Malcolm Z. Roth

Techniques for Toddlers: Linear Band Incision for Harlequin Ichthyosis with Associated Compartment Syndrome

Harlequin ichthyosis (HI) is a rare autosomal recessive disorder of cornification in which children are born with an extremely thick stratum corneum that becomes a restrictive circumferential encasement around the orifices, limbs, chest, and abdomen, resulting in limb contractures. We present a neonate diagnosed in utero with HI. The infant was born with encasing bands of thickened skin creating strictures that were causing digital and limb cyanosis (compartment syndrome). We treated the child using a new technique of lysis of the encasing bands that we call linear band incision, using a new escharotomy‐like procedure while the infant was undergoing a 3‐week course oral acitretin therapy. The technique involved linear incision and lysis of encasements that resulted in reperfusion of the injured limbs and prevention of further digital necrosis. The child is currently a healthy 8‐year‐old boy with skin manifestations resembling congenital ichthyosiform erythroderma. He has use of all of the limbs that were released in the procedures and is maintained on frequent application of bland emollients. Linear band incision is a potentially life‐ and limb‐saving technique in children with HI.

The Anatomy of the Facial Vein: Implications for Plastic, Reconstructive, and Aesthetic Procedures

Background: Anatomical knowledge of the facial vasculature is crucial for successful plastic, reconstructive, and minimally invasive procedures of the face. Whereas the majority of previous investigations focused on facial arteries, the precise course, variability, and relationship with adjacent structures of the facial vein have been widely neglected. Methods: Seventy-two fresh frozen human cephalic cadavers (32 male and 40 female cadavers; mean age, 75.2 ± 10.9 years; mean body mass index, 24.2 ± 6.6 kg/m2; 99 percent Caucasian ethnicity) were investigated by means of layer-by-layer anatomical dissection. In addition, 10 cephalic specimens were investigated using contrast agent–enhanced computed tomographic imaging. Results: The facial vein displayed a constant course in relation to the adjacent anatomical structures. The vein was identified posterior to the facial artery, anterior to the parotid duct, and deep to the zygomaticus major muscle. The angular vein formed the lateral boundary of the deep medial cheek fat and the premaxillary space, and the medial boundary of the deep lateral cheek fat and the sub–orbicularis oculi fat. The mean distance of the inferior and superior labial veins, of the deep facial vein, and of the angular vein from the inferior orbital margin was 51.6 ± 3.1, 42.6 ± 2.3, 27.4 ± 3.0, and 4.2 ± 0.7 mm, respectively. Conclusions: This work provides detailed information on the course of the facial vein in relation to neighboring structures. The presented clinically relevant anatomical observations and descriptions of landmarks will serve as helpful information for plastic, reconstructive, and aesthetic surgeons.

Updated anatomy of the buccal space and its implications for plastic, reconstructive and aesthetic procedures

BACKGROUND The buccal space is an integral deep facial space which is involved in a variety of intra- and extra-oral pathologies and provides a good location for the harvest of the facial artery. The age-related anatomy of this space was investigated and compared to previous reports. METHODS We conducted anatomic dissections in 102 fresh frozen human cephalic specimens (45 males, 57 females; age range 50-100 years) and performed additional computed tomographic, magnetic resonance and 3-D surface volumetric imaging studies to visualize the boundaries and the contents of the buccal space after injection of contrast enhancing material. RESULTS The mean vertical extent of contrast agent injected into the buccal space was 25.2 ± 4.3 mm and did not significantly differ between individuals of different age (p = 0.77) or gender (p = 0.13). The maximal injected volume was 10.02 cc [range: 3.09-10.02] without significant influence of age (p = 0.13) or gender (p = 0.81). The change in surface volume was 3.64 ± 1.04 cc resulting in a mean surface-volume-coefficient of 0.87 ± 0.12 without being statistically significant influenced by age (p = 0.53) or gender (p = 0.78). CONCLUSIONS The facial artery was constantly identified within the buccal space whereas the facial vein was found to course within its posterior boundary. The buccal space did not undergo age-related changes in volume or size which highlights this space is a reliable and predictable landmark for various plastic, reconstructive and aesthetic procedures.

An Evaluation of Remuneration Patterns in Academic Plastic Surgery.

RESULTS: Eighty-five out of the 282 ACAPS members (30.1%) responded to the survey (Table 1). Eighty participants (94%) reported having mainly a reconstructive practice. The majority of survey participants (69.1%) had a base salary plus a bonus based either on collections or WRVUs (Figure 1). Sixtythree percent of plastic surgeons in the survey received less than

The Changing Demographics and Needs of Employed Versus Private Practice Plastic Surgeons: Identifying Challenges and Solutions in the Era of the Affordable Care Act.

50 as a compensation per WRVU. Sixty-four percent of respondents had benchmark WRVUs of 5000-9000. Seventy-one percent of academic plastic surgery practices reported having an average collection of

The Crisis of Deficiency in Emergency Coverage for Hand and Facial Trauma: Exploring the Discrepancy Between Availability of Elective and Emergency Surgical Coverage

500,000-

Abstract: A Validated Multi-Institutional Approach To Optimizing Outcomes Of Reduction Mammoplasty: A Critical Analysis Of 7,068 Patients.

1,000,000. Sixty-four percent of practices reported a starting salary of

Abstract: Optimized Surgical Approach for Applying Mechanical Force to Murine Models to Simulate Human Hypertrophic Scar Formation

225,000-

An Evaluation of Health Literacy in Plastic Surgery Patients.

300,000 for new hires out of fellowship. Eleven percent of participants were compensated for taking call, and another 30.5% of participants were compensated for participation in committees, research and publications. Fourteen percent received bonuses based on patient satisfaction and 15.8 % received bonuses based on quality metrics. Seventeen percent of practices reported having a free-standing aesthetic center, with none of the facility fee contributing to their compensation.

The Baltodano Breast Reduction Score: A Nationwide, Multi-Institutional, Validated Approach to Reducing Surgical-Site Morbidity

INTRODUCTION: As health care systems consolidate and more patients become insured, plastic surgeons face declining reimbursement for reconstructive procedures and increasing volatility in demand for aesthetic procedures. Administrative, regulatory, and legislative roadblocks have risen for providers, at a time when patients ironically have improved access to care. This study compares and contrasts the changing demographics and needs of employed versus private practice plastic surgeons, with the goal of identifying solutions to current/future challenges.