November 11th, 2009 by RamonaBatesMD in Better Health Network, News
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A new study on fat grafting for breast augmentation was presented at last week’s American Society of Plastic Surgeons (ASPS) Plastic Surgery 2009 conference which I wasn’t able to attend. The ASPS News Brief section gave an update on the presentation with a pdf of the abstract.
The main study author, Roger Khouri, MD, FACS, is featured in a video explaining the study and technique. He feels that his study of 50 women is enough to settle the question of safety and effectiveness of fat injections for cosmetic breast augmentation. Even though his results are good, I remain a skeptic.
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*This blog post was originally published at Suture for a Living*
October 29th, 2009 by RamonaBatesMD in Better Health Network, Health Tips
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Flipping through the 1908 textbook, A Text-Book of Minor Surgery by Edward Milton Foote, MD I found at an antique store last month, I came across the section on ingrown toenails. The causes of ingrown toenails were much the same as one hundred years.
This is a condition in which the edge of the nail, usually of the great toe, by its too close contact with the flesh beneath causes irritation, ulceration, or suppuration. There has been much discussion as to whether the nail or the flesh is the more at fault. This discussion is without profit. It is much better to study the normal conditions, and see what can be done to restore them. Read more »
*This blog post was originally published at Suture for a Living*
October 22nd, 2009 by Shadowfax in Better Health Network, Opinion
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In the comments, a question was posed from reader “Seattle Plastic Surgery on Lake Union” (an online handle that is as unwieldy as it is descriptive). He asks:
I would like to hear your opinion on a topic that is rapidly growing near and dear to my heart…the scenario is thus:
I’m on call, the local plastic surgeon, for the local ER. You are seeing a nice family with a child that has sustained a simple facial laceration. No fractures, no missing tissue, just a simple, linear, forhead laceration.
The Mom asks that a plastic surgeon be called to come in from home and close the wound. You reply that you are able to do the closure, the child is medically stable, and that a you are qualified to close the wound. The family presses you: call the plastic surgeon.
Can you tell me, from an ER doc’s standpoint- what is the most appropriate response from the on call plastic surgeon? Read more »
*This blog post was originally published at Movin' Meat*
October 15th, 2009 by RamonaBatesMD in Better Health Network
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There has been recent debate over whether circumcision should be made mandatory as a way to prevent the spread of HIV, so I thought I would share the section on circumcision from the 1908 textbook, A Text-Book of Minor Surgery by Edward Milton Foote, MD.
Circumcision
This little operation can be performed in a number of ways. The practice among the Hebrews when circumcision is performed as a religious rite is to draw the foreskin well forward, to cut it off with one stroke of a long knife, to immerse the penis in wine held in the mouth of the rabbi to stop the hemorrhage, and then to wrap it in linen rags. It is not surprising that dangerous hemorrhage and infection sometimes follow this procedure, and a few lives have been lost in consequence.
Equally reprehensible is the practice among some surgeons of trying to perform this little operation in the shortest possible time. For this purpose clamps have been devised to hold the foreskin so that both the external and reflected portions can be cut away by a single stroke of the knife. It is obvious that the amount of skin thus removed cannot be controlled with certainty, and even if the line of incision be a perfectly smooth circular one, a thing which rarely happens, the adjustment in length of the external and internal portions of the prepuce is at best uncertain. There is no part of the body concerning which most patients are more sensitive, so that the surgeon ought to be willing to give up a few minutes of his time in order to secure a perfect result. Read more »
*This blog post was originally published at Suture for a Living*
September 20th, 2009 by Bongi in Better Health Network, True Stories
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Recently a plastic surgeon I know was called out to fix a lacerated ear. It is the domain of plastic surgeons pretty much all over the world. But in my neck of the woods it may be tricky to extricate a plastic surgeon from his warm bed on a cold night. Let me also say that back in those days all registrars of all disciplines earned the same overtime each month. Even opthalmologists and dermatologists and pathologists earned exactly the same overtime as surgeons. They weren’t complaining. We, however, were.
As calls went it was fairly standard for us general surgeons. I had found a moment to empty my bladder which was a nice change, but other than that one reprise there had not been a moment to even realise that I hadn’t eaten all day. At least there hadn’t been any lethal disasters…yet.
Somewhere in the madness the house doctor asked me to evaluate a patient with a lacerated ear. He had had half his ear detached in a bar brawl. It was hanging precariously from what still connected it to the body. Now at this time in that hospital there was a policy that once a patient had been referred by a casualty officer they would not take the patient back. If the referral was erroneous then we would be required to refer further as appropriate. So when I heard my house doctor had accepted the patient I was not impressed.
“You suture his ear.” I told him. Poor guy, he hadn’t studied at our university and therefore wasn’t used to our sink or swim approach to medical training. He freaked. My level of being impressed dropped even more. I’d have to phone the plastic surgeon myself.
The plastic surgeon was not keen. By that I mean he basically said he was not coming out. By the tone of his voice I assumed he was getting a back rub from his significant other under the warm duvet on his bed. Who could blame him. If you’re not in the trenches why would you want to go into them, even for a short while to suture an ear.
“Anyone can suture an ear. you’re there now. I’d have to come in to the hospital. You just do it.” I considered telling him that I’m at the hospital because I have so much bloody work to do and that he is drawing the same overtime that I am and that it is his bloody job and not mine. But I knew that at that stage, even if I walked on water and then turned it into wine he was not going to come out. I hung the phone up. my house doctor looked at me questioningly. He had already told me he couldn’t do it. But he was not from our neck of the woods. I needed a student. One walked past, unsuspectingly.
“You! have you ever sutured an ear back on?”
“No.”
“When I ask this same question tomorrow, you will answer yes. Come with me.”
He did quite well.
*This blog post was originally published at other things amanzi*
