Systems-based practice: education in plastic surgery

The current Accreditation Council for Graduate Medical Education guidelines separate residents' education into six core competencies or subjects. The authors address the least intuitive of these, systems-based practice. In systems-based practice, educators and residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Plastic surgery is a specialty that is intimately involved with the economics, coordination of care, and real-life experience of resource allocation. It should be avant-garde in the development of a systems-based educational experience and be in the forefront in creating an appropriate and well-thought-out teaching agenda for graduate medical education. The authors explain and expand this definition to include objectives for plastic surgery training, programs, and individual learning goals. A series of didactic lectures, small group discussions, and grand round presentations are suggested to fulfill and facilitate the educational objectives. A potential time allotment and method of objective and subjective evaluations are offered.     

Advances in plastic surgery

The influence of the war period has been reflected in an active trend toward the conservation of time in the execution of reconstructive operations. The myriad improvements in the technique of tissue transplantation and the use of large flaps rather than tubed pedicles have been in keeping with this trend. The goal of the complete restoration of function and appearance applies not only to the correction of post-traumatic defects but also to the cosmetic repair of defects created by the surgical excision of malignant tumors and to correction of congenital anomalies.     

Thromboembolism in plastic surgery

Thromboembolism is a dreaded complication of surgery in multiple disciplines, including plastic surgery, and deep venous thrombosis and pulmonary embolus cause significant morbidity, even death. This article provides methods for understanding and preventing deep venous thrombosis and pulmonary embolus in plastic surgery.     

Priorities in plastic surgery

The study of historical priorities in plastic surgery must be based on established principles in the field instead of mere chronology. Examples of application of these principles to two landmarks in plastic surgery are given. The reader is commended to adhere to these principles in the study of other developments in plastic surgery.     

Apoptosis and plastic surgery

Apoptosis, or programmed cell death, is a phenomenon that is integral to development and cellular homeostasis. In the last decade, many of the essential molecules and pathways that control this phenomenon have been elucidated. Because apoptosis is involved in almost all physiologic and pathologic processes, the understanding of its regulation has significant clinical ramifications. This article reviews the basic understanding of programmed cell death in terms of the effector molecules and pathways. Areas of interest to plastic surgeons are reviewed as they pertain to apoptosis. These areas include allotransplantation, craniofacial and limb development, flap survival, wound healing, stem cell science, and physiologic aging. These topics have not yet been studied extensively in the context of cell death. In this review article, other related and more comprehensively studied scientific areas are used to extrapolate their relevance to apoptosis. Apoptosis is an increasingly better understood process. With the knowledge of how programmed cell death is controlled, combined with the improved ability to effectively perform genetic manipulation and to design specific chemical approaches, apoptosis is gaining clinical relevance. In the next few years, practical clinical breakthroughs will help the medical community to understand the phenomenon of apoptosis and how it relates to the needs of patients.     

Advanced technologies in plastic surgery: how new innovations can improve our training and practice

Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. Reports on simulator applications in medicine now appear regularly in the medical, computer science, engineering, and popular literature. The goal of this article is to review the emerging intersection between advanced technologies and surgery and how new technology is being utilized in several surgical fields, particularly plastic surgery. The authors also discuss how plastic and reconstructive surgeons can benefit by working to further the development of multimedia and simulated environment technologies in surgical practice and training.