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De Henau M, van Kuijk SM, Colla C, Van den Kerckhove E, Van der Hulst RR, Piatkowski A. Pressure Masks for Facial Scar Treatment after Oncological Reconstruction: Long-Term Patient Satisfaction and Quality of Life. Facial Plast Surg 2024; 40:36-45. [PMID: 36787790 PMCID: PMC10774008 DOI: 10.1055/a-2035-4468] [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] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION With increasing incidence of facial skin cancer, more patients undergo facial reconstruction following Mohs micrographic surgery (MMS). Aesthetically unpleasing, thickened facial flaps, and disturbing scars can be treated with a pressure mask with inner silicone lining to help improve functional and aesthetic outcomes. However, data on long-term patient satisfaction and quality of life (QoL) following this treatment are lacking. METHODS We aimed to assess long-term satisfaction and QoL of patients who underwent local flap reconstruction following MMS. Patients treated between January 2012 and October 2020 were invited to answer FACE-Q and SCAR-Q questionnaires. Demographic data, skin cancer type and location, type of reconstruction, postoperative complications, duration of pressure mask therapy, daily compliance, and additional scar treatment were collected to explore possible predictors. RESULTS Of 92 eligible patients, 50 responded. Eighteen respondents were male (36%) and 32 were female (64%). Mean duration of pressure mask therapy was 10.20 ± 4.61 months. Patients were 61.14 ± 32.91 months after completion of pressure mask therapy upon participation. Patients whose reconstruction consisted of multiple flaps had significantly worse outcomes in social function (p = 0.012), scar appearance (p = 0.045), and scar symptoms (p = 0.008). A trend of increasing time since therapy completion predicting better outcomes was observed for all scales, and it was a significant predictor for better scar appearance (p = 0.001) and less scar symptoms (p = 0.001). CONCLUSION Pressure mask treatment for facial flaps and scars following MMS results in good long-term patient satisfaction and QoL. Multiple local flaps, reflecting a larger skin defect postexcision, is a predictor for worse outcomes in social function, scar appearance, and symptoms. Increasing time is associated with increasing satisfaction, which reflects satisfactory and stable long-term effects of treatment, possibly combined with more acceptance of the result over time.
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Affiliation(s)
- Melissa De Henau
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School of Oncology and Reproduction, Maastricht University, the Netherlands
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carlo Colla
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric Van den Kerckhove
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Rehabilitation Sciences, Faber, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation and Burns Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Rene R.W.J. Van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Plastic Surgery, VieCuri Medical Centrum, Venlo, the Netherlands
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Singh P, Chan K, Dhar S, Ashby I, Krumhuber E, Mosahebi A, Ponniah A. Patient-Reported Outcome Measures in a Facial Reconstruction Case Series Following the Implementation of an Integrated Craniofacial Multidisciplinary Team Clinic, Three-Dimensional Photography, and Computer Modeling. Aesthet Surg J Open Forum 2023; 5:ojad082. [PMID: 37780530 PMCID: PMC10540727 DOI: 10.1093/asjof/ojad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Background Facial reconstruction surgery is often a complex and staged process, leading to lengthy reconstructive journeys for patients. The integration of a clinical pathway can give patients a clearer understanding of what to expect at each stage of their reconstructive journey. Objectives The authors demonstrate how the incorporation of multidisciplinary team clinics, three-dimensional (3D) photography, and 3D modeling into an integrated pathway can streamline the process for patients undergoing facial reconstructive surgeries and aid their understanding of their surgeries. Methods A novel clinical pathway was developed for patients undergoing facial reconstructive surgery at a tertiary reconstructive unit in London. A case series was collated of 35 patients who had been through the integrated pathway. Patient-reported outcome measures (PROMs) were assessed using FACE-Q scales, Global Aesthetic Improvement Scale, Self-Perception of Age score, and Ordinal Rank change in facial aesthetic appearance, determined subjectively and objectively. Statistical analysis was performed to calculate mean averages for each scale and PROM. Results High patient satisfaction with overall facial appearance, aging appearance, and the decision-making process was demonstrated. The average perceived improvement in age-related facial appearance was -7.7 years postreconstruction compared with prereconstruction. The Ordinal Rank improvement on facial aesthetic appearance showed considerable improvement, both subjectively and objectively. Conclusions The authors advocate the implementation of an integrated clinical pathway for facial reconstruction, with positive impacts observed in terms of patient satisfaction and objective assessments of facial appearance. Similar principles can be extrapolated to other aspects of reconstructive surgery. Level of Evidence 3
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Affiliation(s)
- Prateush Singh
- Corresponding Author: Mr Prateush Singh, Royal Free Hospital Plastic Surgery Department, Royal Free Hospital, Pond Street, London NW3 2QG, UK. E-mail:
