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Proietti I, Svara F, Battilotti C, Tolino E, Bernardini N, Skroza N, Potenza C. Extreme makeover filler edition: Non-surgical correction for facial deformities post-trauma. J Cosmet Dermatol 2024; 23:2304-2306. [PMID: 38456485 DOI: 10.1111/jocd.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/23/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Ilaria Proietti
- Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Terracina, Italy
| | - Francesca Svara
- Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Terracina, Italy
| | - Chiara Battilotti
- Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Terracina, Italy
| | - Ersilia Tolino
- Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Terracina, Italy
| | | | - Nevena Skroza
- Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Terracina, Italy
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Terracina, Italy
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102
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Cox SE, Kaufman-Janette J, Cohen JL, Gold M, Joseph J, Nestor MS, Rzany B, Taylor S, Zhou J, Cecerle M, Pueraro E, Irvine R, Dayan S. LetibotulinumtoxinA Attenuates the Psychological Burden of Glabellar Lines and Is Associated With High Subject Satisfaction in Phase 3 Clinical Trials. Dermatol Surg 2024; 50:535-541. [PMID: 38470985 DOI: 10.1097/dss.0000000000004152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Hyperfunctional glabellar frown lines can transmit facial miscues that adversely affect emotional communication, increase perceptions of age, and diminish self-esteem. OBJECTIVE To evaluate the efficacy of letibotulinumtoxinA in mitigating the negative psychological impact associated with moderate to severe glabellar lines and to assess subject satisfaction with treatment outcome in the BLESS phase 3 clinical trials. MATERIALS AND METHODS Baseline and posttreatment assessments were made using validated subject-administered instruments: Modified Skindex-16 Glabellar Line Quality of Life (GL-QoL) Scale, Facial Assessment and Cosmetic Evaluation Questionnaire (FACE-Q) Appraisal of Lines Between Eyebrows Scale, FACE-Q Age Appraisal Visual Analog Scale, and FACE-Q Satisfaction with Outcome Scale. An integrated analysis using pooled BLESS data was conducted on these secondary end points. RESULTS Among enrolled and treated subjects ( N = 1,272), 85.5% had moderate to severe psychological impact at baseline. LetibotulinumtoxinA subjects experienced significant improvements compared with placebo on all measures. Mean improvement to Week 4 for the Modified Skindex-16 GL-QoL Scale overall score was -33.84 for letibotulinumtoxinA subjects compared with -1.37 for placebo subjects ( p < .001). Attenuation of psychological burden was highly correlated with improvement in glabellar line severity ( p < .0001). CONCLUSION LetibotulinumtoxinA significantly improved the psychosocial burden associated with glabellar lines across all trials. Treated subjects experienced improved quality of life, younger perceived age, and satisfaction with treatment outcome.
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Affiliation(s)
| | | | - Joel L Cohen
- AboutSkin Dermatology and DermSurgery, Greenwood Village, Colorado
| | - Michael Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, Tennessee
| | - John Joseph
- Clinical Testing of Beverly Hills, Beverly Hills, California
| | - Mark S Nestor
- Center for Clinical and Cosmetic Research, Aventura, Florida
- Division of Plastic Surgery, Department of Dermatology and Cutaneous Surgery and the Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Berthold Rzany
- Private Practice, Berlin, Germany . Dr. Rzany now with the Medizin am Hauptbahnhof, Vienna, Austria
| | - Susan Taylor
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jihao Zhou
- JZ Consulting, Orange County, California
| | | | | | - Ryan Irvine
- Hugel America, Inc., Newport Beach, California
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103
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Pires G, Marquez JL, Memmott S, Sudduth JD, Moss W, Eddington D, Hobson G, Tuncer F, Agarwal JP, Kwok AC. Early Complications after Prepectoral Tissue Expander Placement in Breast Reconstruction with and without Acellular Dermal Matrix. Plast Reconstr Surg 2024; 153:1221-1229. [PMID: 37285211 DOI: 10.1097/prs.0000000000010801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Prepectoral breast reconstruction has become popularized with the concurrent use of acellular dermal matrix (ADM). The authors sought to compare 3-month postoperative complication rates and explantation rates for first-stage, tissue-expander-based, prepectoral breast reconstruction with and without the use of ADM. METHODS A single-institution retrospective chart review was performed to identify consecutive patients undergoing prepectoral tissue-expander-based breast reconstruction from August of 2020 to January of 2022. Chi-square tests were used to compare demographic categorical variables, and multiple variable regression models were used to identify variables associated with 3-month postoperative outcomes. RESULTS The authors enrolled 124 consecutive patients. Fifty-five patients (98 breasts) were included in the no-ADM cohort and 69 patients (98 breasts) were included in the ADM cohort. There were no statistically significant differences between the ADM and no-ADM cohorts with regard to 90-day postoperative outcomes. On multivariable analysis, there were no independent associations between seroma, hematoma, wound dehiscence, mastectomy skin flap necrosis, infection, unplanned return to the operating room, or explantation in the ADM and no-ADM groups after controlling for age, body mass index, history of diabetes, tobacco use, neoadjuvant chemotherapy, and postoperative radiotherapy. CONCLUSIONS The authors' results reveal no significant differences in odds of postoperative complications, unplanned return to the operating room, or explantation between the ADM and no-ADM cohorts. More studies are needed to evaluate the safety of prepectoral, tissue expander placement without ADM. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Giovanna Pires
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Jessica L Marquez
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Stanley Memmott
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Jack D Sudduth
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Whitney Moss
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine
| | - Gregory Hobson
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Fatma Tuncer
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Jayant P Agarwal
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Alvin C Kwok
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
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104
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Lalonde DH, Gruber MM, Ahmad AA, Langer MF, Sepehripour S. New Frontiers in Wide-Awake Surgery. Plast Reconstr Surg 2024; 153:1212e-1223e. [PMID: 38810165 DOI: 10.1097/prs.0000000000011414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Explain the most important benefits of wide-awake surgery to patients. 2. Tumesce large parts of the body with minimal pain local anesthesia injection technique to eliminate the need for sedation for many operations. 3. Apply tourniquet-free surgery to upper and lower limb operations to avoid the sedation required to tolerate tourniquet pain. 4. Move many procedures out of the main operating room to minor procedure rooms with no increase in infection rates to decrease unnecessary cost and solid waste in surgery. SUMMARY Three disruptive innovations are changing the landscape of surgery: (1) minimally painful injection of large-volume, low-concentration tumescent local anesthesia eliminates the need for sedation for many procedures over the entire body; (2) epinephrine vasoconstriction in tumescent local anesthesia is a good alternative to the tourniquet and proximal nerve blocks in extremity surgery (sedation for tourniquet pain is no longer required for many procedures); and (3) evidence-based sterility and the elimination of sedation enable many larger procedures to move out of the main operating room into minor procedure rooms with no increase in infection rates. This continuing medical education article explores some of the new frontiers in which these changes affect surgery all over the body.
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Affiliation(s)
| | | | | | - Martin F Langer
- the Clinic for Trauma, Hand, and Reconstructive Surgery, University Clinic Muenster
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105
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Boz U, Köse E. Ultrasonographic Evaluation of Facial Artery in the Nasolabial Fold for Gender Differences and Symmetry Between Hemifaces. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1045-1051. [PMID: 38356337 DOI: 10.1002/jum.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES The aim of this study was to establish the relationship of facial artery with nasolabial fold by color Doppler sonography and to determine facial artery variations and their relationship with age, gender, or hemifaces. METHODS The study included 188 patients (94 women, 94 men) aged 18-60 years. Overall, 376 facial arteries in both hemifaces were evaluated for the course within nasolabial fold, symmetry, and relationship with gender. RESULTS The mean age of the patients was 39.29 ± 12.81 years. Type A (55.7%) was the most common type in both hemifaces. There was no significant relationship between the course of facial artery and age (P > .05). Asymmetrical course of facial artery was more common in females (54.3%). In both genders, type A was the type with highest symmetry detected. CONCLUSIONS Nasolabial fold is one of the important facial regions for filler injection. To prevent vascular injection, course of facial artery should be identified within the nasolabial fold. Type A was the most common type in both hemifaces and genders. Although the rates were close to each other, asymmetry in the course of the facial artery was observed in most of the patients. Ultrasonographic examination which is non-invasive and non-ionizing imaging method can be performed carefully before filler injection to determine vascular tissues.
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Affiliation(s)
- Ukte Boz
- Oral and Maxillofacial Radiologist, Kütahya Oral Health Hospital, Kütahya, Turkey
| | - Emre Köse
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
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106
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Ferragina F, Caruso D, Barca I, Kallaverja E, Arrotta A, Cristofaro MG. Efficacy of Pulsed Electromagnetic Field Therapy for Pain Management After Impacted Mandibular Third Molar Surgery. A Randomized Clinical Trial. J Oral Maxillofac Surg 2024; 82:692-698. [PMID: 38453135 DOI: 10.1016/j.joms.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Postoperative pain and swelling associated with the removal of the third molar (M3) adversely affect the patient's quality of life. PURPOSE The study aims to measure pain reduction and analgesic use in patients treated with pulsed electromagnetic field (PEMF) therapy following M3 removal and compares it to patients who did not receive PEMF. STUDY DESIGN, SETTING, SAMPLE The single-center study was designed as a randomized, prospective, controlled, double-blinded trial on a sample of patients with impacted mandibular M3 ascertained by x-ray orthopantomography and computed tomography. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES The predictor variable is postoperative pain management. It was assigned randomly to each subject who received either PEMF or standard therapy. MAIN OUTCOME VARIABLES The pain was quantified using a 100 mm visual analog scale and the number of analgesics taken. Each subject kept a daily clinical diary for 7 days, recording the amount of pain using the visual analog scale and the number of analgesic tablets taken. COVARIATES The study covariates were age, sex, tobacco use, and Pell and Gregory's classification of M3s. ANALYSES Student's t test was used, placing the statistical significance for P value < .05. The primary planned analysis was a 2-group, continuity-corrected, χ2 test of equality of proportions. RESULTS The study sample included 90 patients, 47 men and 43 women, with an average age of 32.43 ± 8.80 years. PEMF was statistically associated with improved pain reduction (2.08 vs 5.04 with a P value = .0002) and consumption of fewer analgesics than the control group (2.6 vs 5.8 with a P value = .0062). CONCLUSIONS AND RELEVANCE The study's results attest to the effectiveness of PEMF therapy in pain control after M3 surgery.
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Affiliation(s)
- Francesco Ferragina
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy.
| | - Davide Caruso
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Ida Barca
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Elvis Kallaverja
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Antonella Arrotta
- Department of Medicine and Surgery Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
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107
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Chou DW, Annadata V, Willson G, Gray M, Rosenberg J. Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review. Laryngoscope 2024; 134:2568-2577. [PMID: 37947302 DOI: 10.1002/lary.31178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS). DATA SOURCES PubMed and Web of Science. REVIEW METHODS According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS. RESULTS Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma. CONCLUSION AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2568-2577, 2024.
