Cosmetic patients have many options when seeking out their surgeons. In midsize and larger cities, these options span not only different specialties but also different levels of experience. Because surgical experience can best be gained first hand, there exists a special and symbiotic relationship between a surgeon-in-training and his or her patient. Benefits stem from the opportunity for a surgeon to gain independent experience while offering cost effective benefits to patients who may or may not otherwise have access to cosmetic surgery. To meet the needs of both patients and the surgeons-in-training, the Wake Forest University Plastic and Reconstructive Surgery Training Program has set up and maintained a chief resident run cosmetic surgery clinic for 17 years. Each chief resident serves as primary surgeon 1 day a week during the chief year. We present a 7-year retrospective outcome analysis of this experience. The authors performed an Institutional Review Board approved retrospective chart review of all patients who received major cosmetic procedures performed in the WFU chief resident clinic over a 7-year span from 2000 to 2007. A total of 210 charts were reviewed. Fourteen charts were excluded because of inadequate records or non esthetic procedures performed concomitantly. All procedures were viewed as independent events. A total of 196 patients underwent 272 procedures. All procedures were evaluated for major and minor complications and revisions. A total number of 272 initial cosmetic procedures were performed in a 7-year span. Adverse events were divided into major and minor complications. There were no major complications for any of the procedures. Overall minor complication rate was 8.0%. Overall revision rate was 14.4%. Procedures with greatest probability of revision were abdominoplasty and reduction mammaplasty. Chief resident clinics provide a unique experience wherein surgeons-in-training are allowed to hone previously developed surgical acumen while providing a safe and expectedly desirable result for their patients. Because many cosmetic patients desire secondary touch up procedures, a rate of 14.4% in this cohort is neither unexpected nor unacceptable. In addition, the postoperative evaluation and the decision to pursue secondary procedures provides a unique perspective to the chief residents. A chief resident run clinic can be an effective and safe learning tool, providing benefit to patient and the surgeon in training.

Treatment with mechanical tissue resuscitation during reperfusion reduces both early cell death and the delayed, programmed cell death after ischemia-reperfusion. This cardioprotection is also associated with a significant reduction in interstitial water. Additional cardioprotection may be derived from mechanical tissue resuscitation-induced increased blood flow. Mechanical tissue resuscitation, particularly with a resorbable device, is a straightforward and efficacious mechanical strategy for decreasing cardiomyocyte death following myocardial infarction as an adjunctive therapy to surgical revascularization.

Mechanical tissue resuscitation with controlled subatmospheric pressure can significantly modulate levels of excitatory amino acids and lactate in traumatic brain injury, decrease the water content and volume of injured brain, improve neuronal survival, and speed functional recovery.

BackgroundReperfusion following an ischemic myocardial event increases cell death by activation of inflammatory processes. Reducing reperfusion injury may improve morbidity and mortality following AMI. We have previously shown MTR to reduce infarct size following MI/R. Here, we determine the effects of MTR on apoptosis and edema using a novel, bio‐absorbable patch.MethodsA left, anterior free‐wall ischemic lesion (80 minutes) was created using reversible tourniquets in swine. Animals were randomized to receive either no treatment (Control) or MTR (− 50mmHg) using a bio‐absorbable patch at reperfusion. Following 3 hours of reperfusion, infarct size, apoptosis and edema were determined.ResultsWhile both groups had similar areas at risk (AAR/LV, 13.2 ± 0.7% and 14.8 ± 0.5%; p=.09), infarct size (AN/AAR) was significantly reduced in MTR‐treated animals (16.8±2.8%, p <.05) compared to controls (26.4±2.8%). This myocardial protection was accompanied by a reduction in epicardial apoptosis (7.7 ± 1.9% vs. 29.3 ± 7.7% TUNEL positive cells). MTR also reduced interstitial space in the endocardium by 53% and in the epicardium by 34%.ConclusionsMTR applied directly over the infarcted area of the heart by means of a bio‐absorbable patch results in tissue preservation which may be the result of changes in apoptosis and edema formation. These data suggest that MTR could be an appropriate therapeutic approach to decrease myocyte death following a myocardial infarction.