Principles of plastic surgery portrayed by the professional life of Dr John Peter Mettauer

Regarded as "America's first plastic surgeon," Dr John Peter Mettauer's professional life displays 3 fundamental keystones of plastic surgery: education, innovation, and practice. To fully appreciate the history of our plastic surgery, one must look beyond a purely factual recount of noteworthy actions performed decades ago. Fundamental principles that governed achievements of our predecessors remain applicable even today. Dr Mettauer thrived as a medical student under the influence of distinguished professors in medicine at the University of Pennsylvania. Later, he continued to propagate their basic tenets when he established his medical institute in 1837. Throughout his life, Dr Mettauer combined ingenuity with scientific inquiry to devise numerous unprecedented surgical techniques and instruments. He was a prolific writer and exquisitely documented his work in medical journals for the benefit of both contemporary and future surgeons. One of Dr Mettauer's momentous achievements in plastic surgery that displays his remarkable capabilities was his contributions to management of both simple and complicated cases of cleft palate. He was the first to describe relaxing lateral incisions for treating complete cleft palates and, incidentally, was the first to successfully treat this in America. He invariably replicated similar success in establishing techniques for treating a wide range of anatomic deformities. Cumulatively, Dr Mettauer's lifelong commitment and diligence have truly laid a foundation for the eventual progress and success in the field of plastic surgery

Postoperative Antibiotic Prophylaxis for Implant-Based Breast Reconstruction with Acellular Dermal Matrix

Background: The use of acellular dermal matrix in implant-based breast reconstruction has been described for improving inferolateral prosthesis coverage and support and inframammary fold reconstruction. Recommended guidelines for infection prophylaxis are the same as for any clean procedure-antibiotic administration only before surgery. Previous studies have demonstrated increased postoperative rates of infection and seroma associated with the use of acellular dermal matrix. The authors evaluated the impact of postoperative antibiotic prophylaxis on infection rates in postmastectomy expander-based breast reconstruction with acellular dermal matrix. Methods: A retrospective study reviewed data of 96 patients who underwent either immediate or delayed expander-based breast reconstruction using Allo-Derm allogenic acellular dermal matrix. Infection rates were analyzed after patients received postoperative antibiotic prophylaxis for at least 48 hours compared with those who received only perioperative antibiotics. Results: Infection rates for breast reconstructions with a postoperative antibiotic course were 7.9 and 3.2 percent. Patients with only perioperative antibiotics had an infection rate of 31.6 percent. Infections were defined by the endpoint of implant removal. Patient demographics, comorbidities, and intraoperative variables were recorded. Uncontrolled variables were time course between mastectomy and reconstruction, nodal dissection, operative history, and whether reconstruction was unilateral or bilateral. Conclusions: This study demonstrates significant differences in the rate of infection between the groups of patients undergoing the first stage of two-stage implant-based breast reconstruction who received postoperative antibiotic prophylaxis and the group that received only perioperative antibiotics. This study suggests that the optimal duration of postoperative antibiotic prophylaxis is at least 48 hours. (Plast. Reconstr. Surg. 131: 453, 2013.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III

The Role of the Buccal Fat Pad in Facial Aesthetic Surgery

Social media have triggered a buccal fat pad excision frenzy. Not surprisingly, there is tremendous appeal of having a slimmer lower face and more defined jawline after undergoing a small intraoral procedure under local anesthesia. Although this procedure is great for social media and seemingly beneficial for jawline aesthetics, the evidence remains limited as to whether or not this is an effective long-term solution. How much the buccal fat pad persists or diminishes as we age is an area of debate. However, the possibility of causing premature aging and midface distortion in the long run is disconcerting

Inferior pedicle breast reduction: a retrospective review of technical modifications influencing patient safety, operative efficiency, and postoperative outcomes

The inferior pedicle technique remains the most popular approach to breast reduction in the United States. Modifications to this procedure have enhanced versatility, patient safety, and outcome satisfaction in patients with all degrees of macromastia. A 6-year retrospective review of 241 patients who underwent bilateral inferior pedicle breast reduction was conducted at our institution. Modifications analyzed included methylene blue tattooing to provide preoperative landmarks, preoperative hydrodissection to reduce intraoperative blood loss, incorporation of inframammary darting to reduce tension at the “T-junction,” preservation of superomedial volume for enhanced medial fullness, and dermatome blade–guided tissue resection. Inframammary darting reduced the incidence of wound dehiscence. Preoperative hydrodissection reduced intraoperative blood loss by a factor of 2. Dermatome blade use reduced operative times at no increased incidence of postoperative seromas or hematomas. Outcomes resulting from these modifications appear to be at least comparable to, and perhaps better than, those previously reported

sj-tif-4-fac-10.1177_27325016221138749 – Supplemental material for Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty

Supplemental material, sj-tif-4-fac-10.1177_27325016221138749 for Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty by Yash J. Avashia, Hannah L. Martin, Dennis O. Frank-Ito, Katrina Z. Hodges, Rose T. Trotta, Hang Li, Carolyn Lowry, Charles R. Woodard, Alexander C. Allori and Jeffrey R. Marcus in FACE</p

sj-tif-5-fac-10.1177_27325016221138749 – Supplemental material for Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty

Supplemental material, sj-tif-5-fac-10.1177_27325016221138749 for Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty by Yash J. Avashia, Hannah L. Martin, Dennis O. Frank-Ito, Katrina Z. Hodges, Rose T. Trotta, Hang Li, Carolyn Lowry, Charles R. Woodard, Alexander C. Allori and Jeffrey R. Marcus in FACE</p