional, yet unique; it holds and expresses history, yet that history is elsewhere and legendary; is Malay but with Chinese decorations, which articulate hybridity; is specifically local, yet involved in national and international flows. It embraces both oscillation and direction. The house is made of wood. This paper takes up this element, showing how the wood not only shelters, but also leads us to venture out to a garden of trees and a dream of jungles where encounters with things, stories and myths subvert our normal categories and expectations. The house leads us places and clears things for us, leading us into a new social field.     

Narrating Professional Development: Teachers' Stories as Texts for Improving Practice

This article traces a systematic, respectful process for using narrative materials as vehicles for teachers' professional development. Ann, a high school history teacher, wrote a series of stories about school experiences, using them as departure points for discussing, thinking, and writing about her ongoing practice in collaboration with the author. The article outlines in detail the methods of narrative inquiry the author employed to safeguard Ann's voice and perspective while supporting her in critical reflection and changed practices     

Telemedicine in plastic surgery: E-consult the attending surgeon

Telemedicine has evolved into a valuable but underused resource for the delivery of health care to patients at a distance, particularly where patient transport is impractical, expensive, complicated, and/or urgent. Today, over 250,000 telemedicine consults are generated annually, involving various specialties in both military and civilian health delivery systems. The ability to evaluate and triage plastic surgery patients through the use of telemedicine has not been widely explored. We have designed, developed, and tested a "store-and-forward" solution at UMass Memorial Hospital and Beth Israel Deaconess Hospital whereby the plastic surgery residents who responded to a consult request transmitted digital photographs by means of the Internet to the attending physician on call. The customary telephone call between resident and attending physician benefited from the additional photographic data, and patient management resulted in a clear, concise, and unambiguous treatment plan. The initial management suggested by the resident was modified on some occasions, particularly with complex problems. The use of digital images was especially helpful for evaluation of radiographs and complex wounds of the hand and face. The solution proved to be very valuable for both attending physicians and residents in plastic surgery. The photographs provide rich detail and resolution comparable to high-quality prints. The mechanics of obtaining images and the process of sending them electronically was readily mastered. Images reached their destination in only a few minutes over standard telephone lines. No problems were encountered while sending or viewing images on Macintosh or Windows platforms. Determining course of action with a complete clinical history now includes a level of visual detail previously not available. As this application expands into wider use, data integrity and safety will have to be more formally secured and monitored. Our model of telemedicine has broad-reaching ramifications for the improvement of health-care delivery locally, nationally, and internationally.     

Aesthetic surgery economics: lessons from corporate boardrooms to plastic surgery practices

Healthcare traditionally has been described as not conforming to the laws of economics. Consumers pay for aesthetic surgery directly, thus freeing it from the usual confounding factors and making it more likely to comply with the market forces explained by economics. Recent studies have demonstrated the ability of classic economics to analyze, predict, and optimize the financial environment of aesthetic surgery. This article describes economic principles and how they can be applied to aesthetic surgery. Some of the basic instruments of economics include the study of supply and demand, prices, and price elasticity; capital investments; communication and cooperation; and consumer cognitive limitations. Each of these tools offers plastic surgeons the opportunity to gain improved control of their financial environment.     

The transformative power of story for healing

One of our goals in this session was, not just to talk about the healing power of narrative, but to experience it as well. Louise Profeit-LeBlanc is one of the presenters we invited specifically because of her skills as a storyteller. She has been heavily involved for several years as both an organizer and a participant in the Yukon Storytelling Festival, held every year in late May in Whitehorse. Woven into her presentation is a useful framework for differentiating various kinds of stories. As she tells us a series of stories, she takes us through a wide range of emotions from grief and loss to laughter and awe. For each of her stories, she gives us some personal contextual information that adds to the story’s meaning and helps us appreciate its significance. Her final story, in particular, is the kind of traditional story that has probably existed for a very long time. Such stories may be told with slightly different emphases, depending on the occasion, but they carry wisdom and value for every generation that hears them.     

Creating long-term benefits in cleft lip and palate volunteer missions

The authors present their experience with 15 years of organizing cleft lip and palate surgical volunteer missions in Latin America. The history, basic principles, and objectives of Operation San Jose, a volunteer goodwill program from Christus St.Joseph Hospital in Houston, Texas, are covered. This report addresses the different problems encountered and solutions found. Following the principles set by Operation San Jose, CIRPLAST is a Peruvian foundation for plastic surgery that travels to remote areas in Peru, operating on patients with cleft lip and palate deformities. This report highlights the importance of working with local plastic surgeons and their residents, and emphasizes that the program should be organized by and the operations performed by accredited plastic surgeons and with the auspices and support of the national plastic surgery society and the local medical board. Operation San Jose promotes the creation of long-term benefits by offering a program to teach local surgeons cleft lip and palate repair techniques and to set up guidelines to organize local surgeons so that they can continue this effort by treating their own patients in their own countries.     

A completely detachable aortic clamping instrument for minimally invasive cardiac surgery

A minimally invasive cardiac surgery is becoming more popular and is still undergoing a refinement of surgical techniques and dedicated instrumentarium as well. New specifically designed instruments are quintessence of safe surgery with improving operative outcomes and comfortable operator-oriented working conditions. In this article, we attempt to present our early clinical experience with a new aortic clamping instrument specifically developed for limited single-access minimally invasive valve surgery.     

Managed care's attempts to capture aesthetic surgery

Managed care organizations recently have attempted to add aesthetic surgery to their line of available services. To better understand the challenges posed by these actions, all members of the American Society for Aesthetic Plastic Surgery were surveyed about managed care overtures to aesthetic plastic surgeons, their responses, and the likely responses of their patients. The goal was to examine both the supplier and consumer ends of the aesthetic surgery market to determine the likely effects of managed care's attempts to capture aesthetic surgery. A total of 632 plastic surgeons returned the surveys (response rate, 54.5 percent). Twenty-two percent reported being approached by managed care organizations about joining a panel of aesthetic surgeons. Approximately one-quarter of the plastic surgeons said they would participate in aesthetic surgery panels developed by managed care organizations. Characteristics significantly associated with willingness to participate were solo practice structure, a low percentage of practice revenues from aesthetic surgery, and a very competitive practice environment. Plastic surgeons believed that their colleagues would be even more willing to acquiesce to managed care aesthetic surgery; more than one-third said that 25 to 50 percent of their colleagues would join, and nearly one-third thought that more than half would participate. Plastic surgeons believed that many of their patients would also participate in managed care aesthetic surgery. Twenty-four percent thought that more than half of their patients would choose an aesthetic surgeon through their managed care organization if that organization developed a network for aesthetic surgery. This figure increased to almost 40 percent if the organization would deny coverage for complications resulting from nonpanel surgeons, and to 41 percent if the organization would offer price discounts. This survey shows that most plastic surgeons are against managed care aesthetic surgery. But it also shows that some plastic surgeons will participate, and that most plastic surgeons think many of their colleagues and patients will do likewise. This means that managed care organizations have the potential to make inroads in aesthetic surgery on both the supplier and consumer ends of the market. To prevent managed care from capturing aesthetic surgery, plastic surgeons must anticipate the likely business strategy of managed care. To this end, they must understand the steps involved in the creation of a new service business and offer organized countermeasures against each of them.