Comparison of Plastic Surgery Training Programs Between Hong Kong and Shanghai

The field of plastic surgery has developed rapidly in the last couple of decades in Hong Kong and Shanghai, China. Both cities have their own educational system for training plastic surgeons. Their training programs differ in many ways, including the surgical exposure of undergraduate studies, the structure, curriculum, and operative requirements of residency training. In general, Hong Kong has a single pathway of residency training with more early clinical exposure in an undergraduate study. On the contrary, Shanghai has multiple pathways of residency training that are heavily emphasized in academic research. Both Hong Kong and Shanghai should complement each other to modify their plastic surgery training programs that will eventually benefit the field of plastic surgery education.     

整形外科中的发明原理分类研究--发明原理之No．1至No．20

目的为了指导整形外科创新设计，对整形外科中的发明原理分类研究。方法根据TRIZ理论，研究了40条发明原理在整形外科领域的应用，并给出其对应的医疗设计实例，将部分典型实例按TRIZ中的40条发明原理中的前20条原理进行分类。结果这些医疗实例及其设计过程，可为医务人员解决医疗设计冲突提供发明原理参考。结论TRIZ发明原理具有普遍性，已成功应用于整形外科设计领域。     

Handchirurgie in der deutschen Orthopädie

The intention of this report is to present an overview of the development of hand surgery and its status in German orthopedics. An important role was played by orthopedics in the development of hand surgery: many insights and classifications in this field originate from orthopedic surgeons and retain their validity in this century. In the past few decades, traumatologists and plastic surgeons have become increasingly active in the field of hand surgery and have added to their surgical repertoire some fields formerly regarded as part of classic orthopedics, e.g., correction of malformations of the hand. Although microsurgical techniques of hand surgery were primarily developed by plastic surgeons, the past should nevertheless motivate all orthopedists to continue considering hand surgery the "pearl of orthopedics" in the future.     

Improving Surgical Care in Mongolia: A Model for Sustainable Development

The W. C. Swanson Family Foundation selected Mongolia to help improve access to affordable quality surgical and medical care in 2000. Over the last 12 years of partnering with the Health Sciences University of Mongolia, three major concepts have been identified that have promoted sustainable progress in expanding and improving surgical care throughout the healthcare system—including urban and rural areas. Understanding and targeting the needs identified by the Mongolian surgical community has cultivated a critical working environment that has had a profound effect on expanding surgical care in Mongolia. Integrating modern surgical care training with basic emergency and essential surgical and medical initiatives created a trusting foundation providing many unforeseen educational opportunities. Lastly, the educational model introduced, including long-term capacity-building programs, has helped enable the local Mongolian surgeons, nurses, biotechnicians, administrators, and educators to continue pioneering independent efforts to further expand modern surgical care in Mongolia.     

Computer-assisted training system for knee arthroscopy

This paper presents an educational method for minimally invasive surgery, conceived in collaboration with educationalists and arthroscopists, and an integrated system to train a priori knowledge and to exercise manual dexterity. The approach is generally suitable for minimally invasive surgery interventions but has been developed specifically for knee arthroscopy. Based on a classification of the knowledge, the system provides multimedia modules to train anatomical and procedural knowledge and a surgical simulator for training perceptual motor skills. We have tested the system in making three surgeons perform a series of tests. The results show that performance increases with the degree of experience. We also delivered a usability questionnaire and evaluated the appreciation by the surgeons. The test results and the appreciation showed by the surgeons encourage the prosecution of the research.     

The effect of new technologies on plastic surgery.

Plastic surgery has always been a technique- and technology-driven surgical discipline, given that there is no regional anatomic focus. There has been a remarkable evolution in technique over the last 25 years with an increased understanding of anatomy leading to a whole host of new and more reliable flaps, which has transformed reconstructive surgery, breast reconstruction being one notable example. The development and maturation of microsurgery has led to the full fruition of anatomic principles. With better understanding of blood supply to the skin, fascia, muscle, and bone, many traditional reconstructive procedures are constantly being superseded by the new, ingenious use of various tissue flaps. Advances in technology will accomplish another transformation of the specialty, notably the recent advances in tissue engineering, the potential of gene therapy, new alloplastic materials, and computer-assisted imaging technology. It would be impossible to address all of the recent advances in this rapidly expanding field of surgery in a short article. We have selected a few topics that we thought would be the most interesting to all surgeons to give a wide view of a variety of challenges addressed by the modern plastic surgeon. Major advances in surgery often come from cross-fertilization between specialties, and plastic surgeons have frequently been involved in this process.     

