Case report of robotic dor fundoplication for scleroderma esophagus with aperistalsis on manometry.

Scleroderma is a systemic disease of collagen deposition resulting in fibrosis of small arteries and arterioles. It commonly affects the skin, lungs, and gastrointestinal tract. The most common site of GI tract involvement is the esophagus. We present the case report of a 44year old female with scleroderma esophagus and severe reflux which was successfully treated with robotic dor fundoplication. Because of the wide variety of symptoms with which this problem can present, a tailored approach taking into consideration the patient's symptomatology and findings during diagnostic work-up was implemented with good results. The patient exhibited complete resolution of symptoms at short term follow up. Robotic dor fundoplication is an effective option for patients with scleroderma esophagus and no evidence of hiatal hernia or esophageal shortening.

Complex craniofacial reconstruction using stereolithographic modeling.

Stereolithographic modeling allows preoperative preparation and improved intraoperative precision by clearly displaying detailed anatomy in patients undergoing craniofacial surgery. There is a lack of plastic surgery literature describing this modality as a useful adjunct to reconstructive surgery of the craniomaxillofacial skeleton. Specifically, the ability to use mirror-image modeling to recreate patient anatomy using the unaffected side as a model presents an advantage that plastic surgeons should be aware of. We applied this technology in patients with major craniofacial defects requiring bony reconstruction and observed many qualitative benefits with respect to functional and cosmetic outcomes of reconstruction. This article presents stereolithographic modeling as a feasible and useful tool in complex head and neck/craniomaxillofacial reconstruction after tumor resection.

The VersaJet for Breast-Reduction Surgery: Operator Beware.

BACKGROUND: Modern techniques for breast-reduction surgery depend on large surface de-epithelialization. The current gold standard technique involves the use of a scalpel for sharp debridement and is a time-consuming process that is labor-intensive and often requires an assistant to stabilize the breast. Surgeons who perform breast-reduction surgery continue to search for instruments and innovations that may reduce the time and effort required for successful de-epithelialization. One such innovation is the use of the VersaJet Hydrosurgery system. The purpose of this article is to highlight an important complication that may result from the use of this device. METHODS: The authors describe their experience with the VersaJet Hydrosurgery System in reduction mammoplasty of 28 breasts. RESULTS: The authors experienced several complications characterized by the formation of epithelial inclusion cysts requiring reoperation. CONCLUSION: The VersaJet Hydrosurgery system may lead to quicker speeds of de-epithelialization as compared with traditional methods but poses a risk of epidermal cyst formation.

Bioterrorism: preparing the plastic surgeon.

INTRODUCTION: Many medical disciplines, such as emergency medicine, trauma surgery, dermatology, psychiatry, family practice, and dentistry have documented attempts at assessing the level of bioterrorism preparedness in their communities. Currently, there is neither such an assessment nor an existing review of potential bioterrorism agents as they relate to plastic surgery. Therefore, the purpose of this article is to present plastic surgeons with a review of potential bioterrorism agents. METHODS: A review of the literature on bioterrorism agents and online resources of the Centers for Disease Control and Prevention was conducted. Category A agents were identified and specific attention was paid to the management issues that plastic surgeons might face in the event that these agents are used in an attack. RESULTS: Disease entities reviewed were smallpox, anthrax, plague, viral hemorrhagic fever, tularemia, and botulism. For each agent, we presented the microbiology, pathophysiology, clinical presentation, potential for weaponization, medical management, and surgical issues related to the plastic surgeon. CONCLUSION: This article is the first attempt at addressing preparedness for bioterrorism in the plastic surgery community. Many other fields have already started a similar process. This article represents a first step in developing evidence-based consensus guidelines and recommendations for the management of biological terrorism for plastic surgeons.