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Aycart et al. Plast Aesthet Res 2019;6:13 Plastic and
DOI: 10.20517/2347-9264.2019.29 Aesthetic Research

Commentary Open Access

Plastic surgeons: critical members of the mass
casualty team

Mario A. Aycart, Simon G. Talbot

Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
Correspondence to: Dr. Simon G Talbot, Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital,
Harvard Medical School 75 Francis Street, Boston, MA 02115, USA. E-mail: sgtalbot@bwh.harvard.edu

How to cite this article: Aycart MA, Talbot SG. Plastic surgeons: critical members of the mass casualty team. Plast Aesthet Res
2019;6:13. http://dx.doi.org/10.20517/2347-9264.2019.29

Received: 13 Jun 2019 Accepted: 30 Jun 2019 Published: 11 Jul 2019
Science Editor: Raúl González-García Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Keywords: Reconstructive Surgical Procedures, blast injuries, extremity reconstruction

Plastic and reconstructive surgeons are uniquely positioned to care for a variety of patients in all walks
of life. We routinely take part in the multidisciplinary care that ranges from prenatal consultation for
congenital abnormalities such as cleft lip and palate to nuanced reconstructive care of our aging population
after tumor extirpation. This intimate involvement in the acute management and longitudinal follow-up is
exemplified in traumatic extremity reconstruction.

Extremity reconstruction, like other aspects of plastic surgery, is governed by principles that allow us
[2]
[1]
to tailor sophisticated solutions to challenging problems . Crystal et al. highlight the full spectrum of
solutions using all rungs of the reconstructive ladder. To add to an already comprehensive list are two
additional innovative treatment modalities particularly germane to extremity reconstruction. These are the
use of “spare parts” and considering the possibility of future vascularized composite allotransplantation
[2-4]
[5]
(VCA) . Spare parts surgery is particularly appropriate in mass casualty incidents and blast injuries, as
these can cause devastating segmental loss of domain with potentially viable distal tissues. These instances
may present the opportunity for innovative use of these otherwise discarded tissues or “spare parts”
as heterotopic or nonanatomic replantation or rearrangement. Over two decades since the first upper
extremity VCA, transplantation now factors in the planning and execution of surgical plans to preserve
limb length in lieu of optimal prosthetic fit . VCA has ushered new possibilities to fully restore and make
[6]
[7]
whole whilst fulfilling Sir Harold Gillies’ dictum of replacing like with like .

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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