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Affiliation(s)
- David W Chou
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vivek Annadata
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gloria Willson
- Education and Research Services, Levy Library, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mingyang Gray
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Rosenberg
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Fearington FW, Awadallah AS, Hamilton GS, Olson MD, Dey JK. Long-Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review. Laryngoscope 2024; 134:2525-2537. [PMID: 37991145 DOI: 10.1002/lary.31193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long-term efficacy of septoplasty is unclear, and no literature reviews have examined long-term outcomes of septoplasty with or without turbinate modification. This systematic review aimed to evaluate the long-term efficacy of septoplasty with or without turbinate modification in improving nasal obstruction. DATA SOURCES PubMed, EMBASE, Cochrane CENTRAL. METHODS A systematic review of the literature was conducted using the aforementioned databases. Studies reporting outcomes 12+ months after functional septoplasty with or without turbinate surgery for nasal obstruction were included. Septorhinoplasties, concurrent sinus surgery, pediatric studies, and studies where septoplasty was performed for indications other than nasal obstruction were excluded. RESULTS After screening, 35 studies with 4,432 patients were included. Mean weighted post-operative follow-up time was 29.1 months (range 12-120 months). All studies reported significant improvement in subjective and objective outcomes at long-term follow-up compared to baseline. When comparing short-term (<12 months) to long-term (≥12 months) outcomes, four studies noticed that subjective outcomes worsened slightly over time, but no study found a significant change in objective outcomes over time. In addition, 23 studies reported patient satisfaction and/or improvement rates, with 75.4% (2,348/3,113) of patients expressing satisfaction/improvement at an average of 27.0 months after surgery. CONCLUSIONS Overall, septoplasty with or without turbinate modification shows significant improvement in obstructive symptoms at long-term follow-up per both objective and subjective measures. Whether outcomes may worsen slightly over time remains indeterminate based on mixed results in the literature. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2525-2537, 2024.
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Affiliation(s)
| | | | - Grant S Hamilton
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael D Olson
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jacob K Dey
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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109
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Soltantabar P, Sharma S, Wang D, Lon HK, Czibere A, Hickmann A, Elmeliegy M. Impact of Treatment Modality and Route of Administration on Cytokine Release Syndrome in Relapsed or Refractory Multiple Myeloma: A Meta-Analysis. Clin Pharmacol Ther 2024; 115:1258-1268. [PMID: 38459622 DOI: 10.1002/cpt.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/27/2024] [Indexed: 03/10/2024]
Abstract
B-cell maturation antigen (BCMA)-targeting immunotherapies (e.g., chimeric antigen receptor T cells (CAR-T) and bispecific antibodies (BsAbs)) have achieved remarkable clinical responses in patients with relapsed and/or refractory multiple myeloma (RRMM). Their use is accompanied by exaggerated immune responses related to T-cell activation and cytokine elevations leading to cytokine release syndrome (CRS) in some patients, which can be potentially life-threatening. However, systematic evaluation of the risk of CRS with BCMA-targeting BsAb and CAR-T therapies, and comparisons across different routes of BsAb administration (intravenous (i.v.) vs. subcutaneous (s.c.)) have not previously been conducted. This study utilized a meta-analysis approach to compare the CRS profile in BCMA-targeting CAR-T vs. BsAb immunotherapies administered either i.v. or s.c. in patients with RRMM. A total of 36 studies including 1,560 patients with RRMM treated with BCMA-targeting CAR-T and BsAb therapies were included in the analysis. The current analysis suggests that compared with BsAbs, CAR-T therapies were associated with higher CRS incidences (88% vs. 59%), higher rates of grade ≥ 3 CRS (7% vs. 2%), longer CRS duration (5 vs. 2 days), and more prevalent tocilizumab use (44% vs. 25%). The proportion of CRS grade ≥ 3 may also be lower (0% vs. 4%) for BsAb therapies administered via the s.c. (3 studies, n = 311) vs. i.v. (5 studies, n = 338) route. This meta-analysis suggests that different types of BCMA-targeting immunotherapies and administration routes could result in a range of CRS incidence and severity that should be considered while evaluating the benefit-risk profiles of these therapies.
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Affiliation(s)
- Pooneh Soltantabar
- Oncology Research and Development, Pfizer Inc, San Diego, California, USA
| | - Sheena Sharma
- Oncology Research and Development, Pfizer Inc, San Diego, California, USA
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Diane Wang
- Oncology Research and Development, Pfizer Inc, San Diego, California, USA
| | - Hoi-Kei Lon
- Oncology Research and Development, Pfizer Inc, San Diego, California, USA
| | - Akos Czibere
- Oncology Research and Development, Pfizer Inc, San Diego, California, USA
| | - Anne Hickmann
- Oncology Research and Development, Pfizer Inc, San Diego, California, USA
| | - Mohamed Elmeliegy
- Oncology Research and Development, Pfizer Inc, San Diego, California, USA
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Ibarra-Hurtado TR, Nuño-Guzmán CM, Ambriz-Plascencia AR, Ibarra-Tapia ME. Minimally Invasive Video-Assisted Submuscular Gluteal Augmentation with Implants: An Innovative Technique. Plast Reconstr Surg 2024; 153:1302-1305. [PMID: 37220272 DOI: 10.1097/prs.0000000000010732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
SUMMARY Gluteal augmentation is one of the most requested cosmetic procedures. This article describes the surgical technique and early results of an innovative minimally invasive video-assisted submuscular gluteal augmentation with implants. The authors aimed to perform a technique that would reduce complications and surgical time. Fourteen healthy women without obesity or relevant pathologic background who requested gluteal augmentation with implants as a single procedure were included. The procedure was performed through bilateral parasacral 5-cm incisions at cutaneous and subcutaneous planes as far as the gluteus maximus muscle fascia. Through a 1-cm incision in the fascia and muscle, the index finger was introduced under the gluteus maximus, and a submuscular space was created by blunt dissection toward the greater trochanter to avoid a sciatic nerve injury, until the middle gluteus level was reached. Next, the balloon shaft of a Herloon trocar was introduced in the dissected space. Balloon dilatation in this submuscular space was performed as required. The balloon shaft was replaced by the trocar, through which a 30-degree 10-mm laparoscope was introduced. Submuscular pocket anatomic structures were observed, and while the laparoscope was being retrieved, hemostasis was verified. The submuscular plane collapsed, leaving the pocket for the implant to be placed. There were no intraoperative complications. The only postoperative complication was a self-limited seroma in one patient (7.1%). This innovative technique was simple to perform and safe, allowing direct visualization and hemostasis, with a short surgical time, low complication rate, and high degree of satisfaction.
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Affiliation(s)
| | - Carlos M Nuño-Guzmán
- General Surgery, Hospital Civil de Guadalajara Fray Antonio Alcalde
- Department of Surgical Clinics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
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111
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Innocenti A, Melita D. Tuberous Breast: A Wide Spectrum of Features of the Same Disorder-13-Year Experience-Based Classification and Reconstructive Algorithm. Plast Reconstr Surg 2024; 153:1231-1238. [PMID: 37335572 DOI: 10.1097/prs.0000000000010838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND A multitude of variants of tuberous breast exist, and a reconstructive algorithm could help in assessment of all features that affect the breast and planning the most appropriate surgical correction strategy. Although several efficient techniques have been described in the literature, the authors propose their experience to help standardize a diagnostic and therapeutic approach. The aim of this article is to assess the pathologic hallmarks of each type of tuberous breast and to propose a one-step reconstructive algorithm tailored to the patient characteristics based on the use of three different adipo-glandular flaps. METHODS From September of 2006 to December of 2019, 118 patients were treated for tuberous breast in a one-step procedure using tailored local flaps according to the preoperatively assessed clinical variant. Minimum follow-up was 12 months. All the procedures were performed under local anesthesia. RESULTS A total of 220 tuberous breasts (98 hypoplastic and 122 normoplastic) were treated. Mean patient age was 20.2 years. Mean follow-up was 36.5 months. Six minor complications (capsular contracture and nipple-areola complex hypesthesia) but no major complications were reported. In 9% of cases, minor secondary procedures, including lipofilling, scar revisions, and breast implant substitution, were performed. CONCLUSION The proposed algorithm, including a comprehensive classification, preoperative planning, and surgical approach derived from the authors' experience, presents a tailored surgical approach for each type of tuberous breast. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
| | - Dario Melita
- From Plastic and Reconstructive Microsurgery, Careggi University Hospital
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112
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Cinar F, Yalcin CE, Ayas G, Celik U, Okyay MF, Demiröz A, Bağhaki S, Cetinkale O. Increased Total Antioxidant Capacity Value Improves Survival of Fat Grafts in Rat Model. Plast Reconstr Surg 2024; 153:1307-1316. [PMID: 37389602 DOI: 10.1097/prs.0000000000010873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Although studies aiming to increase fat graft survival continue, in this study, the authors aimed to investigate the effects of different antioxidants on total antioxidant capacity (TAC) and their effect on graft survival. METHODS Thirty-two male Wistar rats were divided into four equally sized groups, including a control group and three antioxidant groups receiving either melatonin (10 mg/kg), zinc (2 mg/kg), or vitamins E and C (100 mg/kg). Autologous fat grafts (1.7 ± 0.4 g) were transferred to the dorsal subcutaneous region, and total antioxidant capacity was measured on days 0 and 1, week 1, and monthly until the third month. Transferred graft volume and mass (1.3 ± 0.4 g) were measured using the liquid overflow method and precision scales at the end of the study. Routine hematoxylin and eosin staining and immunohistochemistry against perilipin were performed for semiqualitative analysis and H-score for viable adipose cells, respectively. RESULTS Collected fat grafts measured significantly less in weight and volume and the survival rate was lower in the control group ( P < 0.01). The control group exhibited a reduction in TAC, whereas all groups receiving antioxidants had an increase in TAC during the first week ( P = 0.02, P = 0.008, and P = 0.004 for melatonin, zinc, and vitamins, respectively). Immunohistochemistry of the antioxidant group demonstrated a statistically significant excess and reactivity of cells staining with perilipin antibodies. CONCLUSION In this animal study, the beneficial effect of antioxidants on fat graft survival can be related to the significant increase in TAC following the first week of their administration. CLINICAL RELEVANCE STATEMENT Antioxidants improve fat graft survival and quality in this rat model, by increasing total antioxidant capacity in the first week of administration.
