Cosmetic patients have many options when seeking out their surgeons. In midsize and larger cities, these options span not only different specialties but also different levels of experience. Because surgical experience can best be gained first hand, there exists a special and symbiotic relationship between a surgeon-in-training and his or her patient. Benefits stem from the opportunity for a surgeon to gain independent experience while offering cost effective benefits to patients who may or may not otherwise have access to cosmetic surgery. To meet the needs of both patients and the surgeons-in-training, the Wake Forest University Plastic and Reconstructive Surgery Training Program has set up and maintained a chief resident run cosmetic surgery clinic for 17 years. Each chief resident serves as primary surgeon 1 day a week during the chief year. We present a 7-year retrospective outcome analysis of this experience. The authors performed an Institutional Review Board approved retrospective chart review of all patients who received major cosmetic procedures performed in the WFU chief resident clinic over a 7-year span from 2000 to 2007. A total of 210 charts were reviewed. Fourteen charts were excluded because of inadequate records or non esthetic procedures performed concomitantly. All procedures were viewed as independent events. A total of 196 patients underwent 272 procedures. All procedures were evaluated for major and minor complications and revisions. A total number of 272 initial cosmetic procedures were performed in a 7-year span. Adverse events were divided into major and minor complications. There were no major complications for any of the procedures. Overall minor complication rate was 8.0%. Overall revision rate was 14.4%. Procedures with greatest probability of revision were abdominoplasty and reduction mammaplasty. Chief resident clinics provide a unique experience wherein surgeons-in-training are allowed to hone previously developed surgical acumen while providing a safe and expectedly desirable result for their patients. Because many cosmetic patients desire secondary touch up procedures, a rate of 14.4% in this cohort is neither unexpected nor unacceptable. In addition, the postoperative evaluation and the decision to pursue secondary procedures provides a unique perspective to the chief residents. A chief resident run clinic can be an effective and safe learning tool, providing benefit to patient and the surgeon in training.

These studies were carried out in the maxillofacial unit, surgical specialties hospital, medical city, Baghdad, included 55 patients with orofacial tumors; their ages ranged from 2 days to 14 years (mean, 7 years). Twenty-eight of them were girls, and 27 were boys. Tumors included 20 cases of benign tumors and 35 cases malignant. Treatment modalities ranged from complete surgical excision, surgical shaving operations, and deep x-ray therapy (DXT; radiotherapy) for some benign tumors. The management of malignant tumors was carried out by the use of chemotherapy, chemotherapy and DXT to radical surgery, or radical surgery with DXT. Reconstruction of the mandible was carried out using a rib graft or a block of a corticocancellous bone graft from the iliac crest with reimplantation of the condyle after resection from the tumor and fixed by rigid fixation to the bone graft. Temporary reconstruction of the mandible done by Kirschner wire for malignant tumors required a postsurgical DXT. A temporalis muscle flap was used for the augmentation of the orbit with a frontoorbital flap after radical excision of a malignant tumor of the orbit, and a silastic implant (silicon rubber) was used for reconstruction of the orbital floor. A long-term follow-up ranged from 2 to 15 years. The aim of this study was to present a certain number of cases with an interesting pathologic tumor condition showing peculiar behaviors; the management of these cases was a challenge to our surgical experience.

Long-term experience with spring-assisted surgery has facilitated the development of standardized, reproducible techniques allowing spring design modifications to optimize clinical outcome.

the circumflex, a transatrial approach would no doubt be ideal. In cases similar to ours, a direct approach through a left thoracotomy is a good alternative because the circumflex artery can be clearly visualized and protected. Moreover, most patients do not have significant mitral regurgitation and might not require an additional mitral valve procedure.Our approach, which is based on the relationship of the circumflex coronary artery to the neck of the aneurysm as demonstrated on a preoperative angiogram, appears to be safe and will result in significant reduction in mortality and morbidity in managing this rare and difficult condition, particularly in parts of the world outside Africa.