Putting it all together: recommendations for pain management in nonsurgical facial rejuvenation.

BACKGROUND: Nonsurgical procedures for facial rejuvenation vastly outnumber surgical procedures among board-certified plastic surgeons; interest in nonsurgical cosmetic procedures is rapidly growing for patients and physicians, with less down time, less scars, and potentially less cost. Nonsurgical procedures are often a gateway for patients into more invasive surgical procedures. Providing patients with a comfortable, pleasant experience increases the chance of referrals and return for future procedures, surgical and nonsurgical. METHODS: In this review article, we describe basic principles for providing patients with a pleasant, minimal pain experience during nonsurgical facial rejuvenation procedures. The procedures are grouped into injectables, noninvasive devices, and minimally invasive devices, and basic guidelines for pain management are provided. RESULTS: A review of each nonsurgical facial rejuvenation procedure is provided with typical patient perception of discomfort and methods to reduce or eliminate pain. This article covers the most popular procedures performed in many plastic surgery offices but is not inclusive of all devices and technologies available on the market. CONCLUSIONS: A wide range of nonsurgical options exist for rejuvenation, and there is nearly as much variety in pain associated with these procedures. As with any procedure that potentially may lead to pain or anxiety for a patient, it is important to assess patient's pain tolerance preprocedurally to determine the level of intervention needed. Providing a relaxed, calm environment and satisfactory pain control helps to reduce anxiety and improve the overall perception of the procedure and provider.

SPY-Q analysis toolkit values potentially predict mastectomy flap necrosis.

BACKGROUND: Previously, we and other investigators have reported the benefits of using SPY Intraoperative Perfusion Assessment System to assist in the prediction of mastectomy flap necrosis. To date, analysis of the SPY images has been subjective. However, the new SPY-Q postprocessing software allows for objective quantification of SPY images through the application of absolute and relative values of fluorescence intensity. This study seeks to determine the use of these objective, numerical data and their role in potentially predicting mastectomy flap necrosis. METHODS: In a retrospective fashion, 20 SPY images from immediate breast reconstructions were randomly selected from a database of more than 100 images: 10 from breasts that developed flap necrosis and 10 from breasts that demonstrated adequate healing. Groups were matched for age, body mass index, and comorbidities. The points of necrosis and points of adequate healing were evaluated using the postprocessing software, and the groups were compared. RESULTS: The mean "relative" fluorescence of the necrosis and the adequate healing groups was 25.2% and 43.3%, respectively (P < 0.001). The mean absolute fluorescence of the 2 groups was 18.5 and 25.0, respectively (P = 0.07). CONCLUSIONS: These findings suggest that quantitative "relative" perfusion values as generated by the postprocessing software may augment clinical judgment of flap viability in an objective and reproducible fashion.

Improving education under work-hour restrictions: comparing learning and teaching preferences of faculty, residents, and students.

BACKGROUND: Faced with work-hour restrictions, educators are mandated to improve the efficiency of resident and medical student education. Few studies have assessed learning styles in medicine; none have compared teaching and learning preferences. Validated tools exist to study these deficiencies. Kolb describes 4 learning styles: converging (practical), diverging (imaginative), assimilating (inductive), and accommodating (active). Grasha Teaching Styles are categorized into "clusters": 1 (teacher-centered, knowledge acquisition), 2 (teacher-centered, role modeling), 3 (student-centered, problem-solving), and 4 (student-centered, facilitative). STUDY DESIGN: Kolb's Learning Style Inventory (HayGroup, Philadelphia, Pennsylvania) and Grasha-Riechmann's TSS were administered to surgical faculty (n = 61), residents (n = 96), and medical students (n = 183) at a tertiary academic medical center, after informed consent was obtained (IRB # 06-0612). Statistical analysis was performed using χ(2) and Fisher exact tests. RESULTS: Surgical residents preferred active learning (p = 0.053), whereas faculty preferred reflective learning (p < 0.01). As a result of a comparison of teaching preferences, although both groups preferred student-centered, facilitative teaching, faculty preferred teacher-centered, role-modeling instruction (p = 0.02) more often. Residents had no dominant teaching style more often than surgical faculty (p = 0.01). Medical students preferred converging learning (42%) and cluster 4 teaching (35%). Statistical significance was unchanged when corrected for gender, resident training level, and subspecialization. CONCLUSIONS: Significant differences exist between faculty and residents in both learning and teaching preferences; this finding suggests inefficiency in resident education, as previous research suggests that learning styles parallel teaching styles. Absence of a predominant teaching style in residents suggests these individuals are learning to be teachers. The adaptation of faculty teaching methods to account for variations in resident learning styles may promote a better learning environment and more efficient faculty-resident interaction. Additional, multi-institutional studies using these tools are needed to elucidate these findings fully.

Composite tissue engineering on polycaprolactone nanofiber scaffolds.

Tissue engineering has largely focused on single tissue-type reconstruction (such as bone); however, the basic unit of healing in any clinically relevant scenario is a compound tissue type (such as bone, periosteum, and skin). Nanofibers are submicron fibrils that mimic the extracellular matrix, promoting cellular adhesion, proliferation, and migration. Stem cell manipulation on nanofiber scaffolds holds significant promise for future tissue engineering. This work represents our initial efforts to create the building blocks for composite tissue reflecting the basic unit of healing. Polycaprolactone (PCL) nanofibers were electrospun using standard techniques. Human foreskin fibroblasts, murine keratinocytes, and periosteal cells (4-mm punch biopsy) harvested from children undergoing palate repair were grown in appropriate media on PCL nanofibers. Human fat-derived mesenchymal stem cells were osteoinduced on PCL nanofibers. Cell growth was assessed with fluorescent viability staining; cocultured cells were differentiated using antibodies to fibroblast- and keratinocyte-specific surface markers. Osteoinduction was assessed with Alizarin red S. PCL nanofiber scaffolds supported robust growth of fibroblasts, keratinocytes, and periosteal cells. Cocultured periosteal cells (with fibroblasts) and keratinocytes showed improved longevity of the keratinocytes, though growth of these cell types was randomly distributed throughout the scaffold. Robust osteoinduction was noted on PCL nanofibers. Composite tissue engineering using PCL nanofiber scaffolds is possible, though the major obstacles to the trilaminar construct are maintaining an appropriate interface between the tissue types and neovascularization of the composite structure.