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Affiliation(s)
- Fatih Cinar
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty
| | - Can Ege Yalcin
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty
| | | | - Ugur Celik
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty
| | | | - Anil Demiröz
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty
| | - Semih Bağhaki
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty
| | - Oguz Cetinkale
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty
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113
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Ang BJ, Suardi N, Abduraman MA. Exploring differentiation-dependent responses to 532 nm green laser photobiomodulation in SHSY5Y neuroblastoma cells. Lasers Med Sci 2024; 39:147. [PMID: 38822930 DOI: 10.1007/s10103-024-04102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
Photobiomodulation (PBM) holds promise as a therapy modality, but its applicability is hindered by the lack of a quantitative model to predict the optimal dose for all forms of PBM. This study investigated the optimal PBM parameters for 532 nm green laser irradiation on SHSY5Y neuroblastoma cells, a commonly used in vitro model for neurodegenerative disease studies. A two-tailed, two sample t-test with equal variance was used to obtain the p-values and statistical significance. There are 3 sets of parameters showing significant ( p < 0 . 01 ) positive percentage biostimulation. 160 m W , 15 m i n produce a percentage biostimulation of ( 9 ± 10 ) % ; 180 m W , 5 m i n produce a percentage biostimulation of ( 19 ± 7 ) % ; and ( 200 m W , 5 m i n ) produce a percentage biostimulation of ( 9 ± 2 ) % . The highest significant ( p < 0 . 01 ) percentage bioinhibition observed is for 220 m W , 15 m i n (dose: 1008 J / c m 2 ) producing a bioinhibition of ( 54 ± 1 ) % . After identifying several parameters that produce noticeable photobiological effects (biostimulation and bioinhibition), this study compared the reaction of undifferentiated and differentiated SHSY5Y cells to laser irradiation and found that undifferentiated SHSY5Y cells shows greater photobiological effect from 532 nm laser irradiation ( p < 0 . 01 ) . This study demonstrated the differentiation-dependant photobiological effect of SHSY5Y in 532 nm laser PBM. This shows that considerations on the differentiation state of cells is important in PBM studies. The hypothesis of difference in intracellular reactive oxygen species (ROS) accumulation from laser irradiation can serve as a versatile explanation of the observed difference in photobiological effect. Further investigation into the role of ROS as a mediator of various photobiological effects from laser of different wavelengths is warranted.
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Affiliation(s)
- Beng Jiong Ang
- School of Physics, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Nursakinah Suardi
- School of Physics, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.
| | - Muhammad Asyraf Abduraman
- Eman Biodiscoveries Sdn Bhd, A1-4, Lot 5, Persiaran 2/1, Kedah Halal Park, Sungai Petani Industrial Area, 08000, Sungai Petani, Kedah, Malaysia
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114
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Wang E, Tran JT, Chapa EM, Cody R, Greives MR, Nguyen PD. Correlation of Orthognathic Surgical Movements to Perception of Facial Appearance in Patients With Cleft Lip and Palate. J Craniofac Surg 2024; 35:1205-1208. [PMID: 38738880 DOI: 10.1097/scs.0000000000010251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 05/14/2024] Open
Abstract
STUDY DESIGN Cephalometric scans were compared before and after surgery to assess the degree of correction. Correlations between skeletal movements and survey outcomes were determined using multivariate regression analysis. OBJECTIVE This study aims to identify relationships between subjective observer-reported improvements in esthetics and emotional appearance with specific surgical movements. METHODS Ten patients at a single tertiary institution (average age: 18.1 ± 0.8), 9 males and 1 female, underwent orthognathic repair and had comprehensive cephalometric records. Standardized anterior posterior and lateral pre and postoperative photographs of patients were included in a survey to clinicians to assess noncognitive domains on a Likert Scale (1-10). CLEFT-Q was administered to gauge patient satisfaction in categories of appearance, speech, and quality of life. RESULTS Per clinicians, multiple domains increased including facial attractiveness (4.1 ± 0.7 versus 7.3 ± 0.7, P < 0.001), friendliness (4.5 ± 0.4 versus 7.3 ± 0.5, P < 0.001), confidence (4.1 ± 0.4 versus 7.1 ± 0.4, P < 0.001), and recommendation for surgery decreased (8.9 ± 0.1 versus 3.6 ± 0.5, P < 0.001). Speech distress decreased with increased SNA and convexity, whereas Psychological and Social scores decreased with an increased ANB. Functional eating and drinking scores increased with maxillary depth. CONCLUSIONS Orthognathic surgery improves many noncognitive domains in patients with cleft lip and palate as assessed by both patients and clinicians on all aspects of facial attractiveness and perception. These findings demonstrate objective bases of skeletal adjustments for perceived improvements in facial appearance and emotion.
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Affiliation(s)
- Ellen Wang
- Division of Plastic Surgery, Department of Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School and Children's Memorial Hermann Hospital
| | - Joseph T Tran
- Division of Plastic Surgery, Department of Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School and Children's Memorial Hermann Hospital
| | - Elysa M Chapa
- Division of Plastic Surgery, Department of Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School and Children's Memorial Hermann Hospital
| | - Ryan Cody
- Department of Plastic Surgery and Orthodontics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Matthew R Greives
- Division of Plastic Surgery, Department of Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School and Children's Memorial Hermann Hospital
| | - Phuong D Nguyen
- Department of Pediatric Plastic Surgery, Children's Hospital Colorado
- Department of Surgery, Division of Plastic Surgery, University of Colorado, Aurora, CO
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115
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Nguyen NH, Taylor JM, Huang KX, Shariati K, Chevalier JM, Miller MN, Cronin BJ, Lee JC. Ethnic variation in lower face anthropometry on facial computed tomography scans for patients seeking facial feminization surgery. J Plast Reconstr Aesthet Surg 2024; 93:222-231. [PMID: 38705125 DOI: 10.1016/j.bjps.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Facial feminization surgery (FFS) is the most common form of facial gender-affirming surgery. One of the current knowledge gaps is the understanding of differences among racial groups in baseline craniofacial norms for transgender and nonbinary patients. METHODS All patients who sought consultation for FFS and underwent craniofacial computed tomography (CT) scans at a single institution between 2018 and 2023 were included. Patients who underwent previous facial surgeries were excluded. Chart reviews were conducted for patient characteristics, including race, age, hormone therapy duration, and prior gender-affirming surgeries. Racial categorizations included White, Latinx, African American, or Asian. Patients with other or multiracial identities were excluded. Lower face measurements were derived from preoperative facial CT scans. Comparative analyses were performed on all measurements among the racial groups. RESULTS In this study, 204 patients were included with an average age of 32.0 ± 10.2 years and a median hormone therapy duration of 2.0 years. The notable differences among the racial groups were: 1. Zygomatic width was the largest in Asian patients (13.5 ± 0.6 cm) compared to all other racial groups (p = 0.03), 2. Nasolabial angle was the smallest in African American patients (82.5 ± 13.1 degrees, p < 0.001), 3. Lower face height was the largest in African American patients (6.9 ± 0.7 cm, p < 0.001), and 4. Lateral mandibular flare was the largest in African American patients (0.4 ± 0.1 cm) and the smallest in Latinx patients (0.2 ± 0.1 cm, p < 0.001). CONCLUSIONS Specific target areas of FFS should be carefully considered to account for possible baseline ethnic differences. Relative facial proportions may also be a more salient surgical planning tool in transgender and gender nonbinary patients rather than absolute measurements alone.
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Affiliation(s)
- Nghiem H Nguyen
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Jeremiah M Taylor
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Kelly X Huang
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Kaavian Shariati
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Jose M Chevalier
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Meghan N Miller
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Brendan J Cronin
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Justine C Lee
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States; UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States.
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116
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Yesantharao P, Heron MJ, Lee E, Darrach H, Xun H, Mundy LR, Sacks JM, Broderick KP. Revisiting the nipple-areola complex: A study on aesthetic preferences. J Plast Reconstr Aesthet Surg 2024; 93:232-234. [PMID: 38714042 DOI: 10.1016/j.bjps.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/04/2024] [Accepted: 04/05/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Pooja Yesantharao
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Matthew J Heron
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Erica Lee
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Halley Darrach
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Helen Xun
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Lily R Mundy
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Justin M Sacks
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St Louis, MO 63110, USA
| | - Kristen P Broderick
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
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van Cruchten C, Feijen MMW, Lazaâr S, Piatkowski A, van der Hulst RRWJ. The non-operative correction of ear anomalies in infants using the EarWell infant corrective system in the Netherlands. J Plast Reconstr Aesthet Surg 2024; 93:9-17. [PMID: 38603996 DOI: 10.1016/j.bjps.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Congenital ear anomalies are regular but often overlooked occurrences. The golden standard of treatment has been to surgically correct these anomalies at a minimum age of 5 to 7 years. As of the last century, ear molding has developed to be a safe, reliable, and effective treatment method. Different treatment methods are still under investigation. This study aims to investigate the use of the EarWell Infant Corrective System in the Dutch population. METHODS Children aged 0-12 weeks were included in the Zuyderland Medical Center to be treated with the EarWell Infant Corrective System in case of ear deformations. Every 2 weeks, the system was replaced and correction was evaluated by both physician and parents. RESULTS Seventy-three participants were included, of whom 123 ears in total were treated. Age at initiation was 35.5 days on average; treatment lasted an average of 59 days. Parents and physicians both reported an amelioration of all ear anomalies after treatment, scoring the correction grade an 8.8. Overall satisfaction with the treatment method was 9 or higher for both groups. CONCLUSIONS The EarWell Infant Corrective System is a safe, reliable, and effective treatment method for the correction of ear anomalies in infants.
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Affiliation(s)
- Cas van Cruchten
- Department of Plastis, Reconstructive and Hand Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, Limburg, the Netherlands.
| | - Michelle M W Feijen
- Department of Plastis, Reconstructive and Hand Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, Limburg, the Netherlands
| | - Sherida Lazaâr
- Department of Plastis, Reconstructive and Hand Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, Limburg, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastis, Reconstructive and Hand Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, Limburg, the Netherlands
| | - Rene R W J van der Hulst
- Department of Plastis, Reconstructive and Hand Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, Limburg, the Netherlands
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Grippaudo F, Nigrelli S, Patrignani A, Ribuffo D. Quality of the Information provided by ChatGPT for Patients in Breast Plastic Surgery: Are we already in the future? JPRAS Open 2024; 40:99-105. [PMID: 38444627 PMCID: PMC10914413 DOI: 10.1016/j.jpra.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction In recent years, artificial intelligence (AI) has gained popularity, even in the field of plastic surgery. It is increasingly common for patients to use the internet to gather information about plastic surgery, and AI-based chatbots, such as ChatGPT, could be employed to answer patients' questions.The aim of this study was to evaluate the quality of medical information provided by ChatGPT regarding three of the most common procedures in breast plastic surgery: breast reconstruction, breast reduction, and augmentation mammaplasty. Methods The quality of information was evaluated through the expanded EQIP scale. Responses were collected from a pool made by ten resident doctors in plastic surgery and then processed by SPSS software ver. 28.0. Results The analysis of the contents provided by ChatGPT revealed sufficient quality of information across all selected topics, with a high bias in terms of distribution of the score between the different items. There was a critical lack in the "Information data field" (0/6 score in all the 3 investigations) but a very high overall evaluation concerning the "Structure data" (>7/11 in all the 3 investigations). Conclusion Currently, AI serves as a valuable tool for patients; however, engineers and developers must address certain critical issues. It is possible that models like ChatGPT will play an important role in improving patient's consciousness about medical procedures and surgical interventions in the future, but their role must be considered ancillary to that of surgeons.
