Frey syndrome represents a fascinating example of how nerve regeneration can go awry. The syndrome is characterized by profuse facial sweating and flushing that occurs when salivation is stimulated. It can develop following a variety of insults but is most commonly encountered as a complication of parotidectomy. Consequently, it is mainly head and neck surgeons who see and treat this disorder; however, it is important for other clinicians to recognize what these unusual symptoms represent. Diagnosis may be based either on clinical presentation or through objective testing methods. Potential negative social and psychologic implications of this condition can be significant, and treatment ranging from topical agents to local injections of botulinum toxin (Botox) to surgical intervention should be offered to patients. In this article, we present an up-to-date review of the surgical and medical treatment of this syndrome.

Integra dermal matrix (Integra Life Sciences Corp., Plainsboro, NJ) was introduced in 1981, and its use in acute surgical burns is well established. However, Integra also has been found to be useful in the surgical treatment of scars. The Integra neodermis is placed at the time of scar excision and then overgrafted several weeks later with a very thin (6/1000-inch) skin graft. The stabilized matrix appears to resist recurrence better than traditional skin grafts, which have a reported recurrence rate of 59%. Many surgeons have had anecdotal success using Integra for both hypertrophic and keloidal scars. This case series presents several patients who underwent reconstructive surgery with the use of Integra to treat their debilitating scar formation. None of the patients developed significant scar morbidity at the donor site when the skin was harvested for grafting during the second stage of the procedure. All patients had documented success with improved appearance, range of motion, and skin quality.

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Patient safety and medical error reduction are topics of extreme importance. Although there has been considerable media controversy regarding reports of decreased patient safety and errors that have occurred in operating rooms of hospitals, ambulatory surgery centers, and doctors' offices, the majority of data across various specialties demonstrate a very low incidence of adverse events resulting from office-based surgery. Limited research has been conducted in patient safety on the topic of outpatient surgery. Since the release of the Institute of Medicine's (IOM) report To Err Is Human, significant progress has been made in patient safety. According to the IOM's report in 2000, between 48,000 and 98,000 annual US hospital deaths result from medical errors. Following the report, there have been numerous calls to improve patient safety and place it at the forefront of the national agenda. The Florida Board of Medicine restricted office procedures in 2000 after a series of incidents occurred in the outpatient setting. The objectives of this paper are to review the Florida moratoria data over the last 6 years to discuss what we have learned as a specialty and to continue a culture of safety in plastic surgery. One of the remaining challenges is the need to continually improve this culture of safety and emphasize the need for continued patient education, specifically related to esthetic procedures administered in nonclinical settings by amateur, unlicensed, or unqualified practitioners, with a misrepresentation of their credentials and training. This is a long-term proposition and one that has been driven foremost by our leaders in plastic surgery.