Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world: part II. Ethical considerations.

Background: Many international volunteer groups provide free reconstructive plastic surgery for the poor and underserved in developing countries. An essential issue in providing this care is that it meets consistent guidelines for both quality and safety-a topic that has been addressed previously. An equally important consideration is how to provide that care in an ethical manner.

Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world.

Background: A significant need is met by volunteer groups who provide free reconstructive plastic surgery for underserved children in developing countries. However, at present there are no consistent guidelines for volunteer groups in plastic surgery seeking to provide high-quality and safe care.

Methods: With these quality and safety standards in mind, in 2006, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Educational Foundation undertook a project to develop a detailed set of guidelines for volunteer groups from developed countries seeking to provide plastic surgery services to children in developing countries.

Incorporation of titanium mesh in orbital and midface reconstruction.

Several authors have demonstrated the safety and effectiveness of titanium in orbital reconstruction. One question posed by clinicians is what happens to large pieces of titanium in communication with the paranasal sinuses or nasal-oral-pharyngeal area. This question becomes increasingly relevant as titanium is used to reconstruct extensive defects for which the destruction of bony architecture requires the placement of mesh in proximity to these areas.

Safety of titanium mesh for orbital reconstruction.

During the past several decades, the standard of care for orbital reconstruction after trauma has been autogenous bone grafts. Complications of bone grafts, including donor site morbidities such as scar alopecia and graft resorption with delayed enophthalmos, have inspired an interest in the use of alloplastic substitutes such as titanium. Titanium's role in orbital reconstruction was limited originally to small orbital defects, and as an adjunct to bone grafts.