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Introduction Plastic surgeons endure years of training yet remain poorly equipped to negotiate first employment contracts. Our aims were to evaluate typical plastic surgeon employment contracts and assess contract comprehensiveness. We sought elements that should be included to better preserve varied interests. Methods A brief, anonymous, e-mailed survey was sent to California Society of Plastic Surgeons members and responses collected over 2 months. We collected information such as years in practice, geographic area, types of practices and number of surgeons within them, and legal standing of partnerships. We asked whether respondents sought legal assistance and specific elements were elaborated. We asked how content they were with their contracts while allowing commentary. Results Our survey generated 113 responses. 50.0% of respondents reported being in practice for at least 20 years; 2.68% had been in practice for up to 5 years. 62.5% reported being in private practice and 27.7% reported being in academia. In-state geographic distribution of respondents accounted for 85.6%, whereas 14.4% reported practicing out-of-state.Practice size was diverse, with 41.4% of respondents having worked in a group practice of 3 or more, 27.9% in partnership, and 23.4% in solo practice. For partnerships, 29.9% had made formal legal arrangements, whereas 20.6% had made informal arrangements. 74.5% of respondents did not seek legal assistance.Malpractice coverage varied from 51.6% with claims-made, to 21.7% with tail, to 33.0% with no coverage at all. 63.9% reported having no group disability policy. 26.4% reported annual income of less than US $100,000; 49.1% reported US $101,000 to US $200,000; 17.9% reported US $201,000 to US $300,000; 6.60% reported greater than US $300,000. Using a 5-point scale, 7.69% of respondents reported being "extremely dissatisfied" with their first employment contracts (score of 1), whereas 24.0% were "perfectly happy" (5).Eighty-two respondents offered advice. Common themes included seeking legal counsel; considering eventual solo practice; planning long-term; seeking mentorship; and cautioning against third party interests. Conclusions New plastic surgeons will find themselves employed by institutions. Seeking attorneys familiar with the profession is advisable. Lack of awareness regarding malpractice options and disability coverage are 2 areas of concern. We reveal critical contract elements that surgeons should negotiate to ensure smooth transition to practice.

"Pixie-ear" deformity is a postrhytidectomy sequela in which the ear lobe is pulled inferiorly. This deformity may be attributed to excessive skin excision inferior to the earlobe, direct suturing of the facial flap to lobule skin, or excessive scarring. When there is increased tension on the earlobe, the otobasion inferius (cephalic attachment point of lobe) migrates from a posterior cephalic position to an anterior caudal position. The authors present an operative technique to prevent pixie-ear deformity and optimize earlobe position in face-lifting.

Treatment of patients with infected median sternotomy wounds includes debridement and closure using vascularized tissue, most often the pectoralis major muscle. However, occasionally, surgeons use other flaps to close sternotomy wounds. The purpose of this study is to review 1 center's experience with infected median sternotomy wounds utilizing a less common technique, the rectus abdominis musculocutaneous flap.

The consensus in the literature is that fracture healing within the midface occurs via fibrous union. Clinical experience with the surgical correction of established traumatic deformities has not borne this out. An earlier histological examination with human biopsy specimens demonstrated that eventually repair occurred by direct bony union. However, a recent study in a rabbit model challenged this conclusion and indicated that the process of new formation resembles secondary bone formation as in endochondral formed bone. The purpose of our inquiry is to elucidate further the process of midfacial bony repair in an adult male Sprague-Dawley rat model.

Neurofibromas cause unsightly and crippling deformities. These locally destructive tumors arise along the distribution of peripheral and cranial nerves. The 2 patients presented here had neurofibromas of the external ear. In one patient, the lesion was limited to the auricle. In the other, the tumor extended into the facial nerve and parotid gland. Preoperative computed tomographic scanning, a postauricular approach to the tumor, and careful dissection produced an aesthetic debulking of the auricular neurofibromas with preservation of facial nerve function and improvement in hearing.

Two patients with squamous cell carcinoma of the perineum are presented. The carcinomas were treated by wide local excision using Mohs' fresh-tissue technique for control of the surgical margins. The wounds were closed using a gluteal thigh flap. In 1 patient the flap was extended across the midline for coverage of a contralateral perineal site. Healing was complete in each case. The combination of Mohs' fresh-tissue methods and the posterior thigh flap provided accurate identification and removal of the perineal tumor with stable wound coverage.

Les syringomes sont des tumeurs annexielles benignes, souvent localisees sur la peau de la paupiere inferieure. Les patients reclament habituellement la resection pour des raisons esthetiques. L'electrodessiccation et le curettage de ces lesions assurent l'eradication locale tout en conservant la peau non atteinte de la paupiere

The tube pedicle flap is useful in reconstruction of an absent ear helix. However, immediate tubing of the flap may result in vascular compromise. By elevating a bipedicle flap in the postauricular region and shielding it with a silicone sheet, it is possible to allow the flap to assume a tubular shape while preventing adherence to the underlying suture line. Once mature, the flap maintains both a cylindrical shape and a sufficiently thin external diameter to provide adequate restoration of the ear helix.

Patients requiring reconstruction by muscle or musculocutaneous flaps often have an associated area of skin anesthesia. This skin is susceptible to trauma because of its insensibility. This study reports 3 cases in which patients sustained deep partial-thickness burns of anesthetic skin following flap reconstruction. All burns healed by reepithelialization. Following flap reconstruction, patients should be warned regarding the use of heating pads. Burns of this type represent a preventable complication of flap reconstruction.

We present a congenital deformity of the right ear, characterized by absence of the central portion of the helix and antihelix. The deformity was reconstructed by advancing retroauricular skin and closing the resultant defect with a composite graft from the posterior aspect of the left ear. This technique was performed in a single stage and required no incisions on the anterior surface of either ear. Postoperative appearance of the right ear was satisfactory, and donor deformity was minimal.

Large wounds of the hand and upper extremity require secure closure for protection of the underlying structures. The skin of the lower abdomen can be raised in a lenticular fashion, supported by the superficial inferior epigastric artery and veins and applied as a flap to wounds of the distal upper extremity. The flap demonstrates versatility in positioning, and the donor site can be closed in a linear fashion. Viability of this superficial inferior epigastric artery flap is demonstrated by the case reports.

The patient with a through-and-through defect of the nose suffers from a loss of skin, subcutaneous tissue, cartilage, and nasal lining. Repair of this defect is generally directed toward restoring the components of skin and lining. The forehead flap is a useful substitute for nasal skin. A full-thickness skin graft may be used to substitute for absent nasal mucosa and serve as a lining for the forehead flap, covering its deep surface and retarding wound contracture. In the case presented, firm contact was maintained between the forehead flap and its full-thickness graft lining using a bolster dressing of simple design. We believe this dressing discourages seroma and hematoma formation while maintaining contact between the graft and the vascularized flap bed.