Certification and Accreditation in Plastic Surgery Subspecialty Training.

There are multiple subspecialties that residents can pursue after core plastic surgery training, including 5 major fellowship categories: aesthetic, burn, craniofacial, hand, and microsurgery. Hand surgery remains the only plastic surgery subspecialty to date, with a formal accreditation process following fellowship. The purpose of this study was to review the literature regarding the accreditation and match process of plastic surgery fellowship programs, the process of hand surgery certification, and future directions pertaining to certification in other plastic surgery subspecialties.

Foreign Body Reaction to Poly-D-L-Lactic Acid Resorbable Plates Used in Craniofacial Surgery.

Resorbable surgical materials are often used in the pediatric population to provide fixation in the growing skeleton. Although foreign body reactions to poly-D-L-lactic acid (PDLLA) plates and screws have been previously reported in other fields, to date PDLLA polymers have been well-tolerated in the setting of craniofacial surgery. The authors report a case of a previously healthy 4-month-old patient with Crouzon syndrome who underwent a frontal-orbital advancement with resorbable PDLLA plates and screws and subsequently experienced extensive foreign body reactions and wound healing complications.

Establishing a Telemedicine Program for Breast Reconstruction.

Telemedicine is an application of modern technology that allows for the remote delivery of healthcare services to diagnose and treat patients. The potential patient benefits of such a program include added convenience, lowered costs, and improved access. From a practical standpoint, establishing a telemedicine program may seem daunting to the plastic surgeon; success requires not only patient and provider adoption, but also integration of new technology. Despite these challenges, breast reconstruction patients are among those who stand to benefit most from telemedicine technology, as this patient population remains vulnerable to limitations to access following an emotion-provoking breast cancer diagnosis. Geographical limitation, especially in rural areas, represents a major barrier to access. To date, the application of telemedicine in caring for breast reconstruction patients has not been described in the literature. In this article, we describe the protocol developed and implemented by our academic plastic surgery group to care for new breast reconstruction candidates and discuss the role of telemedicine in improved access to breast reconstruction care.

A Standardized Approach to Deep Inferior Epigastric Perforator Flap Marking.

The deep inferior epigastric perforator (DIEP) flap is the most commonly utilized flap in autologous breast reconstruction. This perforator-based free flap includes the lower abdominal wall adipocutaneous layers while sparing the abdominal musculature. Several studies have looked at preoperative planning for DIEP flap reconstruction using CT angiography; however, no study to date has proposed a standardized approach to DIEP flap markings. We propose a novel technique to standardize DIEP flap marking that leads to greater symmetry and consistency in the donor site.

Short Total Synthesis of Δ12-Prostaglandin J2 and Related Prostaglandins. Design, Synthesis, and Biological Evaluation of Macrocyclic Δ12-Prostaglandin J2 Analogues.

Comprised of a large collection of structurally diverse molecules, the prostaglandins exhibit a wide range of biological properties. Among them are Δ12-prostaglandin J2 (Δ12-PGJ2) and Δ12-prostaglandin J3 (Δ12-PGJ3), whose unusual structural motifs and potent cytotoxicities present unique opportunities for chemical and biological investigations. Herein, we report a short olefin-metathesis-based total synthesis of Δ12-PGJ2 and its application to the construction of a series of designed analogues possessing monomeric, dimeric, trimeric, and tetrameric macrocyclic lactones consisting of units of this prostaglandin. Biological evaluation of these analogues led to interesting structure-activity relationships and trends and the discovery of a number of more potent antitumor agents than their parent naturally occurring molecules.

Enantioselective Total Synthesis of Antibiotic CJ-16,264, Synthesis and Biological Evaluation of Designed Analogues, and Discovery of Highly Potent and Simpler Antibacterial Agents.

An improved and enantioselective total synthesis of antibiotic CJ-16,264 through a practical kinetic resolution and an iodolactonization reaction to form the iodo pyrrolizidinone fragment of the molecule is described. A series of racemic and enantiopure analogues of CJ-16,264 was designed and synthesized through the developed synthetic technologies and tested against drug-resistant bacterial strains. These studies led to interesting structure-activity relationships and the identification of a number of simpler, and yet equipotent, or even more potent, antibacterial agents than the natural product, thereby setting the foundation for further investigations in the quest for new anti-infective drugs.