Selection criteria for the integrated model of plastic surgery residency.

BACKGROUND: The purpose of this study was to identify those qualities and characteristics of fourth-year medical students applying for the Integrated Model of Plastic Surgery residency training that will make a successful plastic surgery resident. METHODS: A three-part questionnaire was distributed to the training program directors of the 20 Integrated Model of Plastic Surgery programs accredited by the Residency Review Committee for Plastic Surgery by the Accreditation Council on Graduate Medical Education. The first section focused on 19 objective characteristics that directors use to evaluate applicants (e.g., Alpha Omega Alpha Honor Society membership, United States Medical Licensing Examination scores). The second section consisted of 20 subjective characteristics commonly used to evaluate applicants during the interview process. The third section consisted of reasons why, if any, residents failed to successfully complete the training program. RESULTS: Fifteen of the 20 program directors responded to the questionnaire. The results showed that they considered membership in the Alpha Omega Alpha Honor Society to be the most important objective criterion, followed by publications in peer-reviewed journals and letters of recommendation from plastic surgeons known to the director. Leadership capabilities were considered the most important subjective criterion, followed by maturity and interest in academics. Reasons residents failed to complete the training program included illness or death, academic inadequacies, and family demands. CONCLUSIONS: The authors conclude that applicants who have achieved high academic honors and demonstrate leadership ability with interest in academics were viewed most likely to succeed as plastic surgery residents by program directors of Integrated Model of Plastic Surgery residencies.

Otoplasty: sequencing the operation for improved results.

LEARNING OBJECTIVES: : After studying this article, the participant should be able to: 1. Understand the anatomy and embryology of the external ear. 2. Understand the anatomic causes of the prominent ear. 3. Understand the operative maneuvers used to shape the external ear. 4. Be able to sequence the otoplasty for consistent results. 5. Understand the possible complications of the otoplasty procedure. Correction of prominent ears is a common plastic surgical procedure. Proper execution of the surgical techniques is dependent on the surgeon's understanding of the surgical procedure. This understanding is best founded on an understanding of the historical bases for the operative steps and the execution of these operative steps in a logical fashion. This article describes the concept of sequencing the operation of otoplasty to produce predictable results combining the technical contributions from many authors. The historical, embryological, and anatomic bases for the operation are also discussed. Finally, the authors' preferred techniques are presented. Sequencing the steps in the preoperative assessment, preoperative planning, patient management, operative technique, and postoperative care will produce reproducible results for the attentive surgeon. Careful attention to the details of the operation of otoplasty will avoid many postoperative problems.

A cutaneous manifestation of antiphospholipid antibody syndrome.

Antiphospholipid antibody syndrome is a disease defined by the presence of a hypercoagulable clinical state in association with antiphospholipid antibodies. This syndrome can involve large-vessel thrombosis or thrombotic microangiopathy. Approximately 40% of patients will present with a cutaneous manifestation as the first indication of this disease, with a marked number of patients concurrently developing multiorgan involvement. The authors present a patient with extensive cutaneous necrosis-a devastating sequela of antiphospholipid antibody syndrome. Additionally, multiorgan involvement developed, requiring systemic anticoagulation and supportive care. When medically stable, plastic surgical intervention was necessary to treat extensive areas of cutaneous necrosis. Widespread cutaneous necrosis is a rare but known sequela of this syndrome. Studies have demonstrated that prophylaxis for thrombosis is not effective. However, long-term medical management with oral anticoagulants has been shown to reduce the risk of recurrent thrombosis. Occasionally, plastic surgical intervention is needed to treat the sequelae of this disease. Therefore, knowledge of the presentation and manifestations of this disease is critical in the early detection and prompt treatment of patients to prevent life-threatening consequences of this catastrophic disease process.