Plastic surgery in Sheffield--an Australian trainee's view

A common misconception by those that have not worked with us, and sorry to say even some of our colleagues in other specialties, is that plastic surgery is unimportant and is all cosmetic surgery, aimed at making vain people look as if they have just walked off a movie set in Hollywood. This is not so. Most people just want to look normal and fit in with their peers. Cosmetic surgery is beginning to be more socially acceptable and openly talked about in Australia. Even our Prime Minister's wife has done a story in a magazine about her recent face-lift. Years ago this would never have been talked about openly.

The "standard technique" of liposuction. Viewpoint from a plastic surgeon

So, do I recommend the tumescent technique to accomplish liposuction contouring? You bet. Is it the "standard technique"? Not yet, but it probably will become so as it is better known and safety issues are addressed. The tumescent technique also offers a variety of possibilities for research and application for other areas.

[The state of the art in plastic and reconstructive surgery: a growing art]

On studying the state of the art in Plastic and Reconstructive Surgery there are two different aspects that have achieved very different levels of advance and progress: the organisation and establishment of this speciality, and scientific and technical progress. In an analysis of the former. The author outlines the principal problems facing Plastic Surgery in Portugal, the present shortcomings and the almost complete lack of coherent planning, and the prevailing rules for the training of new specialists. A study of the second aspect reveals manifest progress and innovation in many areas of this speciality. The Author describes in greater detail, controlled tissue growth, innovations with flaps, principally facial-cutaneous and inverted flow, advances in the remodelling of the face where there are many examples of implantation of material, modelling osteotomy and surgical interventions in the field of muscular dynamics, and lipo-aspiration which has extended horizons in both Plastic and Reconstructive Surgery.

Mohs micrographic surgery for melanoma

The results of multiple investigators have confirmed the value of Mohs surgery in the treatment of melanoma. In addition, these studies have contributed to our understanding of the biologic behavior of melanoma. The success of Mohs surgery confirms that melanoma grows in a contiguous fashion before it spreads systemically. It is known that once tumor breaks away from the main mass, trying to improve survival by increasing the extent of conventional surgery is often fruitless. Therefore, the goal of surgery is to remove all of the tumor, including the silent contiguous foci. If melanoma did not grow in a contiguous fashion before metastasis, the results of Mohs surgery would be inferior to wide excision, and higher local recurrences would be expected. Instead, the excellent results support the concept of contiguous tumor growth. Satellites and in-transit metastases that appear later may be removed with the fixed-tissue technique. We have also learned that melanoma sends out silent contiguous extensions, necessitating excision of some normal-appearing skin. The width of those extensions is unrelated to the depth of the melanoma. The value of Mohs surgery is the ability to identify these extensions microscopically and to excise tumor-bearing tissue while sparing normal skin. In fact, Mohs surgery often spares a diameter of 1.8 cm or more when compared with standard surgery, a distinct advantage to patients whose melanomas are on the head, neck, hands, feet, or genitalia or in patients whose melanoma has indistinct clinical margins and would require an even wider margin of normal skin when using standard surgical techniques. We now have long-term results from large numbers of patients--confirmed by multiple investigators and data--to support the concept of Mohs surgery for melanoma. This information emphasizes the important role that Mohs micrographic surgery plays in the treatment of melanoma.

New concepts in pediatric plastic surgery

The pediatric patient who requires plastic surgery usually has a birth defect or congenital deformity. Such problems may vary from a simple strawberry hemangioma to the most complex deformity involving the entire facial skeleton and soft tissue. New technics in treatment and advances in diagnosis allow such problems to be corrected with impunity, giving patients the opportunity to grow and lead normal, productive lives.