Regional Plastic Surgery order to understand regional surgery one must define general plastic surgery. It is identified primarily by surgical techniques that will alter the shape, size, and contour of different areas of the body and, in many instances, improve the physiology and functional capacity of that area. It encompasses abnormalities derived from congenital deficiencies, trauma, infections, tumors, and biological diseases. It specifically affects the anatomy, physiology, biology and, in many instances, the esthetics. Training to become this type of specialist has emphasized general surgery and general plastic surgery. Plastic surgery has existed since the concept of surgery, and has been practiced by all surgeons in one form or another. In 1939 the American Board of Plastic Surgery was incorporated. It was formed by a group of general surgeons, maxillofacial surgeons, and otolaryngologists. They were sensitive to, and interested in, specific types of operations and principles. Many of their cases had been abandoned by other surgeons or were neglected, and were often exception¬ ally difficult problems. Their record is a splendid one and speaks for itself. Some of their original groups were regional plastic surgeons, and some of their present members were regional
In plastic
preferences. There is, therefore, nothing new about regional plastic surgery. Any surgical specialist working in a particular region of the body would have a natural interest in the develop¬ ment of the surgical techniques in that region. To obstruct or deny this fact would not be in the best interests of medicine or surgery. All of the specialty surgical groups have ex¬ panded their surgical activity in their
working areas, and will continue to do It is inconceivable that the ortho¬ pedic surgeon would not be interested in the hand, the joints of the body, the bones, and do all the operations that are available to mend these struc¬ tures. The same applies to the so.
otolaryngologist, ophthalmologist, gynecologist, genitourinary surgeon, general surgeon, and dermatologist. It is taken for granted that some of the procedures that they do must be clas¬ sified as plastic and reconstructive surgery. In a broad sense, it can be stated that a large percentage of the plastic and reconstructive procedures in the different regions of the body
actually performed by regional surgical specialists. This understand¬ ably challenges the general plastic are
surgeon, who is interested in and
performs
many of these techniques. It should be understood that there is no covert effort on our part to incon¬ venience or exclude any other surgical specialist. We hold respect for their contributions and recognize the need for their considerable talents, and support them. Some of their success is measured by the fact that they are increasing in numbers more rapidly than any other surgical group, that they have the highest increase in income of any surgical group, and about a third of their residents are from foreign countries. It is unreasonable, however, for the general plastic surgeon to deny the fact that regional plastic surgery is in existence, is very active and, in some instances, is equal or superior to the services of the general plastic sur¬ geon. It is also paradoxical that in his denial of this general fact he has
already recognized regional plastic surgery by accepting the Society of Maxillo-Facial Surgeons as associate
members of the Plastic Society. This tactical move leaves them with the
responsibility
to
explain why they
accept individuals with dental and
surgical training, specific training
and not necessarily in general plastic into their society if their surgery, main concern is the prestige of their training program. It is somewhat more than imaginative to assert that one training program is supportive and exclusive of all others, and then to make modifications and exceptions to that assertion. They have reduced the number of years of training in general surgery from four to three, indicating that they now believe that a prolonged period in general surgery is no longer necessary. They also recognize the value of the board qualifications in other specialty groups and have reduc¬ ed the period of training for those qualified in other boards. These progressive changes have actually brought the board qualifications of all specialty societies closer together and the differences that separate them are much less conspicuous. It would seem appropriate for the otolaryngology group to reevaluate their structure and qualifications in light of the broad spectrum of poten¬ tial practice in the region of the head and neck. This accommodation would recognize the qualities of the general otolaryngologist and the qualities of the other otolaryngologic specialists in this region. This should ultimately point the way to changes in the training programs that would more honestly comply with the require¬ ments of the various specialty boards and facilitate the practice of a surgi¬ cal specialty in this area. JOHN CONLEY, MD New York
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In plastic
preferences. There is, therefore, nothing new about regional plastic surgery. Any surgical specialist working in a particular region of the body would have a natural interest in the develop¬ ment of the surgical techniques in that region. To obstruct or deny this fact would not be in the best interests of medicine or surgery. All of the specialty surgical groups have ex¬ panded their surgical activity in their
working areas, and will continue to do It is inconceivable that the ortho¬ pedic surgeon would not be interested in the hand, the joints of the body, the bones, and do all the operations that are available to mend these struc¬ tures. The same applies to the so.
otolaryngologist, ophthalmologist, gynecologist, genitourinary surgeon, general surgeon, and dermatologist. It is taken for granted that some of the procedures that they do must be clas¬ sified as plastic and reconstructive surgery. In a broad sense, it can be stated that a large percentage of the plastic and reconstructive procedures in the different regions of the body
actually performed by regional surgical specialists. This understand¬ ably challenges the general plastic are
surgeon, who is interested in and
performs
many of these techniques. It should be understood that there is no covert effort on our part to incon¬ venience or exclude any other surgical specialist. We hold respect for their contributions and recognize the need for their considerable talents, and support them. Some of their success is measured by the fact that they are increasing in numbers more rapidly than any other surgical group, that they have the highest increase in income of any surgical group, and about a third of their residents are from foreign countries. It is unreasonable, however, for the general plastic surgeon to deny the fact that regional plastic surgery is in existence, is very active and, in some instances, is equal or superior to the services of the general plastic sur¬ geon. It is also paradoxical that in his denial of this general fact he has
already recognized regional plastic surgery by accepting the Society of Maxillo-Facial Surgeons as associate
members of the Plastic Society. This tactical move leaves them with the
responsibility
to
explain why they
accept individuals with dental and
surgical training, specific training
and not necessarily in general plastic into their society if their surgery, main concern is the prestige of their training program. It is somewhat more than imaginative to assert that one training program is supportive and exclusive of all others, and then to make modifications and exceptions to that assertion. They have reduced the number of years of training in general surgery from four to three, indicating that they now believe that a prolonged period in general surgery is no longer necessary. They also recognize the value of the board qualifications in other specialty groups and have reduc¬ ed the period of training for those qualified in other boards. These progressive changes have actually brought the board qualifications of all specialty societies closer together and the differences that separate them are much less conspicuous. It would seem appropriate for the otolaryngology group to reevaluate their structure and qualifications in light of the broad spectrum of poten¬ tial practice in the region of the head and neck. This accommodation would recognize the qualities of the general otolaryngologist and the qualities of the other otolaryngologic specialists in this region. This should ultimately point the way to changes in the training programs that would more honestly comply with the require¬ ments of the various specialty boards and facilitate the practice of a surgi¬ cal specialty in this area. JOHN CONLEY, MD New York
Downloaded From: http://archotol.jamanetwork.com/ by a University of Manitoba User on 06/18/2015