Ethical issues in plastic and reconstructive surgery

Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed in order to repair or restore body parts to look normal or to enhance a certain structure or anatomy that is already normal. Several ethical considerations such as a patient’s right for autonomy, informed consent, beneficence, and nonmalfeasance need to be given careful consideration. The principal objective of the medical profession is to render services to humanity with full respect for human dignity. Plastic surgeons should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. They require an extensive amount of education and training. The increases in demand for aesthetic plastic surgery and the advocacy of practice in the media have raised concerns about the circumstances under which cosmetic surgery is ethical and permissible. Innovative research, and new technologies derived from such research, almost always raises ethical and policy concerns. Medical ethics regulate what is, and what is not, correct in promoting plastic surgery to the public. It is essential to create an educated and informed public about the ethical issues in the plastic and reconstructive surgery field. Plastic surgeons need to carefully evaluate the degree of deformity, physical and emotional maturity, and desired outcome of patients who request plastic surgery procedures. Science is a powerful force for change in modern society and plastic surgeons have a responsibility to shepherd that change with thoughtful advocacy and careful ethical scrutiny of their own behavior.     

Gute Stumpfverhältnisse als Voraussetzung für eine optimale prothetische Versorgung an der unteren Extremität

It is unfortunately still a reality that not all surgeons have sufficient knowledge in the field of orthopedic techniques and the consequences are not always well-prepared stumps. Orthopedic technicians cannot resolve stump problems in all cases. The sequelae are offset, atrophic, pain-sensitive stumps with changing volumes. The surgeon should therefore be well-informed on the principles of stump preparation. Amputations are a form of plastic surgery.     

Completing the metamorphosis: building a center of excellence in postbariatric plastic surgery

Postbariatric body contouring is an expanding and rapidly evolving specialty within plastic surgery. To best address the many clinical issues related to the safe and effective care of the postbariatric patient, the authors have established a dedicated multidisciplinary treatment center. Team building efforts have brought together attending plastic surgeons who specialize in body contouring, nurses focused on body contouring after weight loss, and an administrative staff well trained in the issues related to managing these specific types of cases. Through core partnerships, nutritionists, lifestyle counselors, and psychologic professionals are present in the clinic to evaluate patients alongside the plastic surgeon. A dedicated physician assistant and body-contouring fellow work in both the clinic and the operating room (OR). This team approach has allowed for the establishment of defined screening procedures and patient care algorithms. Outreach and patient education initiatives have allowed the center to forge strong alliances with the regional bariatric surgeons and make patients aware of the role of plastic surgery as they start the process of weight loss. A strong research mission is demonstrated by an IRB-approved clinical registry and database that facilitate outcomes studies.     

Cutaneous vascular lesions

Vascular anomalies are lesions seen in all surgical disciplines, particularly in pediatric patients. Specialization in vascular anomalies involves a team effort, with the team consisting of plastic surgeons, general surgeons, neurosurgeons, pediatricians, interventional radiologists, dermatologists, ophthalmologists, otolaryngologists, hematologists, and pathologists. Inconsistent nomenclature in the literature has historically resulted in confusion about classification, diagnosis, and treatment. A biologic classification system has emerged, based on clinical observations, natural history, and cellular features, which separates vascular anomalies into two broad categories: vascular tumors and vascular malformations. For many vascular anomalies, photodocumentation, psychosocial support, and communication are important throughout the treatment course.     

Community-engaged research in vascular surgery: An approach to decrease amputation disparities and effect population-level change

Community-engaged research (CEnR) is a powerful tool to create sustainable and effective change in health outcomes. CEnR engages community members as equal partners, amplifying their voices and priorities by including them throughout the research process. Such engagement increases the relevance and meaning of research, improves the translation of research findings into sustainable health policy and practice, and ultimately enhances mutual trust among academic, clinical, and community partners for ongoing research partnership. There are a number of key principles that must be considered in the planning, design, and implementation of CEnR. These principles are focused on inclusive representation and participation, community empowerment, building community capacity, and protecting community self-determination. Although vascular surgeons may not be equipped to address these issues from the ground up by themselves, they should work with a team who can help them incorporate these elements into their CEnR project designs and proposals. This may be best accomplished by collaborating with researchers and community-based organizations who already have this expertise and have established social capital within the community. This article describes the theory and principles of CEnR, its relevance to vascular surgeons, researchers, and patients, and how using CEnR principles in vascular surgery practice, research, and outreach can benefit our patient population, with a specific focus on reducing disparities related to amputation.     

The McCollough Facial Rejuvenation System: a condition-specific classification algorithm

The search for the holy grail in facial rejuvenation is an ongoing quest. Perhaps the reason the "ideal" face-lift has yet to be discovered is a result of three factors. First, the term FACE-LIFT has never been adequately defined. Second, fads and trends play a role in how the operation is taught and performed. Third, surgeons searching for the prototypic technique have not had a way to index the physical signs of facial aging. After 37 years of practicing facial plastic surgery and performing more than 5000 face-lifts, the author determined that replacing chaos with order is long overdue. To achieve this goal, he developed a classification system that is designed to match each potential patient's problems with the most appropriate facial rejuvenation treatment plan and a "language" by which facial rejuvenation surgeons can communicate. Five progressive stages of aging have been identified and matched with recommended courses of face-lifting, blepharoplasty, volume augmentation, and skin resurfacing techniques. Ancillary procedures have also been included when indicated. It is the author's hope that a new classification system will bring order to mounting confusion within the aesthetic surgery professions as well as within the public sector.     