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Patterson KN, Beyene TJ, Lehman K, VerLee SN, Schwartz D, Fabia R, Thakkar RK. Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers. Burns 2023; 49:1311-1320. [PMID: 36764839 DOI: 10.1016/j.burns.2023.01.010] [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: 06/08/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate pediatric burn patients' and caregivers' quality of life (QoL), while identifying clinical characteristics correlated with psychological stress. METHODS Pediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0-4 years completed the Infant's Dermatology QoL Index (IDQOL). Patients> 4-16 years completed the Children's Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers' stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics. RESULTS Overall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients' burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern. CONCLUSIONS QoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Veteran Affairs Palo Alto Health System (VAPAHCS), Palo Alto, CA, USA,; Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sarah N VerLee
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dana Schwartz
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Renata Fabia
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Rajan K Thakkar
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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Salinas CA, Morris JM, Sharaf BA. Craniomaxillofacial Trauma: The Past, Present and the Future. J Craniofac Surg 2023; 34:1427-1430. [PMID: 37072888 DOI: 10.1097/scs.0000000000009334] [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: 11/30/2022] [Accepted: 01/01/2023] [Indexed: 04/20/2023] Open
Abstract
Reconstruction of facial trauma has seen a significant evolutionary leap in the last 100 years. The current surgical management of facial fractures was made possible by the efforts and creativity of pioneer surgeons, advances in anatomic understanding, and the continued development of biomaterials and imaging technologies. Virtual surgical planning (VSP) and 3-dimensional printing (3DP) are being incorporated into the management of acute facial trauma. The integration of this technology at the point of care is rapidly expanding globally. This article reviews the history of the management of craniomaxillofacial trauma, current practices, and future directions. The use of VSP and 3DP in facial trauma care is highlighted with a description of EPPOCRATIS, a rapid point-of-care process incorporating VSP and 3DP at the trauma center.
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Affiliation(s)
| | - Jonathan M Morris
- Anatomic Modeling Lab, Department of Radiology, Mayo Clinic
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - Basel A Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic
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Homsy SP, Repo JP, Lindford AJ, Uimonen MM, Lassus P. Validation of the Finnish FACE-Q for use in patients undergoing surgery for functional problems or malignancy. J Plast Surg Hand Surg 2021; 56:270-276. [PMID: 34428115 DOI: 10.1080/2000656x.2021.1964981] [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] [Indexed: 10/20/2022]
Abstract
The aim of this study was to produce a Finnish version of the FACE-Q scales Satisfaction with Forehead and Eyebrows, Adverse effects: Forehead, Eyebrows and Scalp, and Adverse effects: Cheeks, Lower face and Neck, and assess the performance of these scales and the Satisfaction with Facial Appearance, Satisfaction with Outcome and Appearance-related Psychosocial Distress in patients who had undergone surgery for functional problems or malignancy affecting the forehead or cheeks. The general health-related outcomes instrument 15 D was used as a reference. Patients who had undergone a frontal lift, a direct brow lift, a facelift or an excision of a facial tumor in Helsinki University Hospital plastic surgery department in 2009-2019 were identified. A postal survey study was conducted with 305 patients, of whom 135 (44%) responded. Diagnoses included facial nerve dysfunction (53%), brow ptosis (21%) and skin, mucosal or salivary gland tumor (20%). The FACE-Q scales displayed high internal consistency (Cronbach's alphas ≥0.80) and good reliability on repeat administration. The exploratory factor analysis revealed unifactorial influences for all scales except the Adverse effects: Forehead, Eyebrows and Scalp. Weak correlations with 15 D dimensions were detected. The FACE-Q scales evaluated here are suitable for use in patients with functional problems or malignancy.
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Affiliation(s)
- S Pauliina Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Andrew J Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Homsy SP, Uimonen MM, Lindford AJ, Repo JP, Lassus PA. Application of the FACE-Q rhinoplasty module in a mixed reconstructive and corrective rhinoplasty population in Finland. J Plast Surg Hand Surg 2021; 55:373-379. [PMID: 33729899 DOI: 10.1080/2000656x.2021.1898973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The FACE-Q Rhinoplasty module is a patient-reported outcome instrument developed for the assessment of primarily aesthetic outcomes of rhinoplasty. The aim of our study was to produce a Finnish version of the instrument and validate it for use in patients undergoing nasal reconstruction as well as those treated with a rhinoplasty. Finnish versions of the FACE-Q scales Satisfaction with Nose, Satisfaction with Nostrils and Adverse Effects: Nose, were translated following established guidelines. Patients undergoing nasal resection, reconstruction or rhinoplasty in Helsinki University Hospital plastic surgery department in 2009-2019 were identified using theatre records. A total of 240 Finnish-speaking patients 18-85 years old were approached with a postal survey questionnaire. The questionnaire included the translated FACE-Q modules and those for Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress and Satisfaction with Outcome, as well as the general health-related quality of life instrument 15 D. The FACE-Q scales translated readily to Finnish. Eighty-three patients (35%) responded to the survey. Most FACE-Q scales performed well with high internal consistency (Cronbach's alphas 0.87-0.92) and repeatability. Only the Adverse Effects: Nose scale displayed poor consistency and a floor effect with 18% of the patients reporting no adverse outcomes. Answers to the Appearance-Related Psychosocial Distress scale were skewed towards no experienced stress. Answers to the other scales were normally distributed with weak correlation with 15 D dimensions. The Finnish translations of the FACE-Q Rhinoplasty scales perform well at assessing a diverse group of patients including those undergoing nasal reconstruction as well as those undergoing rhinoplasty.
