Grabb And Smith's Plastic Surgery (GRABB'S PLAS...

The Uncomplicated Wound. Much is known about the healing rates of clean surgical incisions. The rate of healing is a direct reflection of the kinetics of collagen deposition and remodeling within the wound. When the healing cascade progresses normally, approximately 30% to 50% of the final strength of the wound is achieved in 42 days. It is for this reason that elective surgery patients are told to refrain from strenuous activity or heavy lifting for at least 6 weeks. This progression represents the expected course of healing. In patients with underlying comorbidities, including renal failure, ischemia, and steroid use, this curve is delayed and shifted to the right (see Figure 3.2). In these particular patients, postoperative instructions should be adjusted to reflect the anticipated delay in healing. Note that in healthy patients, no pharmacologic agent has been demonstrated to shift the curve to the left; that is, healing rates are for the most part maximized in healthy people. However, it may be possible to modify the quality of healing, and research on scar modulation and manipulation is currently an area of significant future promise. Below we will discuss common complicated wounds encountered by the plastic surgeon. General management plans can be found in Figure 3.3.

Wound care is an important component of plastic surgery. As students of soft-tissue anatomy, tissue healing, and surgical reconstruction, plastic surgeons are equipped with the tools necessary to treat most wounds. Understanding the fundamental aspects behind the chronic and problem wound, strategies can be employed to alter the wound environment and tip the balance toward healing. Plastic surgeons can also judiciously intervene surgically to promptly close appropriate wounds. Basic science research and translational findings continue to advance our knowledge of wounds and assist in the development of novel treatment approaches. Unfortunately, many of the wound care products in use today are market and industry driven, with little prospective, randomized comparative studies evaluating efficacy. In addition, the concept of wound care centers has been aggressively marketed. While this concept can benefit patients, many centers are company organized and are biased in treatments delivered. In addition, these centers are often staffed by personnel with limited backgrounds in surgery and/or wound healing. The ideal wound care center is multidisciplinary, with participation of committed plastic surgeons who work closely with other team members for the benefit of the patient.

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Dr. Steve Byrd, inventor of the EarWell Infant Ear Correction System, is an authority on infant ear molding to correct infant ear deformities. With over 30 years of experience in pediatric plastic surgery, Dr. Steve Byrd has a wealth of experience to share as director of the EarWell Centers of Texas. He is board certified by both the American Board of Surgery and the American Board of Plastic Surgery. Dr. Steve Byrd has been elected by his peers as one of the top plastic surgeons in the United States for the past 10 years. He was also nominated by Dallas / Fort Worth pediatricians as a leading pediatric plastic surgeon in the North Texas.

Thus, a structured program for a comprehensive training in the wide range of Plastic and Reconstructive surgery is the need of the hour as it would lay down the gold standard for training across all the platforms in the country. Moreover, it will also help in standardizing the training of future plastic surgeons. This comprehensive document has been prepared keeping this need in mind. The core idea all through has been to prepare a curriculum that is inclusive of theoretical knowledge, practical aspects, and the desired operative capabilities of the trainee. The document will help the teachers micromanage the nitty gritty of the daily training and teaching assignments. At the end of the 3-year training, the candidate would be equipped with vast knowledge, skills, the right aptitude to function as an independent, knowledgeable consultant, teacher and researcher.

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