a Primary Care Physician Should Know William A Wallace MD FACS April 30 2015 Disclosures Lattice Biologics Scottsdale AZ Scientific Advisory Board Member Key Points Plastic Surgeon misconceptions ID: 913088
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Slide1
Plastic Surgery: What a Primary Care Physician Should Know
William
A. Wallace, MD FACS
April 30, 2015
Slide2DisclosuresLattice BiologicsScottsdale, AZScientific Advisory Board Member
Slide3Key PointsPlastic Surgeon misconceptionsPlastic Surgery Scope of PracticeCommon patient complaints warranting a Plastic Surgery evaluation
Slide4Plastic Surgeons
Slide5MisconceptionsA Cosmetic Surgeon is a Plastic SurgeonBoard Certifications/Memberships are all the same
Slide6Slide7Plastic SurgeonAmerican Board of Medical Specialties recognized Certification BoardAmerican Board of Plastic SurgeryOnly ABMS specialty recognized to perform cosmetic proceduresMaintenance of Certification requiredRequires minimum of 3 years of General Surgery TrainingAdditional 2-3 years of Plastic Surgery TrainingAmerican Society of Plastic SurgeonsMembership requires Plastic Surgery Board CertificationFocuses on all aspects of Plastic Surgery
American Society of Aesthetic Plastic SurgeonsMembership requires Plastic Surgery Board CertificationFocuses on Aesthetic Plastic Surgery
Slide8“Cosmetic” Surgeon American Board of Cosmetic SurgeryNot Recognized by ABMSRequire only one year of “surgical training”Limited Apprenticeships observing other Cosmetic SurgeonsLimited examinationGenerous application feeDue to pressure are increasing requirements for new membersAmerican Academy of Cosmetic SurgeonsRequire Board Certification by any board deemed appropriate
by AACS Trustees
Slide9Slide10Slide11Scope of Practice(It’s quite a lot actually)http://www.plasticsurgery.org/for-medical-professionals/legislation-and-advocacy/health-policy-resources/plastic-surgery-clinical-privileges.html
Slide12Misconceptions 2009 Poll of residents in Internal Medicine, Pediatrics, Family Practice1117 respondantsAsked to pick which specialist(s) performed which surgeryEyelid: (1st Plastic Surgery, 2nd Ophthalmologist)Cleft Lip/Palate (1
st OMFS, 2nd Plastic Surgery)Facial Fracture (1
st OMFS, 2nd Plastic Surgery)Hand Surgery (1st Orthopedic Surgery, 2nd Plastic Surgery)
Rhinoplasty (1
st Plastic Surgery, 2nd ENT)
Skin cancers of the face (1
st
Derm
, 2
nd
Plastic Surgery)
Plastic Surgeons perform all these procedures and more
Slide13Skin Neoplasms, Diseases, and TraumaBenign and malignant lesions of the skin and soft tissueReconstructive grafts and flapsLaser therapy for vascular lesionsHemangiomas et. al.Scar revisionKeloids
Hypertrophic scarsUnsightly scarsSkin Resurfacing for acne, rhytids
, traumatic scarringChemical peelLaser skin resurfacingMechanical dermabrasion
Slide14Surgery of the BreastBreast reconstructionBreast reductionBreast biopsyCongenital anomalies (Poland’s disease, et. al.)Mastectomy (subcutaneous and simple)Breast augmentation
Slide15Treatment of Facial Diseases and InjuriesMaxillofacial fractures including the mandibleAcquired or congenital deformities of nose, ear, jaw, eyelid, lips, palateEyelid/Eyebrow PtosisProminent EarsCleft Lip/PalateCraniofacial surgerySkull
base surgeryFacial deformity and wound treatmentTumors of the head and neck
Slide16Surgery of the Hand and ExtremitiesSoft-tissue wounds and congenital abnormalities of the hand and upper extremity fracturesCongenital abnormalities of the bones of the hand, wrist and distal forearm. Carpal tunnel syndrome (endoscopic and open)Dupuytren's contractureSurgery for rheumatoid arthritis
Tumors of the bones and soft tissues
Slide17Reconstructive MicrosurgeryMicrovascular flaps and grafts Replantation/revascularization of upper & lower extremities & digitsReconstruction of peripheral nerve injuriesHand/arm transplantsFace transplants
Slide18Reconstruction of Congenital and Acquired Defects of the Trunk and GenitaliaChest and abdominal wall reconstructionSternal necrosis s/p CABGComponent separation for loss of abdominal domainSurgical closure of pressure ulcersVaginal reconstructionRepair of penis deformitiesGender reassignment
Slide19Complex Wound Healing and Burn TreatmentInitial burn managementIncluding Emergency Room Assessment and Critical Care managementAcute and reconstructive burn treatmentEarly debridement and graftingReconstructive scar revision
Slide20Aesthetic SurgeryBody contouringIncluding Post BariatricFacial contouringBreast augmentationBreast lift (mastopexy)Aesthetic rhytidectomyAesthetic
rhinoplastyAesthetic blepharoplasty
Subcutaneous injections/Botox/filler materialSkin peeling and dermabrasionVein injection sclerotherapy
Liposuction
Endoscopic cosmetic surgeryLaser therapy for vascular and cutaneous lesions
Slide21Common Conditions/Complaints Warranting Plastic Surgery Referral
Slide22SkinScar ConditionsKeloidsHypertrophic ScarsBurn ScarsNeoplasmsLipomas/Sebaceous CystsSkin CancersSuspicious Moles
Slide23BreastsReduction of Macromastia/GigantomastiaBack Pain, Neck Pain, Shoulder PainHeadachesShoulder grooves from bra strapsImprovement in 90% of symptomatic patientsReconstruction after mastectomy or lumpectomyImmediateDelayed
Slide24Post Bariatric Body ContouringIncreasing criteria by insurances