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Affiliation(s)
- F.R. Grippaudo
- Department of Plastic Reconstructive and Aesthetic Surgery, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - S. Nigrelli
- Department of Plastic Reconstructive and Aesthetic Surgery, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A. Patrignani
- Department of Plastic Reconstructive and Aesthetic Surgery, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D. Ribuffo
- Department of Plastic Reconstructive and Aesthetic Surgery, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Zhong Y, Chen Z, Li B, Ma H, Yang B. Correlation analysis of airway-facial phenotype in Crouzon syndrome by geometric morphometrics: A promising method for non-radiation airway evaluation. Orthod Craniofac Res 2024; 27:504-513. [PMID: 38300018 DOI: 10.1111/ocr.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/02/2024]
Abstract
AIM This study aimed to verify the correlation of the airway-facial phenotype and visualize the morphological variation in Crouzon syndrome patients. Additionally, to develop a non-radiation methodology for airway assessments. METHOD In this study, 22 patients diagnosed with Crouzon syndrome (Age: 7.80 ± 5.63 years; Gender distribution: 11 females and 11 males) were analysed. The soft tissue surface and airway were three-dimensionally reconstructed, and the entire facial phenotype was topologized and converted into spatial coordinates. Geometric morphometrics was employed to verify the correlation and visualize dynamic phenotypic variation associated with airway volume. A total of 276 linear variables were automatically derived from 24 anatomical landmarks, and principal component analysis (PCA) identified the 20 most significant parameters for airway evaluation. Correlation analyses between parameters and airway volume were performed. Then, patients were classified into three groups based on airway volume, and the differences among the groups were compared for evaluating the differentiating effectiveness of parameters. RESULTS The facial phenotype was strongly correlated with the airway (coefficient: 0.758). Morphological variation was characterized by (i) mandibular protrusion and anticlockwise rotation; (ii) midface retrusion; (iii) supraorbital frontward and (iv) lengthening of the facial height. All the anthropometric parameters were strongly associated with the airway, and the differences among the groups were statistically significant. CONCLUSION This study confirmed the strong correlation between facial phenotype and airway parameters in Crouzon syndrome patients. Despite the development of the airway, pathological midface retrusion was still aggravated, suggesting that surgical intervention was inevitable. Three-dimensional facial anthropometry has potential as a non-radiation examination for airway evaluation.
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Affiliation(s)
- Yehong Zhong
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhewei Chen
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Binghang Li
- Digital Technology Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hengyuan Ma
- Digital Technology Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bin Yang
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Ahn SJ, Park SE, Choi JY, Min JY, Kim KA, Kim SJ. Internal structural analysis of the nasomaxillary complex in patients with skeletal class III asymmetry: A study on asymmetry patterns. Orthod Craniofac Res 2024; 27:376-386. [PMID: 38058275 DOI: 10.1111/ocr.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To investigate the internal structure of the nasomaxillary complex, including the maxillary sinus, nasal cavity and nasal septum according to the facial asymmetry pattern and to evaluate its correlation with external maxillomandibular asymmetry in Class III patients based on cone-beam computerized tomography (CBCT) images. MATERIALS AND METHODS Facial asymmetry was analysed in a total of 100 Class III patients aged 16 years or older using CBCT scans. Patients were categorized into subgroups based on asymmetry pattern. Measurements of the nasomaxillary complex were obtained from the CBCT scans, including the volume and width of the maxillary sinuses and nasal cavities on deviated and non-deviated sides, as well as the displacement of the nasal septum. Statistical analysis was performed to compare the internal nasomaxillary variables within and between groups, and regression analysis was conducted to evaluate the correlation between facial asymmetry and the internal nasomaxillary variables. RESULTS Group comparisons showed that there were no significant differences in the volume of the maxillary sinus and nasal cavity. However, the direction and extent of nasal septum deviation, as well as the width of the nasal cavity, varied depending on the maxillary asymmetry pattern. Regression analysis indicated a correlation between nasal septum deviation and the difference in maxillary height, while the difference in nasal cavity width was correlated with the difference in maxillary width. CONCLUSION A comprehensive evaluation of the internal nasal anatomy is vital for understanding the intricate relationship between nasal structure and maxillary growth.
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Affiliation(s)
- Sung Jea Ahn
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Song E Park
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jin-Young Choi
- Department of Orthodontics, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Jin Young Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyung-A Kim
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Su-Jung Kim
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
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Krishnanunni K, Parameswaran A, Tangutur SP. Evaluation of nasolacrimal canal morphology in different facial skeletal relationships. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101722. [PMID: 38042348 DOI: 10.1016/j.jormas.2023.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Abnormal morphological variations of nasolacrimal canal (NLC) and its lack of understanding contributes to acquired injuries during craniomaxillofacial surgical procedures which leads untoward postoperative complications like nasolacrimal obstruction (NLO) and epiphora. PURPOSE The purpose of this study was to determine dimensional and volumetric morphological variations of nasolacrimal canal in various facial skeletal relationships which aid in performing a precise and safe surgery. MATERIALS AND METHODS This retrospective cohort study involved dimensional and volumetric analysis of nasolacrimal canal procured from computed tomography scans of 47 individuals grouped as ClassI, Class II and Class III, and unilateral cleft lip and palate (UCLP) groups. The outcome variables included length of NLC, volume of NLC, distance between the inferior orifice of the NLC to nasal floor, distance between inferior orifice of NLC to canine apex and distance between inferior orifice of NLC to central incisor apex. The objectives were to analyse morphological variation of NLC in different facial skeletal relationships and to evaluate the variation with change in facial sides and its relationship with surrounding structures. RESULTS Volume of the NLC was found significant in Class I and UCLP population (p < 0.05) with the greatest volume in the UCLP group. The mean linear and volumetric measurements between the right and left sides were found insignificant among all groups. Inferior orifice of NLC from canine apex were farthest in Class III and nearest in the UCLP group (p < 0.05). There was no significant association between outcome variables and skeletal base configuration. CONCLUSION NLC demonstrates dimensional and anthropometric variations between different skeletal relationships and this study is inevitable in understanding the probability of NLC injury during maxillofacial surgeries.
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Affiliation(s)
- Keerthi Krishnanunni
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu 600095, India
| | - Anantanarayanan Parameswaran
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu 600095, India.
| | - Srinivasa Prasad Tangutur
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu 600095, India
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Perrotta F, Piscopiello D, Iosa G, Gemma D, Rizzo D, De Salvo F, D'Antini D, Scarano E, Colonna F. Bilateral Tapia syndrome in teenager with post traumatic Hangman's fracture and carotid artery dissection. Trauma Case Rep 2024; 51:101029. [PMID: 38633379 PMCID: PMC11021987 DOI: 10.1016/j.tcr.2024.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 04/19/2024] Open
Abstract
Background Tapia syndrome (TS) is a rare condition characterized by unilateral hypoglossal and recurrent laryngeal nerve palsy, leading to tongue deviation, swallowing difficulty and dysphonia. Case report We describe a case of a 17-year-old boy who reported a bilateral TS following head and neck trauma with Hangman's fracture and right common carotid artery dissection. The confirmation occurred only after complete cognitive and motor recovery, verifying the inability to protrude the tongue and swallow, associated with complete paralysis of the vocal cords, diagnosed with fiber optic laryngoscopy.An initial recovery of tongue motility and phonation occurred after just over a month of rehabilitation. Conclusion In addition to the lack of awareness due to the rarity of the syndrome, the diagnosis of TS may be delayed in patients who are unconscious or who have slow cognitive recovery following head trauma. The case we present may help to increase awareness and avoid unnecessary diagnostic investigations.
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Affiliation(s)
- Francesco Perrotta
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Cardinale Giovanni Panico”, Tricase, Lecce, Italy
| | - Donato Piscopiello
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Cardinale Giovanni Panico”, Tricase, Lecce, Italy
| | - Gaetano Iosa
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Cardinale Giovanni Panico”, Tricase, Lecce, Italy
| | - Daniele Gemma
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Cardinale Giovanni Panico”, Tricase, Lecce, Italy
| | - Daniela Rizzo
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Cardinale Giovanni Panico”, Tricase, Lecce, Italy
| | - Francesca De Salvo
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Cardinale Giovanni Panico”, Tricase, Lecce, Italy
| | - Davide D'Antini
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Cardinale Giovanni Panico”, Tricase, Lecce, Italy
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Wang J, Jing Z, Yin C, Wang Z, Zeng S, Ma X, Zheng Y, Cai H, Liu Z. Coatless modification of 3D-printed Ti6Al4V implants through tailored Cu ion implantation combined with UV photofunctionalization to enhance cell attachment, osteogenesis and angiogenesis. Colloids Surf B Biointerfaces 2024; 238:113891. [PMID: 38615392 DOI: 10.1016/j.colsurfb.2024.113891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
The three-dimensional-printed Ti6Al4V implant (3DTi) has been widely accepted for the reconstruction of massive bone defects in orthopedics owing to several advantages, such as its tailored shape design, avoiding bone graft and superior bone-implant interlock. However, the osteoinduction activity of 3DTi is inadequate when applied clinically even though it exhibits osteoconduction. This study developes a comprehensive coatless strategy for the surface improvement of 3DTi through copper (Cu) ion implantation and ultraviolet (UV) photofunctionalization to enhance osteoinductivity. The newly constructed functional 3DTi (UV/Ti-Cu) achieved stable and controllable Cu doping, sustained Cu2+ releasing, and increased surface hydrophilicity. By performing cellular experiments, we determined that the safe dose range of Cu ion implantation was less than 5×1016 ions/cm2. The implanted Cu2+ enhanced the ALP activity and the apatite formation ability of bone marrow stromal cells (BMSCs) while slightly decreasing proliferation ability. When combined with UV photofunctionalization, cell adhesion and proliferation were significantly promoted and bone mineralization was further increased. Meanwhile, UV/Ti-Cu was conducive to the migration and angiogenesis of human umbilical vein endothelial cells (HUVECs) in vitro, theoretically facilitating vascular coupling osteogenesis. In conclusion, UV/Ti-Cu is a novel attempt to apply two coatless techniques for the surface modification of 3DTi. In addition, it is considered a potential bone substrate for repairing bone defects.
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Affiliation(s)
- Jiedong Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, People's Republic of China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, People's Republic of China.
| | - Zehao Jing
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, People's Republic of China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, People's Republic of China.
| | - Chuan Yin
- Beijing Surface Medical Technology Co., Ltd., Beijing 100176, China.
| | - Zhengguang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, People's Republic of China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, People's Republic of China.
| | - Shengxin Zeng
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, People's Republic of China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, People's Republic of China.
| | - Xiaolin Ma
- Beijing AKEC Medical Co., Ltd., Beijing 102200, China.
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing 100871, People's Republic of China.
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, People's Republic of China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, People's Republic of China.
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, People's Republic of China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing 100191, People's Republic of China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, People's Republic of China.
