In 2011, Tim Piper created a video clip featuring a short time lapse of a beauty photo shoot and postprocessing session on Photoshop showing a radical transformation. 1 Piper T. Body evolution—model before and after Photoshop. http://www.youtube.com/watch?v=xKQdwjGiF-s&feature=youtube_gdata_player. Published November 2, 2013. Accessed December 30, 2013. Google Scholar Although the video was created for the website GlobalDemocracy.com to support the need for a mandatory disclaimer for airbrushed models, it touched many more cultural issues surrounding the media and methods of advertising today. It has been used as part of a growing social outcry against unrealistic expectations and the objectification of women in the media. This video has been shared and uploaded through multiple social platforms, resulting in more than 10 million cumulative views on YouTube alone. The culture of image manipulation has been perpetuated in colloquialism by the word Photoshop and continues to be the subject of heated debate. For example, photographer and artist Anna Hill 2 Hill, A. All In One. Nebulae Decay. Available at: http://nebulaedecay.com/digi/4rbopin30pgrakdlpm0zim17u6ukod. Accessed December 30, 2013. Google Scholar created a viral parody of this Photoshop culture using techniques that are rampant in mainstream advertising to create a series featuring herself as the model (Figure 1), touting Photoshop as the “all-in-one” kit that even performs plastic surgery. Indeed, image manipulation in the media is not a new concept. Even the supermodel Cindy Crawford once said, “I wish I looked like Cindy Crawford.” 3 Kilbourne J. Killing Us Softly 4: Advertising's Image of Women. Media Education Foundation, Northampton, MA2010 Google Scholar However, with the growing market in digital imaging technology, high-resolution digital cameras and editing software like Photoshop are quickly becoming more affordable and more attainable. In a recent marketing report published by BCC Research, the global digital photography market was valued at $68.4 billion in 2011 and projected to reach $82.5 billion in 2016. 4 Dueck J. Elder M. Digital Photgraphy: Global Markets. BCC Research, Wellesley, MAMarch 2012http://www.bccresearch.com/market-research/information-technology/digital-photography-global-markets-ift030c.html Google Scholar Similarly, digital imaging continues to grow in the scientific community, and with this growth, issues regarding improper and even fraudulent use of digital images have multiplied.

We previously developed and validated a vortexing-sonication technique for detection of biofilm bacteria on the surface of explanted prosthetic joints. Herein, we evaluated this technique for diagnosis of infected breast tissue expanders and used it to assess colonization of breast tissue expanders. From April 2008 to December 2011, we studied 328 breast tissue expanders at Mayo Clinic, Rochester, MN, USA. Of seven clinically infected breast tissue expanders, six (85.7%) had positive cultures, one of which grew Propionibacterium species. Fifty-two of 321 breast tissue expanders (16.2%, 95% CI, 12.3–20.7%) without clinical evidence of infection also had positive cultures, 45 growing Propionibacterium species and ten coagulase-negative staphylococci. While vortexing-sonication can detect clinically infected breast tissue expanders, 16 percent of breast tissue expanders appear to be asymptomatically colonized with normal skin flora, most commonly, Propionibacterium species.

Objective. The influence of Coherent Ultrapulse, TruPulse and Erbium: YAG laser skin resurfacing on survival of the skin flaps when performed simultaneously was evaluated. Material and methods. We used twelve female Yucatan minipigs in the study. Skin flaps including paniculus carnosus were raised on the animals’ back. The flaps were sutured into the defect under tension. We designed 4 experimental groups: Control-Flaps only, Group 2-Flaps + 4 immediate TruPulse laser passes, Group 3-Flaps + 2 immediate Coherent UltraPulse laser passes, Group 4-Flaps – immediate 50J/cm2 total fluence with Erbium: YAG laser. Results. Flap survival in Control group was 98.8%. There was no flap in Group 2 with complete survival. Survival of the flaps in Group 2 (Tru-Pulse) ranged from 75-90%, with average flap survival area of 85.2%. In Group 3 (UltraPulse) all 24 flaps had some area of necrosis. Flap survival in Group 3 ranged from 75-95%, with an average of 85.6%. In Group 4 (Erbium: YAG) flap survival area ranged from 70-95%, with all 24 flaps with some area of necrosis, with average flap survival area of 87.3%. There is a significant statistical difference in flap survival area between groups 2, 3 and 4 versus Control (p<0.001). Conclusion. The results of our study suggest that laser resurfacing of skin flaps sutured under tension in the same operative session is detrimental for skin flap survival. We also found no significant difference in flap survival area between TruPulse, Coherent UltraPulse and Erbium: YAG laser treated flaps.

