Plastic Surgery or Facial Plastic Surgery: Can the Public Tell the Difference?

Background: Social media and online advertising are increasingly used by plastic surgeons (PSs) to educate patients and obtain referrals, but it remains unclear whether the general public can distinguish the difference in training and accreditation among medical professionals advertising online. Our study elucidates the public's expectations regarding the distinction between plastic surgery and facial plastic surgery. Methods: A survey was distributed via MTurk, an Amazon surveying service, to collect information about demographics and assumptions that would be made solely based on the terminology "facial PS" (FPS) and "PS." Participants were restricted to those residing in the United States. Results: A total of 253 responses were collected. Based on the term FPS, respondents on average moderately to strongly agreed that they would expect an FPS to have completed a plastic and reconstructive surgery residency program (mean = 1.81; scale from 1= strongly agree to 5= strongly disagree) and would feel moderately to strongly misled if they visited an FPS for a consultation and later learned that the provider did not complete a plastic and reconstructive surgery residency (mean = 3.62; scale from 1 = not misled at all to 5 = extremely misled). Conclusions: Despite increasing advocacy by professional societies and the member societies of the American Board of Medical Specialties, this study demonstrated that the lay public is unaware of factually different training and certification pathways given similarity in nomenclature. This study was notably not designed to draw conclusions or imply superiority of one specialty, certifying board, or training model over the other.

Free Tissue Transfer to the Knee for a Complex Wound Coverage When Good Recipient Vessels Are Not Available.

Free tissue transfer to the knee can be difficult due to limited options for reliable recipient vessels and vein grafts or arteriovenous loops may also be associated with an increased risk of flap failure. In this study, the authors describe our experience with creating proper recipient vessels for free flap reconstructions around the knee using the descending branch (DB) of the lateral circumflex femoral vessels (LCFV) or anterior tibial vessels (ATV). Three patients underwent free flap reconstruction of knee wounds secondary to trauma, prosthesis infection, and radiation therapy. The anterolateral thigh, rectus abdominis, and latissimus dorsi flaps were used to close the wounds, respectively. Dissection of the DB of LCFV was carried between the rectus femoris and vastus lateralis, and between the peroneus longus and brevis for the ATV. These recipient's vessels were created and placed in a more desirable location adjacent to the defect for microvascular anastomoses. The DB of LCFV and ATV were dissected successfully and both arterial and venous micro-anastomose were performed in an end-to-end manner with the recipient's vessels. All patients had successful free tissue reconstructions with uneventful postoperative courses. The flaps remained viable and reliable soft tissue coverage with acceptable contour had been accomplished during follow-up. Either DB of LCFV or ATV can serve as adequate recipient vessels after being placed adjacently to soft tissue defects for a straightforward free tissue transfer to the knee. The creation of such recipient vessels avoids vein grafts or arteriovenous loops and allows for a reliable free flap reconstruction of the knee.

Bilateral Orbital Plasmacytomas With Orbital Compartment Syndrome.

Orbital plasmacytomas are uncommon soft-tissue plasma cell neoplasms that are associated with a monoclonal or myeloma protein. There are four types of plasma cell neoplasms: multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS), amyloidosis, and plasmacytoma. Plasmacytomas may be classified as medullary, occurring only within the bone, or extramedullary, occurring in soft tissues. Orbital plasmacytomas are extramedullary manifestations associated with MM and they may present with signs and symptoms such as unilateral proptosis, conjunctival injection, ocular pain, diplopia, and vision changes. The diagnosis of orbital plasmacytomas is based on tissue biopsy and histologic and immunohistochemical confirmation of a homogenous infiltrate of monoclonal plasma cells. In this report, we present a case of a 60-year-old female patient with a prior diagnosis of MM and new-onset bilateral orbital plasmacytomas following an autologous peripheral blood stem cell transplant; her condition improved significantly following treatment with dexamethasone, cisplatin, doxorubicin, cyclophosphamide, and etoposide along with palliative radiation therapy (RT) of 2000 cGy in 10 fractions to the orbits. Unfortunately, three months later, she had progression of extramedullary disease with parotid gland involvement. She had multiple complicated hospitalizations and eventually expired. As patients with orbital plasmacytomas classically have lower remission and survival rates compared to those with extramedullary plasmacytomas involving other locations, they must be considered high-risk patients who require a multidisciplinary approach for early diagnosis and timely treatment in order to prevent disease progression and to alleviate symptoms related to the disease.

Chronic Pilonidal Cyst with Malignant Transformation: A Case Report and Literature Review.

A 63-year-old male with a 20-year history of a chronic, recurrent sacrococcygeal pilonidal cyst was referred to our outpatient clinic. He had received multiple surgical resections in the past with benign pathology. He presented with a verrucous wart-like midline mass on the superior gluteal cleft that had grown since his last resection. The patient subsequently underwent resection of the mass with bilateral gluteal rotational flaps. Pathology showed squamous cell carcinoma with tumor-free margins, and further imaging showed no evidence of metastatic disease. It is believed chronic inflammation with subsequent genetic and impaired DNA repair mechanisms is the leading cause of malignancy. The treatment of choice for pilonidal carcinoma is surgical resection with free margins. Reconstruction methods can be utilized to repair the tissue defect. Pilonidal carcinoma has high mortality risk with surgical treatment yielding a disease-free 5-year survival rate of 55% of patients and a high recurrence rate of 50%. The role of chemoradiotherapy is currently unclear.