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Fernandez-Gonzalez P, Truchuelo-Díez MT, Gómez-Sánchez MJ. Open clinical trial evaluating the efficacy of a novel eyelash growth enhancer with peptides and glycosaminoglycans. J Cosmet Dermatol 2024; 23:2170-2180. [PMID: 38572527 DOI: 10.1111/jocd.16265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/12/2024] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Eyelashes play a crucial role in self-image and ocular protection. Enhancements to their structure are of both cosmetic and clinical interest. AIMS To assess the efficacy of a peptide and glycosaminoglycan-based eyelash enhancer serum in improving eyelash structure. PATIENTS/METHODS This open-label clinical trial involved 30 females aged 25-65. Eyelashes were assessed at baseline (D0), 4 weeks (D28), and 12 weeks (D84) using specialized software and high-resolution imagery. Measurements included lash number, width, length, volume, arc, and angle. RESULTS At 12 weeks, significant increases were observed in lash length (+8.3%), number (+5%), width (+10.1%), volume (+14.1%), arc (+13.4%), and angle (+28.3%) compared to baseline. Global Eyelash Assessment (GEA) scores significantly improved, and patient treatment satisfaction increased from 73.34% at D28 to 84.33% at D84. No adverse effects were reported. CONCLUSIONS The eyelash growth enhancer serum demonstrated significant efficacy in improving eyelash structure by Week 12, with early signs of improvement evident by Week 4. The high patient satisfaction levels underscore the perceived effectiveness of the product.
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Khan G, Cho J, Cha HG, Choi YS, Park ES. A prospective clinical study evaluating the efficacy and safety of a Laminin-5 fragment contained soothing cream in post-laser treatment care. J Cosmet Dermatol 2024; 23:2084-2089. [PMID: 38375949 DOI: 10.1111/jocd.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Photothermolysis effect, resulting from laser procedures, can cause redness/erythema, skin irritation and burning sensation, these symptoms may persist more than several days after the procedure and leading to discomfort for patients. Proper management is necessary for the better outcome, especially in early period after the laser procedure. Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®), is believed to have the calming/soothing effect on overheated/irritated skin after undergoing the laser treatment. It is assumed that cream can help alleviate the redness, erythema and burning sensation commonly experienced after laser treatments. This study aimed to assess the effectiveness and safety of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) during the early post-laser care period. MATERIALS AND METHODS This prospective split-face study involved 28 patients who underwent CO2 laser procedures and met inclusion criteria. The laser treatment was performed on both sides of the midface, and subsequently, the Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) was applied to one side of the midface. The efficacy of the cream was evaluated through objective measures, including photographic evaluation by two independent evaluators and assessment using an automatic skin analysis device. Subjective evaluations were also conducted. RESULTS The objective evaluation, based on the erythema score, revealed a statistical significant difference (p < 0.05) between the side treated with Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) and the control side. The erythema score was 1.34 ± 2.469 after the laser treatment with subsequent application of the cream for 10 min and 0.7 ± 2.28 on the second day after the procedure. The subjective evaluation showed a statistically significant high of patient satisfaction. No complications were observed during the follow-up period. CONCLUSION The application of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) after the CO2 laser treatment was found to be effective, particularly when applied for 10 min after the laser treatment and on the second day after the procedure. Both objective and subjective evaluations yielded significantly different results. Patients reported a high satisfaction rate with the characteristics of the cream during the follow-up period.
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Affiliation(s)
- Galina Khan
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Junyoung Cho
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Han Gyu Cha
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yean Su Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Lv W, Fu P, Wu P. Updated findings of skin flap thickness and residual breast tissue after mastectomy for breast cancer: a systematic review of the literature. Updates Surg 2024; 76:829-838. [PMID: 37864625 DOI: 10.1007/s13304-023-01675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/07/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND There is limited evidence on the ideal retention thickness of skin flap in mastectomy. Residual breast tissue (RBT) after mastectomy still represents an unknown risk for local recurrence or new breast cancer lesions. We made this systematic review to identify the optimal flap after mastectomy with minimal complications and better oncological safety. METHODS A systematic review was performed using MEDLINE search in PubMed, Embase, and Cochrane Library with the search terms relevant to skin flap thickness and residual breast tissue in breast cancer patients undergoing mastectomy. RESULTS Twenty-one studies were included of which fifteen studies enrolled 3814 patients who received mastectomy, and additional six studies were based on cadavers or breast specimens. Four studies confirmed the presence of the superficial fascial layer (Camper's fascia) which can theoretically be used as an anatomical marker for flap retention during mastectomy. Two other studies confirmed Camper's fascia deficiency to a greater or lesser extent. The flap thickness ranged from 3.8 mm to 23 mm in 2692 patients of 7 studies, which was related to BMI, breast size, and examination modalities. Two retrospective and one prospective studies confirmed flaps exceeding 5 mm could significantly increase postoperative complications. Nine studies including 1122 patients explored the association among flap thickness, RBT, and complications, 3 studies of which confirmed excessive flap thickness could cause a significant increase in RBT, which proved to be a potential risk factor for local recurrence in 3 studies. Flaps beyond 5 mm were also found to significantly increase the chance of local recurrence in 4 studies. CONCLUSION Camper's fascia can serve as an ideal demarcation between fat and breast tissue based on most current studies. 5 mm thickness of the flap retention in mastectomy is recommended if Camper's fascia is absent or obscure, through which better cosmetic outcomes and less RBT can be achieved.
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Affiliation(s)
- Wenjie Lv
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Pinting Fu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Wu
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
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Mazzawi M, Maxwell A. Addressing the Healthcare Needs of Transgender Youth in the Emergency Department. Pediatr Emerg Care 2024; 40:486-491. [PMID: 38815145 DOI: 10.1097/pec.0000000000003194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
ABSTRACT Transgender is a term that refers to individuals who identify with a gender that is different from the sex assigned to them at birth. In addition to gender dysphoria, many transgender youth experience a number of challenges including homelessness, violence, and mental health problems such as suicidality. Although transgender people represent a growing subset of the population, most providers receive very little training specific to the unique healthcare needs of transgender patients. In this CME review article, we define relevant terminology then discuss best practices for clinical encounters involving transgender youth in the emergency department. Finally, we review gender-affirming care including behavioral modifications, hormones, and surgeries for transfeminine and transmasculine individuals.
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Affiliation(s)
- Malek Mazzawi
- From the Clinical Assistant Professor of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA
| | - Angela Maxwell
- Assistant Instructor Emergency Medicine and Pediatrics, Division of Emergency Medicine, Children's National Hospital, The George Washington School of Medicine and Health Sciences, Washington, DC
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Aguilar HA, Palacios Huatuco RM, Ruffa T, Chirvechez A, Mayer HF. Synchronous pneumothorax and venous thromboembolism after body contouring surgery. Int J Surg Case Rep 2024; 119:109706. [PMID: 38678998 PMCID: PMC11063891 DOI: 10.1016/j.ijscr.2024.109706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Lipoabdominoplasty is one of the most common abdominal body contouring procedures performed today; however, it carries the risk of significant complications. Pneumothorax is a rare complication of liposuction, while, venous thromboembolism has a low short-term mortality and long-term morbidity. PRESENTATION OF CASE A 57-year-old woman with a history of diabetes mellitus, hypertension, obesity, and severe COVID-19 three years earlier. The patient underwent 360-degree liposuction and abdominoplasty. In the immediate postoperative period, the patient developed a right pneumothorax and followed by deep vein thrombosis (DVT) and pulmonary embolism (PE), which were diagnosed and treated early. After six months of follow-up, the patient presented a complete recovery. DISCUSSION Pneumothorax is recognized as a rare complication of liposuction and has been limited to case reports and small case series in the medical literature with an incidence of 0.04 %. In plastic and aesthetic surgery, body contouring procedures such as lipoabdominoplasty are associated with a risk of DVT and PE of 0.2-0.6 %, and 0.3 %, respectively. In addition, we believe that performing combined aesthetic procedures may increase the risk of complications. CONCLUSION This is the first reported case of pneumothorax, DVT and PE after body contouring surgery. We highlight the importance of awareness of these complications and the need for a high index of suspicion for early diagnosis and treatment, which is critical for patient survival.
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Affiliation(s)
- Hernán A Aguilar
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| | - René M Palacios Huatuco
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina.
| | - Tatiana Ruffa
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| | - Alejandra Chirvechez
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
| | - Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor (C1991ABB), Buenos Aires, Argentina
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Chen YH, Baan F, Bruggink R, Ko EWC, Bergé S, Xi T. Clockwise versus counterclockwise rotation in bimaxillary surgery: 3D analysis of facial soft tissue outcomes. Oral Maxillofac Surg 2024; 28:693-703. [PMID: 37981624 DOI: 10.1007/s10006-023-01196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE This study aimed to compare facial 3D soft tissue changes in subjects with Class III deformities who underwent bimaxillary clockwise (CW) and counterclockwise (CCW) rotational orthognathic surgery. METHODS Asian Class III subjects who completed bimaxillary surgical orthodontic treatments were enrolled and categorized into CW and CCW groups based on maxillary occlusal plane alterations. Preoperative and 9-month follow-up cone-beam computed tomography (CBCT) and 3D stereophotogrammetry were obtained, superimposed, and quantified for skeletal movements and soft tissue changes in six facial regions. Inverse probability of treatment weighting (IPTW) adjusted for potential confounding factors. RESULTS Thirty-seven subjects were included (CW group, n = 20; CCW group, n = 17). Postsurgical chin volume significantly reduced in the CW group compared to the CCW group (mean difference 6362 mm3; p = 0.037), and intergonial width significantly decreased in the CW group (mean difference 6.2 mm; p = 0.005). The postoperative alar width increased by 1.04 mm and 1.22 mm in the CW and CCW groups, respectively (p = 0.70). However, these changes were not significantly correlated to the direction of MMC pitch. CONCLUSION Clockwise rotation of the bimaxillary complex demonstrated a significant advantage in reducing chin volume and intergonial width compared to counterclockwise rotation, leading to a reduced frontal lower face width among Asian Class III subjects.
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Affiliation(s)
- Yi-Hsuan Chen
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Frank Baan
- Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin Bruggink
- Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ellen Wen-Ching Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
- Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525, Ga, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525, Ga, Nijmegen, The Netherlands.
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Maltezou HC, Pavli A. Challenges with medical tourism. Curr Opin Crit Care 2024; 30:224-230. [PMID: 38441086 DOI: 10.1097/mcc.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months. RECENT FINDINGS There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years. SUMMARY Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.
