An advisory panel of academicians, private practice physicians, nurse clinicians, and research nurses was chosen to develop guidelines (minimum standards) for the treatment of arterial insufficiency ulcers of the lower extremities. METHODSPrevious guidelines, meta-analyses, PubMed, MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, recent review articles of arterial ulcer treatment, and the Medicare/CMS consensus of usual treatment of chronic wounds were all searched and reviewed for evidence. Guidelines were formulated, the underlying principle(s) enumerated, and evidence references listed and coded. The code abbreviations for the evidence citations were as follows: There were major differences between our approach to evidence citations and past approaches to evidence-based guidelines. Most past approaches relied only on publications regarding clinical human studies. Laboratory or animal studies were not cited. We have used well-controlled animal studies that present proof of principle, especially when a clinical series corroborated the laboratory results.

Background: As social media have become pervasive in contemporary society, plastic surgery content has become commonplace. Two of the most engaging and popular platforms are Instagram and Twitter, and much research has been performed with respect to Twitter. Currently, there are no studies comparing and contrasting the two platforms. The aim of this study was to robustly sample plastic surgery posts on Twitter and Instagram to quantitatively and qualitatively evaluate platform content differences. Methods: The hashtag #PlasticSurgery was systematically queried twice per day, for 30 consecutive days, on Twitter and Instagram. Account type, specific media content, possible patient-identifying information, content analysis, and post engagement were assessed. Post volume and engagement between Instagram and Twitter posts were compared. Post characteristics garnering high engagement from each platform were also evaluated. Results: A total of 3867 Twitter posts and 5098 Instagram posts were included in this analysis. Daily total post volume for the 1-month duration of the study was significantly higher on Instagram compared with Twitter. Overall post engagement was significantly higher on Instagram compared with Twitter. Plastic surgeons and plastic surgery clinics represented the majority of accounts posting on both platforms with #PlasticSurgery. Identifiable patient features were much more prevalent on Instagram. The majority of Instagram posts were promotional in nature, outcome-based, or unrelated to plastic surgery. Alternatively, tweets were predominantly educational in nature. Conclusions: For physicians to harness the power of social media in plastic surgery, we need to understand how these media are currently being used and how different platforms compare to one another. This study has highlighted the inherent similarities and differences between these two highly popular platforms.

The Wound Healing Society guidelines for the treatment of arterial insufficiency ulcers were originally published in 2006. These guidelines provided recommendations, along with their respective levels of evidence on seven categories: diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy, and long-term maintenance. Over the last 7 years, a great deal of literature regarding these aspects of arterial ulcer management has been published. An advisory panel comprised of academicians, clinicians, and researchers was chosen to update the 2006 guidelines. Members included vascular surgeons, internists, plastic surgeons, anesthesiologists, emergency medicine physicians, and registered nurses, all with expertise in wound healing. The goal of this article is to evaluate relevant new findings, upon which an updated version of the guidelines will be based. METHODS Data sources and searchesWe sought to capture the highest quality of literature available regarding arterial insufficiency ulcer diagnosis and treatment using a key word search of PubMed, Embase, and Cochrane Library databases. Similarly, the citations of relevant articles were examined by hand. Key terms were generated from the existing guidelines. The search was limited to meta-analyses, systematic reviews, randomized controlled trials (RCTs), retrospective series reviews, clinical case series, and expert panel recommendations published between January 2006 and 2013. It was further limited to only English publications, and review articles and case reports were excluded.The findings of these articles have been divided into one or more of the appropriate categories (diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy, and long-term maintenance) as performed in the original guideline.

Summary: Healthcare advocacy is an important tool in the plastic surgeon’s arsenal that stands the potential to improve both patient care and the profession. However, many physicians underestimate the importance and influence that healthcare advocacy has on the profession and feel that they lack the leverage and knowledge to advocate on behalf of themselves, their practices, their patients, and their profession, all of which are untrue. Plastic surgeons are uniquely positioned to advocate based on their clinical acumen, personal experiences with patient care, and their position in the healthcare ecosystem value chain. This article aims to equip plastic surgeons with a general framework of knowledge regarding policy and advocacy. Additionally, the article outlines and discusses recent advocacy efforts related to plastic surgery, and efforts that are on the horizon to provide some context to the relevance of advocacy related to plastic surgery. Finally, we aim to empower plastic surgeons to step into the policy advocacy arena for the betterment of our patients and the professional practice of plastic surgery.

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Background: Despite policies such as the Women's Health and Cancer Rights Act (WHCRA) and Breast Cancer Patient Education Act, rates for breast reconstruction vary and are especially low for some subpopulations of patients, especially rural women. In order to better understand patient perceptions, qualitative analysis using focus groups is an underutilized tool for obtaining patient perspectives regarding health-related issues and access to care. Our aim was to better understand patient perceptions using qualitative analysis. Methods: Three focus groups were held in rural counties within West Virginia in order to better understand patient perceptions, knowledge, and beliefs regarding breast health, breast cancer, access to breast reconstruction, and how to disseminate and educate this patient population regarding their right to accessing breast reconstruction. Results: Major themes analyses revealed perceived barriers to care related to lacking care coordination, lack of insurance coverage and other resources, as well as issues related to transportation. Participants consistently discussed avoiding breast screening care due fear and denial in addition to pain. Few patients were aware of their right to accessing breast reconstruction per the WHCRA, and many were concerned about follow-up burden, complications, and general fear related to breast reconstruction. Themes related to dissemination of information to promote the option of breast reconstruction included social media, patient counseling by their referring physician, and other means of intervention in clinics and other points in the care coordination chain. Conclusions: Rural women have important, unique viewpoints regarding access to and perceived barriers from obtaining breast reconstruction. Plastic surgeons must work diligently to educate, disseminate, and improve care coordination among this population in order to improve access to breast reconstruction among rural breast cancer patients.

The Wound Healing Society (WHS) is a professional society of physicians, nurses, physical therapists, podiatrists, and other wound care specialists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound healing. To that end, the following comprehensive, evidence-and consensus-based guidelines were developed to address the Prevention of Lower Extremity Arterial Insufficiency Ulcers. The guidelines are presented in generic terms; the details of specific tests, therapies, and procedures are at the discretion of an interdisciplinary team of health care professionals who establish, implement, and evaluate policies and procedures directed at prevention of arterial ulcers. METHODSAs with the arterial ulcers treatment guidelines published in 2006, 1 PubMed, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews were searched and reviewed for evidence on arterial insufficiency ulcer prevention. In addition, a search of health care databases for current evidence-based guidelines addressing the prevention of arterial insufficiency ulcers was conducted using electronic and online resources. The panel classified studies based on whether the intervention being evaluated addressed arterial ulcer risk screening and assessment, arterial ulcer prevention plans of care (including interdisciplinary approaches), or patient and caregiver education.Evidence references for each standard are listed and coded. The code abbreviations for the evidence citations were as follows:

Fournier's gangrene isolated to the penis is exceedingly rare. It is an urologic emergency that requires emergent parenteral antibiotics as well as aggressive irrigation and debridement. While human bite wounds can be overlooked as a serious cause of injury and infection, they can result in highly dangerous, polymicrobial infections in affected patients. Here, we report a case of penile Fournier's gangrene caused by a human bite wound managed with broad spectrum antibiotics, irrigation and debridement, penile reconstruction, and skin grafting with successful preservation of a normal penile structure and function.