整形外科进展

目的综述近几年整形外科临床治疗所取得的主要进展.方法广泛阅读国内外相关文献及专著,并进行综合,指出整形外科取得的主要成就.结果在整形外科中,近几年美容外科有了飞速发展,并有将整形、美容学科合二为一的趋势.在手外科不仅重视结构、功能的修复,也要重视形态美、应发展"美容手外科".在面瘫及面部毁损治疗方面,发展了"面部肌肉神经化测量系统"及同种异体颜面部移植技术.穿支血管皮瓣的解剖研究促进了临床应用的发展.结论整形外科已取得很多重要发展,今后在修复重建外科领域应更加重视结构、功能、形态的完美结合.     

Surgical Education in China

A highly skilled surgical team relies on a standardized training system and the most important subject in the development of general surgery in China is to set up standardized education and training systems for surgeons. This article reviews the history of the training of residents, delineates the current situation and problems of residency training in general surgery, and discusses reform and future development of surgical training systems and assessment of competence in surgical practice, in order to put forward the solutions and countermeasures. China needs a large number of highly trained surgeons to improve its medical care system, and some fundamental changes of its residency training system, especially in the field of surgical education, have been made. All of the experts working in this area sum up the historical experience and apply the advanced experience of foreign countries as a reference to build up a surgical education system with Chinese characteristics to achieve a continuous, sound, and rapid development of surgical education in China.     

Assessing adolescents and young girls for plastic surgical intervention: pre-surgical appearance ratings and appearance-related burdens as reported by adolescents and young adults, parents and surgeons.

Currently available research on psychological aspects of plastic surgery offers little basis for clinical decision making in the plastic surgeon's assessment of adolescents and young adults applying for surgery. Therefore, the research aims were to study: first, how these adolescents and young adults estimate their appearance as compared to their parents and plastic surgeons to determine the reality of their own appearance perception; second, what appearance-related burdens they experience to determine the urgency of their request for surgery; and third, the surgeons' considerations for the operation. Data were obtained from 184 plastic surgical patients aged 12-22 years (71.2% girls), 172 of their parents and 37 surgeons from 16 hospitals in The Netherlands, using appearance rating scales and to surgeons and parents, and reported substantial appearance-related suffering. There was a moderate to large overlap between the adolescent- and parent-reported burdens. In their assessment, surgeons took psychological and social impediments into consideration. In conclusion, plastic surgeons may rightfully assume that adolescents and young adults have a realistic view of their appearance and that they suffer from significant appearance-related burdens. Parents prove to be an important additional source of information.     

Development of reconstructive blepharoplasty: The temporofacial rotation flap. Was it first conceived on the spree,on the seine,or on the manzanares?

The development of reconstructive blepharoplasty in the 19th century is analyzed and the techniques classified according to their principles. Besides the main contributions of French, German, and Italian plastic surgeons, those made by two Spanish surgeons are summarized. Argumosa, who published an article on the tempororotation flap two years before Dieffenbach, and Hysern, who developed the first musculocutaneous transposition flaps for eyelid reconstruction, are usually omitted in the literature. After Dieffenbach's publication, German and French surgeons argued about who contributed to the development of plastic surgery in general and to blepharoplasty in particular, while in Spain controversies arose about the importance of Hysern's and Argumosa's contributions. The background and causes of these disputes are analyzed and compared with the present day dissemination and publication of new techniques.     

The paediatric plastic surgery

Paediatric plastic surgery is a complex surgery. The management of traumatized or malformed children needs a lot of contributors: the paediatric plastic surgeon is often the "conductor" of a large team. Paediatric plastic surgery is a very nice but fragile speciality. This surgery needs a long experience, a large recruitment and a rigorous training. Good university education is necessary to know techniques and children's pathologies. An international recruitment is necessary for these rare pathologies. Surgical training is also important with a good training in microsurgery and minimally invasive surgery. The management of children needs to know physiologic particularities, specific pathologies, cicatrisation particularities and especially the outcome of growth and psychomotor development. Some French surgeons are references in the world for surgery of hand abnormalities, ear reconstruction or skin expansion. They changed techniques and indications to improve each day the live of children with abnormalities. Interviews of these surgeons are very useful to understand and improve the French creativity.     

Weichteildefekte als Komplikation nach Knieendoprothetik

Soft tissue defects after knee arthroplasty are a severe problem, which can even result in a loss of the prosthesis or the limb. Well-planned strategies are necessary for sufficient soft tissue reconstruction, resulting in optimal functional and aesthetic results.This report provides information on the classification of the tissue defects and the appropriate options for surgical reconstruction. Besides the basic therapy principles of immobilisation, débridement, planned lavages and antibiotic therapy, defect-dependent surgical techniques of reconstructive surgery are implemented. These include skin transplantation, local fasciocutaneous flaps, local pedicled muscle flaps and free flaps. For best results, interdisciplinary treatment by orthopaedic surgeons, plastic surgeons, microbiologists and physiotherapists is mandatory.