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Affiliation(s)
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
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131
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Heron MJ, Tiongco RFP, Zhu KJ, Habibi M, Cooney CM, Broderick KP. Anthropometric indices fail to predict complications after mastectomy for gynecomastia in adolescents. J Plast Reconstr Aesthet Surg 2024; 93:210-212. [PMID: 38705122 DOI: 10.1016/j.bjps.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/06/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Matthew J Heron
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rafael Felix P Tiongco
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine J Zhu
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mehran Habibi
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Carisa M Cooney
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristen P Broderick
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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132
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Seretis K. Learning from Abdominoplasty to Reduce the Seroma Rate following Deep Inferior Epigastric Perforator Flap with Umbilectomy. J Reconstr Microsurg 2024; 40:e1-e2. [PMID: 37579779 DOI: 10.1055/a-2153-4629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece
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133
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Innocenti A, Tamburello S, El Araby Mohamed M. Comment on "The combination of endoscopic subcutaneous mastectomy and liposuction (Liu and Shang's 2-hole 7-step method) as the treatment of gynecomastia". Surgery 2024; 175:1623. [PMID: 38092634 DOI: 10.1016/j.surg.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 05/12/2024]
Affiliation(s)
- Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.
| | - Sara Tamburello
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Marzouk El Araby Mohamed
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
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134
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Kim SH, Choi BG, Chung KJ. Modified Deep-Plane Face Lift and Lower Midface Lifting Using Deep Fat Compartment Mobilization and Zygomaticus Major Muscle Plication. Plast Reconstr Surg 2024; 153:1084e-1091e. [PMID: 37184450 DOI: 10.1097/prs.0000000000010642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Most face-lift techniques greatly improve the lower face; however, techniques for lifting the midface are limited and difficult. Original deep-plane face lift is a way to lift the superficial musculoaponeurotic system and skin as a compound unit. Although it minimizes tear of the superficial musculoaponeurotic system during dissection, damage to the vascular system, and the incidence of skin necrosis, and can be easily used in secondary cases, the deep-plane face lift does not adequately improve nasolabial fold. The authors perform a modified and enhanced deep-plane face lift to improve the midface. In this article, the authors explain the effects and procedures of the method. METHODS This retrospective study included patients ( n = 632) on whom deep-plane face lift (DPF group; n = 299) and modified deep-plane face lift (M-DPF group; n = 333) was performed by a single surgeon from January of 2014 to January of 2017, and from February of 2017 to December of 2020, respectively, at a local clinic. The degree of improvement in wrinkles in the patients' nasolabial fold was assessed using the five-grade Wrinkle Severity Rating Scale (WSRS). RESULTS The preoperative WSRS score was 2.95 ± 0.89 in the DPF group and 2.89 ± 0.92 in the M-DPF group. There was no significant difference in the preoperative WSRS score between the two groups ( P = 0.058). The postoperative WSRS score was 1.81 ± 0.68 in the DPF group, which was significantly greater than the 1.65 ± 0.66 found in the M-DPF group. CONCLUSION This method developed by the authors that combines deep-plane face lift with deep fat compartment mobilization and zygomaticus major muscle plication is safe and directly improves the nasolabial fold and promotes a smiling expression for rejuvenation effects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Bong Gyu Choi
- Department of Plastic and Reconstructive Surgery, Gangjin Medical Center
| | - Kyu-Jin Chung
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine
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Armengou X, Frank K, Kaye K, Brébant V, Möllhoff N, Cotofana S, Alfertshofer M. Facial Anthropometric Measurements and Principles - Overview and Implications for Aesthetic Treatments. Facial Plast Surg 2024; 40:348-362. [PMID: 37487528 DOI: 10.1055/s-0043-1770765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Facial anatomy is highly individual in each patient. Anthropometric measurements can be a useful tool to objectively analyze individual facial anatomy to allow for better comparability before and after treatments to ultimately improve standardization of facial procedures, both nonsurgical and surgical. The aim of this study was to provide a comprehensive overview over clinically relevant and feasible facial anthropometric measurements and principles for aesthetic medicine. A literature review was conducted to describe the most important and clinically relevant anthropometric measurements and principles for both the entire face and for three aesthetically relevant facial regions: the periorbital region, the nose, and the perioral region. A multitude of different anthropometric measurements and principles have been described in the literature for both the overall facial appearance and specific facial regions. Certain generally accepted anthropometric principles and proportions need to be respected to achieve aesthetic and harmonious results. For the overall facial appearance, a focus on symmetry, certain proportions, facial angles, and indices has been described. Principles and measurements were also described for the periorbital region, the nose, and the perioral region. Although attractiveness and aesthetic perception are subjective, objective evaluation of facial surface anatomy via anthropometric measurements can improve pre- and postinterventional analysis of the face and help the treating physician to individualize treatments, both nonsurgical and surgical.
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Affiliation(s)
| | - Konstantin Frank
- Centre for Plastic and Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
| | - Kai Kaye
- Centre for Plastic and Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
| | - Vanessa Brébant
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Nicholas Möllhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany
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Salehi PP, Shah HP, Torabi SJ, Heiser A, Salehi P, Peng GL, Nassif P, Lee YH, Azizzadeh B. Characterizing the Rhinoplasty Outcomes Most Important to Patients, Surgeons, and the General Population. J Craniofac Surg 2024; 35:1129-1133. [PMID: 38688025 DOI: 10.1097/scs.0000000000010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/24/2024] [Indexed: 05/02/2024] Open
Abstract
Understanding rhinoplasty characteristics important to patients, physicians, and society is essential for evaluating outcomes and designing optimal treatment plans. The authors aimed to elucidate specific rhinoplasty-related outcomes that are most important to patients, surgeons, and the general population. A cross-sectional survey comprising 11 rhinoplasty-specific characteristics, was distributed to patients, facial plastic surgeons, and the general population. Adult patients presenting for rhinoplasty consideration or follow-up after undergoing rhinoplasty were recruited. Characteristics rankings were compared between the 3 respondent groups using Spearman's rank correlation coefficient (ρ). Responses from 150 surgeons, 111 patients, and 102 lay individuals from the general population were included for analysis. When ranking rhinoplasty-specific characteristics in order of importance, patients and the general population ranked "ability to breathe through nose while awake" first and "overall appearance of nose" as second. Surgeons ranked "overall appearance of nose" first and "ability to breathe through nose while awake" second. There were strong correlations between patients' and surgeons' rankings (Spearman's ρ=0.836, P =0.002), between patients' and the general population's rankings (Spearman's ρ=0.773, P =0.007), and between surgeons' and the general population's rankings (Spearman's ρ=0.782, P =0.006). Our results highlight a significant correlation between characteristics of the "ideal" nose as determined by patients, surgeons, and the general population.
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Affiliation(s)
- Parsa P Salehi
- Department of Facial Plastic Surgery, Newport Beach
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
| | - Hemali P Shah
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine
| | - Alyssa Heiser
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA
| | - Pauniz Salehi
- Department of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY
| | | | | | - Yan H Lee
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery, Beverly Hills, CA
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137
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Gallo L, Churchill IF, Wong Riff KWY, Bulstrode NW, Berenguer B, Cui C, Li Y, Zhang R, Klassen AF, Rae C. Patient factors associated with novel EAR-Q appearance, psychosocial, and social scales: A cross-sectional study and regression analysis. J Plast Reconstr Aesthet Surg 2024; 93:62-69. [PMID: 38663166 DOI: 10.1016/j.bjps.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/29/2024] [Accepted: 04/05/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION The EAR-Q is a rigorously validated patient-reported outcome measure, which evaluates ear appearance and health-related quality of life (HRQL) in patients with congenital or acquired ear conditions. The aim of this study was to conduct an exploratory analysis to examine the factors associated with EAR-Q appearance and HRQL scale scores. METHODS In this study, 862 participants, aged 8-29 years, with congenital or acquired ear conditions, completed the EAR-Q as part of an international field-test study. Patients responded to demographic and clinical questions as well as the EAR-Q. Univariable and multivariable linear regression analyses were used to determine factors that were significant predictors for the scores on the EAR-Q Appearance, Psychological, and Social scales. RESULTS Most participants were men (57.4%), awaiting treatment (55.0%), and had a microtia diagnosis (70.4%), with a mean age of 13 (±4) years. Worse ear appearance scores (p < 0.02) were associated with male gender, microtia, no history of treatment, ear surgery within 6 months, unilateral involvement, and greater self-reported ear asymmetry. Decreased psychological scores (p < 0.01) were associated with increasing participant age, no treatment history, recent ear surgery, and dissatisfaction with ears matching or overall dissatisfaction. Lower social scores (p ≤ 0.04) were associated with no treatment history, those awaiting surgery, ear surgery within the last 6 months, bilateral involvement, and self-reported ears matching or overall appearance. CONCLUSION This analysis identified patient factors that may influence ear appearance and HRQL scale scores. These findings provide evidence of patient factors that should be adjusted for when undertaking future observational research designs using the EAR-Q in this patient population.
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Affiliation(s)
- Lucas Gallo
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Karen W Y Wong Riff
- University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada
| | - Neil W Bulstrode
- Division of Plastic Surgery, Great Ormond Street Hospital, London, UK
| | - Beatriz Berenguer
- Division of Plastic Surgery, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Chunxiao Cui
- Division of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai, China
| | - Yiyuan Li
- Division of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai, China
| | - Ruhong Zhang
- Division of Plastic Surgery, Shanghai 9th People's Hospital, Shanghai, China
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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Cheng CY, Lin TM, Chang SL, Hu S, Huang YL. Transcutaneous lower eyelid blepharoplasty with micro-autologous fat transplantation harvested from orbital fat pads for lower eyelid aging treatment. J Plast Reconstr Aesthet Surg 2024; 93:111-113. [PMID: 38678813 DOI: 10.1016/j.bjps.2024.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/04/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
The aging process of lower eyelids results in lower eyelid wrinkles, tear troughs, and eye bags. Many therapies have been described for treatment of lower eyelid aging, and transcutaneous blepharoplasty is often used for treating cases with eyebags and dermatochalasis. However, it may cause depression near the medial orbit resulting in a hollowed look. In the present study, we developed an innovative method transferring the herniated fatty tissue to volume loss area during the surgical procedure of transcutaneous lower eyelid blepharoplasty by means of micro-autologous fat transplantation harvested from resected orbital fat pads. Besides, we also analyze it efficacy and safety compared with traditional methods of transcutaneous lower eyelid blepharoplasty. We reviewed the records of the patients who underwent transcutaneous lower eyelid blepharoplasty with and without micro-autologous fat transplantation, for lower eyelid aging improvement. We used global aesthetic improvement scale, Hirmand's classification system, and Wrinkle Severity Rating Scale to evaluate the cosmetic outcome at 1 week, 1 month, and 3 months after operation by two independent investigators. We found patients received transcutaneous lower eyelid blepharoplasty with autologous fat graft had significantly higher global aesthetic improvement scale and Wrinkle Severity Rating Scale improvement than those underwent transcutaneous lower eyelid blepharoplasty only in each evaluation timepoints. There was no significant difference of adverse effects between both surgical methods. The present study demonstrated the efficacy and safety of the lower eyelid blepharoplasty with micro-autologous fat transplantation harvesting from resected orbital fat pads.
