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Herpes simplex virus (HSV) primary infection and reactivation has been associated with the inflammation and transient decrease in immunocompetence after surgery and local trauma. In addition, HSV infection is known to impair wound healing, increase risk of scarring, and impede connective tissue graft transplantation. To our knowledge, this is the first case of HSV infection complicating cleft palate repair presented in literature. In this report, we present a case of primary HSV infection occurring in a healthy 26-month-old patient after repair of the secondary cleft palate with mucoperichondrial flaps and V-Y pushback. The patient developed high fever on postoperative day 1, which was followed by perioral vesicular lesions and multiple intraoral ulcerations involving the lips, palate, and posterior pharynx. Unknown to the surgeons, the patient was exposed to HSV before surgery by a sibling with orolabial HSV infection. The infective cause was ascertained via polymerase chain reaction for HSV-1 DNA, and the infection was treated with topical and intravenous acyclovir for 1 week. The patient recovered well with adequate flap healing, good aesthetic outcome, and no complications on 1-month follow-up. This report underscores the importance of prompt recognition of herpetic infections in the patient with craniofacial surgery and reviews the association and complications of HSV infection in surgical healing. Early identification with prompt antiviral therapy and meticulous wound care are essential to ameliorate the scarring and delayed wound healing associated with HSV infection.

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Plastic surgery, a defined surgical specialty, can be viewed as an ecosystem facing perturbatory forces, both internal and external, that will disrupt healthy checks and balances. This is an evolving system which will adapt to these disturbances and evolve as will a natural ecosystem. Returning to the beginning of the plastic surgery ecosystem, dating to World War I, identification of the challenges and forces within the ecosystem will raise awareness in the plastic surgery community. A graphic representation of the ecosystem is offered to represent the description and challenges offered to the plastic surgery ecosystem. Will this ecosystem return to balance or be radically altered and bear little resemblance to the past?

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LEARNING OBJECTIVES: After studying this article, the participant should be able to: (1) Develop a surgical plan for improving the contour of the abdominal region by means of abdominoplasty surgery. (2) Describe the current modalities for preventing and managing perioperative pain associated with abdominoplasty surgery. (3) Discuss proper techniques for safely performing simultaneous abdominal wall liposuction and abdominoplasty surgery. (4) Determine the means of decreasing seroma formation and drain duration in abdominoplasty patients. (5) Apply current concepts in preventing and minimizing perioperative complications in abdominoplasty patients. SUMMARY: Abdominoplasty continues to be one of the most popular cosmetic surgeries performed by plastic surgeons throughout the world. Advancements in the area continue to surface which can help improve outcomes. We present an extensive review of the most current literature on this topic. This article offers readers an up-to-date and organized approach to abdominoplasty surgery.

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The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.

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INTRODUCTION: The objectives of this study were (1) to evaluate the role of a full-time academic plastic surgeon, (2) to define the indicators predictive of a successful career in academic plastic surgery, and (3) to understand the current issues that will affect future trends in the practice of academic plastic surgery. METHODS: A questionnaire was developed to evaluate the role of current full-time academic plastic surgeons and to understand the current issues and future challenges facing academic plastic surgery. Each plastic surgery program director in the United States was sent the survey for distribution among all full-time academic plastic surgeons. RESULTS: Over a 6-week period, responses from 143 full-time academic plastic surgeons (approximately 31%) were returned. Fifty-three percent of respondents had been academic plastic surgeons for longer than 10 years. Seventy-three percent of respondents defined academic plastic surgeons as clinicians who are teachers and researchers. However, 53% of respondents believed that academic plastic surgeons were not required to teach or practice within university hospitals/academic centers. The 3 factors reported most frequently as indicative of a successful career in academic plastic surgery were peer recognition, personal satisfaction, and program reputation. Dedication and motivation were the personal characteristics rated most likely to contribute to academic success. Forty-four percent of respondents were unable to identify future academic plastic surgeons from plastic surgery residency applicants, and 27% were not sure. Most (93%) of the respondents believed that academic surgery as practiced today will change. CONCLUSIONS: The overall job description of a full-time academic plastic surgeon remains unchanged (teacher and researcher). Whereas peer recognition, personal satisfaction, and program reputation were most frequently cited as indicative of a successful plastic surgery career, financial success was rated the least indicative. Similarly, whereas the personal characteristics of dedication and motivation were rated most likely to contribute to academic success, economic competence was rated least likely. Although the role of academic plastic surgeons remains constant, the practice of academic plastic surgery is evolving. As a result, the future clinical milieu of academic plastic surgeons and training programs is in question.

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BACKGROUND: The purpose of this study was to identify the common characteristics that may determine potential academicians and chairpersons in academic plastic surgery. The study examined the motivations behind the pursuit of an academic plastic surgery career and the forces that shape this path. METHODS: A 20-question survey was mailed to all members of the Association of Academic Chairmen of Plastic Surgery. This organization was targeted because the members are a group of successful academic plastic surgeons who can be profiled to evaluate the personal and professional characteristics that contribute to accomplishment. RESULTS: A total of 144 of 264 surveys were returned over the allotted 6-week period, for a response rate of 55 percent. The three most important motivating factors in pursuing academic plastic surgery were teaching opportunities (82 percent), influence of mentors (70 percent), and scope of clinical cases (65 percent). Eighty-two percent of respondents reported that their mentor (as a role model) had the most marked effect on their career. Despite the use of an open-ended question, most reported that "persistence and determination" and "passion for the vocation" were the most important characteristics for success in academic plastic surgery. CONCLUSIONS: Perseverance and passion for plastic surgery are essential for professional advancement. These qualities are manifested early in the academic and clinical accomplishments of plastic surgery residents. The data indicate that mentors/role models have the most marked effect on a trainee's decision to pursue a career in academic plastic surgery. To interest talented plastic surgery residents in academic plastic surgery, role models must inspire them and provide mentorship.

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