Background: External hemipelvectomy is the ultimate salvage procedure for locally advanced pelvic tumors, infections, and failed revascularizations. It is associated with high wound morbidity requiring surgical management. In this study, the authors analyzed their experience with primary and secondary reconstruction of hemipelvectomy wounds. Methods: The records of 160 consecutive hemipelvectomy patients from the authors' institution were reviewed to identify the incidence of soft-tissue coverage problems and approaches to their management. Results: At the time of hemipelvectomy, a musculocutaneous hemipelvectomy flap was sufficient for closure in 159 patients, one patient needed a free lower leg fillet flap, and none required pedicle flaps. No hemipelvectomy hernias were observed, although abdominal wall reconstruction was performed in three patients. Wound complications were encountered in 62 patients (39 percent), and 51 patients required operative débridement. Thirty-three patients healed by secondary intention, and 25 underwent delayed reconstruction with local tissue rearrangements (n = 15), split-thickness skin grafting (n = 6), and pedicled flaps (n = 6). All pedicled flaps were contralateral inferiorly based rectus abdominis muscle (n = 2) and musculocutaneous (n = 4) flaps. Conclusions: Hemipelvectomy is associated with high wound morbidity. When the hemipelvectomy flap has a musculocutaneous design, hernias are exceedingly rare. Although immediate reconstruction is accomplished with a hemipelvectomy flap in the vast majority of cases, secondary reconstructions are often required for management of wound complications. For large defects, a contralateral inferiorly based rectus abdominis muscle or musculocutaneous flap is the reconstruction of choice. The rectus abdominis muscle should therefore always be preserved in hemipelvectomy patients by careful preoperative planning, especially when creation of an ostomy is considered.

ABSTRACT Capsular contracture is the most common and frustrating complication in women who have undergone breast implantation. Its cause and, accordingly, treatment and prevention remain to be elucidated fully. The aim of this prospective observational pilot study was to test the hypothesis that the presence of bacteria on breast implants is associated with capsular contracture. We prospectively studied consecutive patients who underwent breast implant removal for reasons other than overt infection at the Mayo Clinic from February through September 2008. Removed breast implants were processed using a vortexing/sonication procedure and then subjected to semiquantitative culture. Twenty-seven of the 45 implants collected were removed due to significant capsular contracture, among which 9 (33%) had ≥20 CFU bacteria/10 ml sonicate fluid; 18 were removed for reasons other than significant capsular contracture, among which 1 (5%) had ≥20 CFU/10 ml sonicate fluid ( P = 0.034). Propionibacterium species, coagulase-negative staphylococci, and Corynebacterium species were the microorganisms isolated. The results of this study demonstrate that there is a significant association between capsular contracture and the presence of bacteria on the implant. The role of these bacteria in the pathogenesis of capsular contracture deserves further study.

BACKGROUND:Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity.METHODS:The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis.RESULTS:There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy.CONCLUSIONS:External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.

Flaps are currently the predominant method of reconstruction for irradiated wounds. The usefulness of split-thickness skin grafts (STSG) in this setting remains controversial. The purpose of this study is to examine the outcomes of STSGs in conjunction with VAC therapy used in the treatment of irradiated extremity wounds.

Annals of Plastic Surgery: September 2006 - Volume 57 - Issue 3 - p 355 doi: 10.1097/01.sap.0000229031.37636.c0

Direct excision of dermoid cysts of the brow may lead to a prominent facial scar. These scars can be completely avoided with an endoscopic temporal approach that places the incisions in the hair-bearing portion of the scalp. Over the past 10 years, this approach was offered to every pediatric patient with a cyst in the area of the brow, and outcomes were favorable. The operative technique and results in 8 consecutive patients are reviewed.

PURPOSE:We review the use of split-thickness skin grafting in children with concealed penis.MATERIALS AND METHODS:Medical records were retrospectively reviewed for all patients younger than 20 years seen at our institution from 1995 to 2003 with a diagnosis of concealed penis. Patients were separated into "primary" and "secondary" groups based on the cause of concealment. Primary factors were prominent prepubic fat pad, dysgenetic dartos fascia or both. Secondary factors were post-circumcision phimosis and overzealous circumcision.RESULTS:A total of 26 patients 1 month to 19 years old were treated. In the primary group of 23 patients 11 underwent lysis of dartos fascia. Four of these 11 patients had insufficient skin, and split-thickness skin grafting was necessary to resurface the penile shaft. Five of the patients underwent excision of the fat pad only, and 2 underwent excision of the fat pad and lysis of fascia. Five patients are being observed. Of the 3 patients in the secondary group 1 underwent manual reduction of post-circumcision phimosis, 1 underwent scrotal flaps and 1 is being observed. Followup ranged from 2 weeks to 46 months (mean 13 months). Of 20 surgically repaired patients 19 (95%) had an excellent cosmetic result, were satisfied with penile length and reported no voiding complaints.CONCLUSIONS:The surgical approach for correcting concealed penis varies, depending on the cause. Of our 26 patients 4 (15%) had insufficient penile skin to resurface the penile shaft. In these select children split-thickness skin grafting provided a good cosmetic appearance and functional result.