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Affiliation(s)
- Chun-Yu Cheng
- Department of Dermatology, Chang Gung Memorial Hospital, No.123, Dinghu Rd., Guishan Dist., Taoyuan City 333, Taiwan; College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan; Center of Tissue Engineering, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Tsai-Ming Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University, No. 100, Ziyou 1st Road, Sanmin Dist., Kaohsiung City 807, Taiwan; Charming Institute of Aesthetic and Regenerative Surgery (CIARS), 2F.-1, No. 172, Ziqiang 2nd Road, Qianjin Dist., Kaohsiung City 801, Taiwan
| | - Shyue-Luen Chang
- Department of Dermatology, Chang Gung Memorial Hospital, No.123, Dinghu Rd., Guishan Dist., Taoyuan City 333, Taiwan; College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan
| | - Sindy Hu
- Department of Dermatology, Chang Gung Memorial Hospital, No.123, Dinghu Rd., Guishan Dist., Taoyuan City 333, Taiwan; College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan
| | - Yau-Li Huang
- Department of Dermatology, Chang Gung Memorial Hospital, No.123, Dinghu Rd., Guishan Dist., Taoyuan City 333, Taiwan; College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan.
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Radulesco T, Ebode D, Medawar C, Penicaud M, Michel J. Prospective Evaluation of Aesthetic and Functional Outcomes following Video-Assisted Rhino-Septoplasty. Aesthetic Plast Surg 2024:10.1007/s00266-024-04146-3. [PMID: 38819447 DOI: 10.1007/s00266-024-04146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Conservative techniques have been developed in the field of rhinoplasty, focusing on limited tissue resection while emphasizing the reshaping of nasal structural elements. OBJECTIVES We aimed to prospectively evaluate aesthetic and functional outcomes following Video-Assisted Rhino-Septoplasty (VARS) using validated tools. METHODS Patients' self-reported outcomes were assessed before and 6 months after surgery. Aesthetic evaluations used FACE-Q Rhinoplasty modules (FQRM) Satisfaction with Nose and Nostrils. Functional evaluations were performed with NOSE scores. T-tests were used to determine the significance of the change in scores before and after surgery. p value < 0.05 was considered statistically significant. RESULTS Fifty patients were included (sex ratio = 0.16, mean age = 30 y.o., 78% primary cases). All patients had associated septoplasties, and 32 had inferior turbinate reductions. Mean FQRM Nose scores were 28.1 ± 16.3 before vs. 83.4 ± 17.2/100 after surgery. Mean FQRM Nostrils scores were 61.5 ± 28.6 before vs. 85 ± 21/100 after surgery. Mean NOSE scores were 49.5 ± 36.3 before vs. 14.8 ± 16.6/100 after surgery. All p <0.001. We found no correlation between FQRM Nose and NOSE scores after surgery (ρ = -0.1553, IC95% (-0.41;0.12), p = 0.28). CONCLUSION Our study showed that VARS is an effective technique, yielding high patient satisfaction in both aesthetic and functional outcomes. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Thomas Radulesco
- Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS, Department, Marseille, France.
| | - Dario Ebode
- Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS, Department, Marseille, France
| | | | - Martin Penicaud
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, 147 Bd Baille, 13005, Marseille, France
| | - Justin Michel
- Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS, Department, Marseille, France
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Polat E, Polat YB, Senturk E, Dogan R, Yenigun A, Tugrul S, Eren SB, Aksoy F, Ozturan O. Evaluating the accuracy and readability of ChatGPT in providing parental guidance for adenoidectomy, tonsillectomy, and ventilation tube insertion surgery. Int J Pediatr Otorhinolaryngol 2024; 181:111998. [PMID: 38830271 DOI: 10.1016/j.ijporl.2024.111998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/08/2024] [Accepted: 05/30/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES This study examined the potential of ChatGPT as an accurate and readable source of information for parents seeking guidance on adenoidectomy, tonsillectomy, and ventilation tube insertion surgeries (ATVtis). METHODS ChatGPT was tasked with identifying the top 15 most frequently asked questions by parents on internet search engines for each of the three specific surgical procedures. We removed repeated questions from the initial set of 45. Subsequently, we asked ChatGPT to generate answers to the remaining 33 questions. Seven highly experienced otolaryngologists individually assessed the accuracy of the responses using a four-level grading scale, from completely incorrect to comprehensive. The readability of responses was determined using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. The questions were categorized into four groups: Diagnosis and Preparation Process, Surgical Information, Risks and Complications, and Postoperative Process. Responses were then compared based on accuracy grade, FRE, and FKGL scores. RESULTS Seven evaluators each assessed 33 AI-generated responses, providing a total of 231 evaluations. Among the evaluated responses, 167 (72.3 %) were classified as 'comprehensive.' Sixty-two responses (26.8 %) were categorized as 'correct but inadequate,' and two responses (0.9 %) were assessed as 'some correct, some incorrect.' None of the responses were adjudged 'completely incorrect' by any assessors. The average FRE and FGKL scores were 57.15(±10.73) and 9.95(±1.91), respectively. Upon analyzing the responses from ChatGPT, 3 (9.1 %) were at or below the sixth-grade reading level recommended by the American Medical Association (AMA). No significant differences were found between the groups regarding readability and accuracy scores (p > 0.05). CONCLUSIONS ChatGPT can provide accurate answers to questions on various topics related to ATVtis. However, ChatGPT's answers may be too complex for some readers, as they are generally written at a high school level. This is above the sixth-grade reading level recommended for patient information by the AMA. According to our study, more than three-quarters of the AI-generated responses were at or above the 10th-grade reading level, raising concerns about the ChatGPT text's readability.
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Affiliation(s)
- Emre Polat
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey.
| | - Yagmur Basak Polat
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Erol Senturk
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Remzi Dogan
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Alper Yenigun
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Selahattin Tugrul
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Sabri Baki Eren
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Fadlullah Aksoy
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Orhan Ozturan
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
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Wu TJ, Huang YL, Kang YN, Chen KH, Chen C. Comparing Energy-Based Devices for Striae Improvement: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Dermatol Surg 2024:00042728-990000000-00825. [PMID: 38820425 DOI: 10.1097/dss.0000000000004252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Striae distensae (SD) are cutaneous lesions that are caused by hormones or mechanical stress leading to rapid expansion of skin. Therefore, SD are now a cosmetic concern. However, improving SD is notoriously difficult. Among different treatments, energy-based devices (EBDs) are much more effective and controllable. OBJECTIVE The aim of this review was to determine the most effective type of EBD for improving the appearance of striae. MATERIALS AND METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The population comprised patients suffering from striae. Different types of EBDs used to improve striae were compared. The primary outcome of the reduction in the width of striae was evaluated. A random-effects model was performed. The means and standard deviations were extracted. RESULTS Eighteen randomized controlled trials were included. The network meta-analysis revealed that after a comparison among the 4 types of EBDs, no significant differences were observed in the reduction of striae width. CONCLUSION Radiofrequency, ablative lasers, nonablative lasers, and intense pulsed light are all effective treatments for reducing the striae width. None of them was superior to the others. However, radiofrequency and ablative lasers may have the highest chance of improving the appearance of striae.
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Affiliation(s)
- Ting-Ju Wu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Cathay General Hospital, Taipei, Taiwan
| | - Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kee-Hsin Chen
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Díez-Montiel A, Pose-Díez-de-la-Lastra A, González-Álvarez A, Salmerón JI, Pascau J, Ochandiano S. Tablet-based Augmented reality and 3D printed templates in fully guided Microtia Reconstruction: a clinical workflow. 3D Print Med 2024; 10:17. [PMID: 38819536 PMCID: PMC11140883 DOI: 10.1186/s41205-024-00213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Microtia is a congenital malformation of the auricle that affects approximately 4 of every 10,000 live newborns. Radiographic film paper is traditionally employed to bidimensionally trace the structures of the contralateral healthy ear in a quasi-artistic manner. Anatomical points provide linear and angular measurements. However, this technique proves time-consuming, subjectivity-rich, and greatly dependent on surgeon expertise. Hence, it's susceptible to shape errors and misplacement. METHODS We present an innovative clinical workflow that combines 3D printing and augmented reality (AR) to increase objectivity and reproducibility of these procedures. Specifically, we introduce patient-specific 3D cutting templates and remodeling molds to carve and construct the cartilaginous framework that will conform the new ear. Moreover, we developed an in-house AR application compatible with any commercial Android tablet. It precisely guides the positioning of the new ear during surgery, ensuring symmetrical alignment with the healthy one and avoiding time-consuming intraoperative linear or angular measurements. Our solution was evaluated in one case, first with controlled experiments in a simulation scenario and finally during surgery. RESULTS Overall, the ears placed in the simulation scenario had a mean absolute deviation of 2.2 ± 1.7 mm with respect to the reference plan. During the surgical intervention, the reconstructed ear was 3.1 mm longer and 1.3 mm wider with respect to the ideal plan and had a positioning error of 2.7 ± 2.4 mm relative to the contralateral side. Note that in this case, additional morphometric variations were induced from inflammation and other issues intended to be addressed in a subsequent stage of surgery, which are independent of our proposed solution. CONCLUSIONS In this work we propose an innovative workflow that combines 3D printing and AR to improve ear reconstruction and positioning in microtia correction procedures. Our implementation in the surgical workflow showed good accuracy, empowering surgeons to attain consistent and objective outcomes.
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Affiliation(s)
- Alberto Díez-Montiel
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Alicia Pose-Díez-de-la-Lastra
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain.
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Leganés, 28911, Spain.
| | - Alba González-Álvarez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Leganés, 28911, Spain
| | - José I Salmerón
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, Leganés, 28911, Spain
| | - Santiago Ochandiano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, 28007, Spain
- Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
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143
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Assiri H, Alfaleh M, AlEnazi A, Alarfaj A. Perception of Rhinoplasty Outcome Utilizing Patients' Photography. J Craniofac Surg 2024:00001665-990000000-01652. [PMID: 38819168 DOI: 10.1097/scs.0000000000010344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Patient satisfaction with rhinoplasty results is evaluated in a manner of subjective and qualitative values, and to a certain degree, it can indicate successful outcomes in rhinoplasty. METHODS The present study was a descriptive study that assessed the rhinoplasty outcome of adult patients who underwent septorhinoplasty between January 2015 and August 2023 at a single center in Saudi Arabia utilizing Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores pre-operatively, postoperatively, and postoperatively with showing the patients their photo before surgery. RESULTS The comparison of Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores showed statistically significant with P value of 0.000 when comparing these scores pre-operatively, postoperatively, and postoperatively with showing the patient their photos before surgery. CONCLUSION Presenting patients with pre-operative images may help them recognize changes in their clinical appearance and, consequently, score higher on the postoperative satisfaction scale. It can help the surgeon to increase patient satisfaction postoperatively.
