As the most prominent portion of the human body, the face embraces a multifaceted responsibility for functionality and survival while contributing to identity and self-image. Inopportunely, due to its distinctive anatomical location, the face as a unit is highly suspectable to trauma, particularly in warfare. As a result, facial injury creates a physical and psychological trauma that needs to be addressed immediately. In the following article, a detailed literature review was conducted to examine the interplay between facial injuries throughout multiple wars in Iraq and their management. The authors found a significant increase in facial injuries due to shell fragments corresponding with modern advances in warfare targeting mass casualties. The capacity to manage the magnitude and level of trauma observed in Iraq requires a substantial amount of resources and a systematic approach that unfortunately is unattainable in a country that is still struggling to rebuild after decades of oppression and war. Due to the circumstances, surgeons have to rely on training and experience to provide the best care for their patients and it is imperative that we continue to train our surgeons to rely on their skills and experience to ensure a high level of care with limited resources and lack of technology.
Background: In response to the COVID-19 pandemic, new guidelines were issued cautioning against performing elective procedures. We aimed to assess the impact of the COVID-19 pandemic on operational and financial aspects of plastic surgery in Miami. Methods: A multiple-choice and short-answer survey regarding practice changes and financial impact was sent to all 67 members of the Miami Society of Plastic Surgeons. Results: A 41.8% (n = 28) response rate was obtained, five responses did not meet the inclusion criteria, and statistical analysis was performed on 34.3% (n = 23) of responses. Of the plastic surgeons who responded, 21.74% operate in an academic setting, 60.87% are in a single practitioner private practice, and 17.39% are in a multi-practitioner private practice. An estimated 60% of academic plastic surgeons had 75% or more of their previously scheduled cases canceled, compared with 57.14% in single practitioner private practice and 100% in multi-practitioner private practice. In total, 64.29% of single practitioner private practices and 50% of multi-practitioner private practices have had to obtain a small business loan. Single practitioner private practice plastic surgeons reported having an average of 6.5 months until having to file for bankruptcy or permanently close their practices, and multi-practitioner private practice plastic surgeons reported an average of 6 months. Conclusions: Guidelines to support small business must be implemented in order to allow private practice surgeons to recover from the substantial economic impact caused by the pandemic because it is necessary to reestablish patient access and provide proper care to our patients.
The industrialization of modern warfare dating back to WWI led to an increase in combat-related injuries with unprecedented levels of severity. The necessity of addressing the clinical challenges that ensued led to the emergence of modern reconstructive surgery and subsequently a robust healthcare initiative for veterans in the form of the Department of Veterans Affairs. In the following article, a literature review was conducted to examine the interplay between combat injuries, veterans’ care, and reconstructive surgery. We found that the relationship between military trauma and reconstructive surgery has led to an increase in survival rates and advances in mass casualty response while allowing the survivors to maintain a high quality of life. The relationship between the Veterans Affairs hospitals and plastic surgery has only strengthened over time as these hospitals play a major role in training the next generation of plastic surgeons throughout the nation. It is imperative to maintain this cooperative relationship to ensure a high level of care for our veterans and a comprehensive training experience for plastic surgery residents.
Background Reduction mammoplasty is a common procedure associated with a very high patient satisfaction rate. It has been shown to alleviate symptoms related to macromastia, such as back, neck, and shoulder pain, poor posture, bra strap grooving, paresthesia, and rashes. Despite the manifold benefits of reduction mammaplasty, some insurance companies require minimum resection weights of at least 500-grams per breast in order to distinguish between a reconstructive and aesthetic procedure. Objective The aim of this study is to assess the origins of the 500-gram rule used in reduction mammaplasty. Methods A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for studies published through July 2020 with multiple search terms related to resection weight criteria for breast reduction. Data on criteria, outcomes, and patient satisfaction were collected. Results A total of 14 articles were selected from the 27 articles that were identified. 500-gram rule appears to be arbitrary. It appears that it is not based on any available hard evidence. However, numerous studies show that patients who have less than 500-grams of tissue removed from each breast still experience significant symptomatic relief from reduction mammaplasty with a marked improvement in quality of life. Conclusion The 500-gram rule should be re-evaluated as criterion for pre-authorization reduction mammaplasty for insurance companies. It may influence surgeons to choose between form and function. Many additional patients might then benefit from this procedure with significant benefits.
The fellows and residents of my time used to call him ''monster.'' Later, we relabelled him as ''big monster'' as others began to call me ''little monster''-and I was pleased at the nickname that reflected my mentor.I always found him to be a great teacher. I loved his morning rounds at the Craniofacial Institute. Throughout the surgeries, he would explain the procedure. If we had questions, he was always more than happy to discuss them. Many times, we would stand chatting in the corridor until his efficient office manager (who was none other than his wife, Marjorie) let him know that there were patients waiting for him. Then he would pose as if he was running to reach the next room, which was only 10 steps away.Publication was in his blood. He had a huge number of publications across plastic surgery-in total, he had more than 300 publications, besides innumerable abstracts published in various transactions and souvenirs. I used to find him writing for something or the other in between surgeries or in any small moment of free time.His magnanimity in publications should be an example for all of us. He was always extremely happy to help others write research papers, and he arranged round-the-clock access to the department as well as the institute library for us fellows. He would make us write the article, but he would edit it for publication, ensuring that we received due credit (often rather more than we deserved). He even encouraged an undergraduate to write a paper while she was visiting the institute as an observer; I dutifully helped her organize the figures and was listed as a co-author. 1 During my fellowship, he helped me write 5 research papers in total including an original research paper on the role of Transforming Growth Factor (TGF) on craniofacial bone healing. 2,3 Dr Jackson saw capability and talent in everyone, and he would not rest until you saw it in yourself. He also used to push us all to attend conferences and present papers. When we shared that attending conferences was a financial strain for us, he went to work to remove that obstacle-we attended the 1993 Mid-Western Society annual meeting in Chicago and the 1993 American Cleft Palate Association meeting in New Orleans with the registration fee waived. This is an example and lesson for all teaching faculty.Years later, Dr Jackson and Marjorie both visited Pondicherry to meet me and my family on the way to many scientific assignments in other parts of the country. At Pondicherry, we conducted a rhinoplasty workshop, and he operated on 3 patients with an attentive audience of 4 plastic surgeons and 1 otolaryngologist. He and Marjorie then graced our home and spent half a day with my family, reminiscing about my time spent with them during my fellowship.In each one of my memories of our friendship and our professional work, it is clear to me that Dr Jackson's kindness, excellence, and humanity were evident in every aspect of his life. Much has been written about his philanthropic activities in newspapers, books, and social media. Working with h...
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