Tran, Nho V MD*, **; Petty, Paul M MD*; Bite, Uldis MD*; Clay, Ricky P MD, FACSa; Johnson, Craig H MD*; Arnold, Philip G MD, FACS* Author Information

Ophthalmic Plastic and Reconstructive Surgery: November 2000 - Volume 16 - Issue 6 - p 473-474

Familial gigantiform cementoma is a rare autosomal dominant tumor that is benign but can result in disfigurement of the facial skeleton. Two families with a total of five patients presented for treatment. Because of a lack of opportunity to obtain treatment early, three of the patients presented in adult life with massive tumors requiring extensive resection and complex reconstruction in multiple stages. The two female patients had chronic anemia caused by multifocal polypoid adenomas of the uterus and required hysterectomy before treatment. The last three patients had elevated alkaline phosphatase levels before tumor resection, and these levels decreased after surgery. With extensive resection of the tumors and reconstruction of both the soft tissues and facial skeleton, good functional and aesthetic results can be obtained. There has been no tumor recurrence with 3 years of follow-up.

Type of Book: An office manual on laser procedures.

Background. Cutaneous malignant melanoma (CMM) is increasing in frequency. Surgery remains the primary and only curative treatment method. Our aim was to define prognostic factors and outcome predictors for patients with clinical stage I CMM of the head and neck.Methods. Surgical treatment and outcome was analyzed for 424 patients with clinical stage I melanoma of the head and neck, completing initial treatment at the Mayo Clinic (1970-1990). The data were analyzed using the Kaplan-Meier product-limit method and Cox multiple-regression models.Results. Overall, 180 (42%) patients underwent elective lymph node dissection (ELND) as part of the initial treatment; occult disease was demonstrated in 15 (8.3%). Among patients with tumor > 1.5 mm thick, occult regional disease was found in 15%. Failure of initial treatment occurred in 152 (36%). Overall, 82% and 75% of patients survived 5 and 10 years, respectively.Conclusions. Tumor thickness, extent of invasion, and the presence of occult regional metastatic disease were the only independently predictive value (p < .005) of recurrence. The detection of disease by ELND did not appear to protect the patient from disease progression but identified those with regionally advanced disease and highest risk for recurrence. The development of recurrence significantly reduced but did not eliminate the potential for extended disease-free survival with subsequent treatment. (C) 1997 John Wiley & Sons, Inc.

We retrospectively reviewed 119 consecutive patients who underwent cleft palate repair at the Mayo Clinic to determine the incidence of postoperative fistula formation, to assess possible contributing factors, and to review the methods of surgical management. Fistulas of the secondary palate were included, but nasal-alveolar fistulas and intentionally unrepaired anterior palatal fistulas were excluded. Six patients whose repairs were performed after 2.5 years of age were excluded to ensure a more uniform patient population. Cleft palate fistulas occurred in 13 of the 113 patients (11.5 percent). The median age at repair was 8.2 months, and the median follow-up period was 5.2 years. Several variables were analyzed by means of the log-rank test to determine their significance in postoperative fistula formation. Sex, extent of clefting (as estimated by the Veau classification), and type of palatal closure did not significantly affect the rate of fistula formation. However, patients who had palatal closure at an age younger than 12 months had a lower incidence of fistula formation (7.8 percent) than children whose closures were performed between the ages of 12 and 25 months (19.4 percent) (p = 0.058). The strongest predictor of the occurrence of a cleft palate fistula was the surgeon performing the procedure (p = 0.008). Fistula repair was deemed necessary in 11 of 13 patients, and 91 percent of these fistulas were healed with a single operation. Most of these fistulas were closed by using local flaps and two-layered closures. Cleft palate repair carries a significant but acceptable risk of fistula formation, which can be managed with local flaps. Fistula occurrence is related most to the experience level of the operating surgeon.

Central to the practice of any surgeon is the process of wound healing. The ongoing mystery of why one wound heals beautifully whereas another on the same patient forms a keloid may hold a Nobel Prize for the researcher who finds the answer.

Most intrathoracic transpositions involve the serratus anterior, pectoralis major, and latissimus dorsi muscles. These muscles provide an adequate mass and length of muscle for coverage of most structures in the mediastinum and have a single, dominant vascular axis. Winging of the scapula can occur with the harvest of the serratus anterior unless this is prevented by the maintenance of the upper two or three muscle slips as described previously. Even if winging does occur, we believe it to be a reasonable price to pay for control of the ongoing infection. Transposition of the latissimus dorsi and pectoralis major produce little if any significant cosmetic or functional defect in these ill patients. These muscles are transposed to assist in sealing of fistulas and to bolster vascular or visceral repair. We do not think that complete soft-tissue obliteration of the pleural cavity is necessary, and we continue to use the Clagett method of antibiotic-solution filling of the chest cavity at closure. In the irradiated patient with poor healing potential, intrathoracic muscle flaps may provide a means to salvage situations previously considered unsalvageable when the flaps are combined with sound principles of infection control; when used prophylactically, the flaps may prevent those same situations.