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Affiliation(s)
- Hassan Assiri
- Department of Otolaryngology-Head and Neck-Facial Plastic Surgery, King Abdulaziz University Hospital
| | - Moath Alfaleh
- Department of Otorhinolaryngology and Head and Neck Surgery
| | - Abdulaziz AlEnazi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Fahad Hospital of the University, Al-Khobar, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Alarfaj
- Department of Otorhinolaryngology-Head and Neck, College of Medicine, King Saud University, Riyadh
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Bonomi F, Limido E, Weinzierl A, Harder Y, Menger MD, Laschke MW. Preconditioning strategies for improving the outcome of fat grafting. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 38818802 DOI: 10.1089/ten.teb.2024.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Autologous fat grafting is a common procedure in plastic, reconstructive and esthetic surgery. However, it is frequently associated with an unpredictable resorption rate of the graft depending on the engraftment kinetics. This, in turn, is determined by the interaction of the grafted adipose tissue with the tissue at the recipient site. Accordingly, preconditioning strategies have been developed following the principle of exposing these tissues in the pre-transplantation phase to stimuli inducing endogenous protective and regenerative cellular adaptations, such as the up-regulation of stress-response genes or the release of cytokines and growth factors. As summarized in the present review, these stimuli include hypoxia, dietary restriction, local mechanical stress, heat and exposure to fractional carbon dioxide laser. Preclinical studies show that they promote cell viability, adipogenesis and angiogenesis, while reducing inflammation, fibrosis and cyst formation, resulting in a higher survival rate and quality of fat grafts in different experimental settings. Hence, preconditioning represents a promising approach to improve the outcome of fat grafting in future clinical practice. For this purpose, it is necessary to establish standardized preconditioning protocols for specific clinical applications that are efficient, safe and easy to implement into routine procedures.
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Affiliation(s)
- Francesca Bonomi
- Saarland University, Institute for Clinical & Experimental Surgery, Homburg, Germany;
| | - Ettore Limido
- Saarland University, Institute for Clinical & Experimental Surgery, Homburg, Germany;
| | - Andrea Weinzierl
- Saarland University, Institute for Clinical & Experimental Surgery, Homburg, Germany
- University Hospital Zurich, Department of Plastic Surgery and Hand Surgery, Zurich, Switzerland;
| | - Yves Harder
- Ente Ospedaliero Cantonale (EOC), Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
- Università della Svizzera italiana, Faculty of Biomedical Sciences, Lugano, Ticino, Switzerland;
| | - Michael D Menger
- Universitätsklinikum des Saarlandes, nstitut für Klinisch-Experimentelle Chirurgie, Geb. 65/66, Homburg, Germany, 66421;
| | - Matthias W Laschke
- Saarland University, Institute for Clinical & Experimental Surgery, Kirrbergerstrasse 100, Homburg, Germany, 66421;
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Sun N, Cao Z, Wu P, Qing L, Yu F, Pan D, Zeng L, Peng L, Pang X, Tang J. Individualized design program of multiple flaps for adapting different zones to repair large irregular wounds in children. Heliyon 2024; 10:e31179. [PMID: 38803926 PMCID: PMC11128512 DOI: 10.1016/j.heliyon.2024.e31179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Objective Management of large irregular wounds in children had been confusing plastic and reconstructive surgeons. Herein, this study was aimed to propose a new treatment method based on the principle of adapting different recipient zones to overcome the intractable wounds, simplifying and programing the design process of targeted flaps for covering large irregular soft-tissue defects. Patients and methods From January 2009 to December 2020, 31 children (9 girls and 22 boys) aged 3-16 years (mean 9.8 years) underwent multiple modular flaps with edge to edge splicing reconstruction of the lower extremities. All the wounds were large with non-adjacent defects and with or without a dead space. Several variants of flaps were harvested according to the needs and reconstruction requirements of patients. Results A total of 71 flaps were harvested from 31 patients and all flaps donor sites received primary closure. Nine patients underwent split-thickness skin grafting, and three cases of flaps survived from vascular crisis by rebuilding the vessels and the rest accepting LD flap transplants. And five partial necrosis of the distal epidermis flaps recovered using skin grafting and dressing change. No major complication was encountered in other patients and donor sites, except one heel ulcer. During the follow-up (ranging from 16 to 38 months, mean 27.7 months), aesthetic and functional results of reconstructed limbs were satisfactory in all patients. Conclusions The Individualized design program of multiple flaps for adapting different recipient zones is an alternative for repairing large irregular soft-tissue defects in children, beneficial for plastic and reconstructive surgeons to simplify and program the process of designing and perform multiple flaps to achieve this goal. Level of evidence III, Retrospective.
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Affiliation(s)
- Nianzhe Sun
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zheming Cao
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Panfeng Wu
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Liming Qing
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yu
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ding Pan
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zeng
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lingli Peng
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyang Pang
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Department of Orthopedics, Hand & Microsurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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146
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Mukit FA, Kim EY, Hilliard G, Pilkinton S, Walker ME, Wilson MW, Fowler BT. Scope of practice of oculofacial plastic and reconstructive surgeons: a public perception survey. Orbit 2024:1-7. [PMID: 38815176 DOI: 10.1080/01676830.2024.2348015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The purpose of this study is to determine the public's perception of the scope of practice for oculofacial plastic and reconstructive surgeons (OFPRS). METHODS A 49-question survey was distributed by QualtricsⓇ to a panel similar to the US demographic composition. Responses collected underwent bivariate statistical analysis. RESULT A total of 530 responses were obtained, with most respondents being white, female, over the age of 35, from the Midwest, and with at least a college education or above. Most respondents did not think ophthalmologists or optometrists were surgeons, and only 158 people (29.8%) knew the primary specialty of OFPRS was ophthalmology. Board certification was preferred by 98.87% of respondents, and 95.28% preferred ASOPRS-trained OFPRS. CONCLUSIONS Our study highlights the gap in knowledge about OFPRS as a field, the qualifications and training required, and the scope of practice. Notably, even for OFPRS-specific procedures, PRS remained the leading subspecialist chosen for interventions such as orbital decompression (58.5% vs. 71.5%), orbital reconstruction (57.9% vs. 74.2%), enucleation/evisceration (48.1% vs. 53.4%), optic nerve-related surgery (39.8% vs. 43.4%), orbital cancer resection (42.8% vs. 46.8%), and tear duct surgery (41.9% vs. 52.5%). Additionally, most respondents did not feel that facial fillers, laser skin resurfacing, eyelid cancer removal, or cataract surgery were within the OFPRS scope of practice.
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Affiliation(s)
- Fabliha A Mukit
- Oculofacial Plastic and Reconstructive Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Emily Y Kim
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Grant Hilliard
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sophie Pilkinton
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marc E Walker
- Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Matthew W Wilson
- Oculofacial Plastic and Reconstructive Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brian T Fowler
- Oculofacial Plastic and Reconstructive Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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147
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Janipour M, Bastaninejad S, Mohebbi A, Amali A, Owji SH, Jazi K, Mirali RA, Moshfeghinia R. Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:194. [PMID: 38816731 PMCID: PMC11138079 DOI: 10.1186/s12871-024-02563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. METHODS Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. RESULTS Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. CONCLUSION In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.
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Affiliation(s)
- Masoud Janipour
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahin Bastaninejad
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohebbi
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Amali
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Imam Khomeni Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Owji
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kimia Jazi
- Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
| | | | - Reza Moshfeghinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
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148
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Silverstein ML, Sorice-Virk S, Wan DC, Momeni A. Microsurgical Breast Reconstruction can be Performed Safely in Patients with Obesity. J Reconstr Microsurg 2024. [PMID: 38815573 DOI: 10.1055/s-0044-1787266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Numerous studies have shown that obesity is a risk factor for postoperative complications following breast reconstruction. Hence, obesity has traditionally been considered a relative contraindication to microsurgical breast reconstruction. In this study, we investigated the impact of obesity on outcomes following microsurgical breast reconstruction. METHODS A retrospective analysis of 200 consecutive patients who underwent microsurgical breast reconstruction with free abdominal flaps was performed. Subjects were divided into Nonobese (body mass index [BMI] < 30 kg/m2) and Obese (BMI ≥ 30 kg/m2) cohorts. Univariate and multivariate analyses were performed to evaluate differences in patient characteristics, complication rates, and efficiency metrics between the two groups. RESULTS Of the 200 subjects included in the study, 128 were Nonobese, 72 were Obese. The prevalence of diabetes (3.9 vs. 16.9%, p = 0.002) and hypertension (14.7 vs. 39.4%, p < 0.001) were significantly greater in the Obese cohort. Among unilateral reconstructions, postoperative length of stay (LOS) was longer among Obese patients (3.1 vs. 3.6 days, p = 0.016). Seroma occurred more frequently in Obese patients following bilateral reconstruction (5.7 vs. 0.0%, p = 0.047). Otherwise, there were no significant differences in complication rates between the groups. On multivariate analysis, BMI was not independently associated with complications, LOS, or operative time. CONCLUSION The improvements in clinical and patient-reported outcomes that have been associated with postmastectomy breast reconstruction do not exclude obese women. This study indicates that microsurgical breast reconstruction can be performed safely and efficiently in patients with obesity.
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Affiliation(s)
- Max L Silverstein
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Sarah Sorice-Virk
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Derrick C Wan
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
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Daungsupawong H, Wiwanitkit V. ChatGPT and Clinical Questions on the Practical Guideline of Blepharoptosis: Correspondence. Aesthetic Plast Surg 2024:10.1007/s00266-024-04152-5. [PMID: 38816655 DOI: 10.1007/s00266-024-04152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Affiliation(s)
| | - Viroj Wiwanitkit
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
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150
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Soto-Galindo GA, Saghir M, Apaydin F. Twelve Steps to Optimize Scar Outcomes in External Rhinoplasty. Facial Plast Surg 2024. [PMID: 38698638 DOI: 10.1055/a-2318-0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
A well-healed scar extends beyond a mere superficial concern, reflecting the precision and care underlying the surgery. This study addresses the lack of recent literature on the complete closure technique for external rhinoplasty scars, emphasizing its potential impact on patient satisfaction and overall aesthetic quality. The main purpose of this article was to introduce and assess the efficacy of a novel closing suture technique for external rhinoplasty and emphasize on 12 specific steps for wound closure. A cohort of 104 patients who underwent external rhinoplasty utilizing the proposed closing suture technique were evaluated. Standardized photographic documentation and scar assessment were performed using the Vancouver-Manchester scale, considering notching, skin level differences, pigmentation, and overall appearance. The surgical approach involved a combination of vertical mattress and interrupted simple sutures, creating an effective closure framework. Analysis revealed an absence of poor scars, with 83.6% classified as good. Note that 65.5% of the good scars achieved a perfect 6-point score. While one moderate scar scored 3 points, the majority demonstrated optimal outcomes. Clinical photographs further illustrated the technique's success, showcasing imperceptible scars and reinforcing the efficacy of the complete closure approach. Our study introduces and assesses the efficacy of the complete closure technique for external rhinoplasty scars. The approach consistently yields positive outcomes, with an emphasis on almost imperceptible scars. While not achieving a 100% imperceptible scar rate, this study underscores the need for ongoing research to refine techniques and enhance patient satisfaction in external rhinoplasty. The proposed technique contributes significantly to scar management practices and encourages further exploration within the evolving landscape of rhinoplasty.
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Affiliation(s)
- Germán A Soto-Galindo
- International Fellow of the European Academy of Facial Plastic Surgery, Ege University, Izmir, Turkiye
| | - Meshari Saghir
- Facial Plastic Surgeon and ENT Specialist, Al Jahra Hospital, Al Jahra, Kuwait
| | - Fazil Apaydin
- Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, Ege University, Izmir, Turkiye
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