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Affiliation(s)
- S Pauliina Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Andrew J Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Patrik A Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Outcome Assessment for Surgical Reconstruction of Mandibular Continuity Defects. J Craniofac Surg 2021; 32:e635-e638. [PMID: 33674508 DOI: 10.1097/scs.0000000000007606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Mandibular continuity defects are associated with multiple functional and esthetic problems. Nonvascularized bone grafting is one of several surgical corrective techniques for such defects with good success predictability. This retrospective clinical study reviewed the outcome of this technique when applied in its 2 protocol variations while minimizing the effect of as many confounding factors as possible through the application of strict eligibility criteria. The surgical records of 16 patients constituted the final sample: 10 patients in the one-stage and 6 patients in the two-stage reconstruction groups. It was found that mandibular reconstruction with nonvascularized bone graft is a good first option as well as a viable alternative in the absence of free flap procedure facilities. Patients' initial expectations should be a crucial factor in deciding the appropriate surgical treatment protocol form the early planning stage. Standardizing success parameters in such cases could further improve objectivity and allow for multi-center research data pooling with reduced effect of heterogeneity featuring these complex injuries.
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Homsy SP, Uimonen MM, Lindford AJ, Repo JP, Lassus PA. Finnish translation and validation of the FACE-Q Eye module. Scand J Surg 2020; 110:504-511. [PMID: 33372569 DOI: 10.1177/1457496920982767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to first produce and cross-culturally validate a Finnish version of the FACE-Q Eye module, a patient-reported outcome measure designed for patients undergoing eyelid surgery for esthetic reasons, and second assess the suitability of this instrument for use in a university hospital setting. MATERIAL AND METHODS The FACE-Q Eye module and the general FACE-Q components Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress, and Satisfaction with Outcome were translated according to established guidelines. A postal survey study was conducted with the translated instrument and the generic health-related quality of life instrument 15D on 245 patients operated in the Helsinki University Hospital between 2009 and 2019. Cronbach's alpha, floor and ceiling effects, measurement reliability with repeat administration, and convergence with 15D dimensions were analyzed. RESULTS The FACE-Q Eye module and general components translated readily into Finnish. Eighty-one patients (33%) responded to the survey, most of whom (78%) had undergone blepharoplasty. Most subscales demonstrated acceptable internal consistency with Cronbach's alphas 0.79-0.96. A ceiling effect was observed for four of the seven subscales evaluated. Intra-class correlation coefficients were high (0.82-0.91) indicating good reliability. Results of the FACE-Q subscales correlated at best moderately with the 15D dimensions. CONCLUSION The Finnish versions of the FACE-Q Eye module and the FACE-Q components Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress, and Satisfaction with Outcome perform well when assessing outcomes relevant to patients after eyelid surgery. However, when used in patients operated on for mainly functional reasons, subtle variations may be missed.
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Affiliation(s)
- S P Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - A J Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J P Repo
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - P A Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Zeiderman MR, Pu LLQ. Contemporary reconstruction after complex facial trauma. BURNS & TRAUMA 2020; 8:tkaa003. [PMID: 32341916 PMCID: PMC7175762 DOI: 10.1093/burnst/tkaa003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/07/2020] [Indexed: 11/12/2022]
Abstract
Complex facial trauma requires complex repair and solutions. This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result. Historically, the use of pedicled flaps, and then free tissue transfer, were the primary techniques utilized. Advancements in soft-tissue reconstruction, such as perforator flaps and pre-expanded and prefabricated flaps, allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage. The advent of contemporary technologies, such as virtual surgical planning, stereolithography and customized implants and plates, facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction. When surgical and technological techniques are combined in complementary multistage reconstructions, better reconstructive and aesthetic outcomes are achievable than ever before. In this review, the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience. Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed. A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result. We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.
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Affiliation(s)
- Matthew R Zeiderman
- Division of Plastic Surgery, Department of Surgery, University of California, Davis, 2335 Stockton Boulevard, Room 6008 Sacramento, CA 95817, USA
| | - Lee L Q Pu
- Division of Plastic Surgery, Department of Surgery, University of California, Davis, 2335 Stockton Boulevard, Room 6008 Sacramento, CA 95817, USA
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