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Jeong T, Liu H, Alessandri Bonetti M, Pandya S, Nguyen VT, Egro FM. Responses to comments on "Revolutionizing patient education: ChatGPT outperforms Google in answering patient queries on free flap reconstruction". Microsurgery 2024; 44:e31173. [PMID: 38553862 DOI: 10.1002/micr.31173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Tiffany Jeong
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hilary Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sumaarg Pandya
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vu T Nguyen
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Ioppolo L, Borelli F, Alessandri Bonetti M, Amenta A, Galati M, Veronesi P, De Lorenzi F. Rib Reduction Technique in Patients with Isolated Chondrocostal Chest Wall Prominence Undergoing Breast Augmentation. Aesthetic Plast Surg 2024:10.1007/s00266-024-04006-0. [PMID: 38565725 DOI: 10.1007/s00266-024-04006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION When planning for breast augmentation, it is important to consider not only implant choice, surgical technique and patient desires, but also the chest wall shape and deformities or irregularities, which remain often underestimated. They can be responsible for implant malposition and breast asymmetry after augmentation. Chondrocostal junction prominence is a minor but frequent chest wall deformity. The aim of this study is to report a new technique for sculpturing isolated chondrocostal prominence deformities in patients undergoing breast augmentation. METHODS A retrospective study was conducted to review surgical outcomes of a novel technique for costal prominence sculpturing and reshaping in patients undergoing breast augmentation. After reaching the subpectoral space, an inferiorly-based perichondral-periosteal flap is harvested just above the prominence. Once the deformity is corrected, the perichondral flap is repositioned over the sculpted rib. RESULTS A total of six patients presenting with isolated chondrocostal prominence underwent bilateral breast implant placement and costal reduction using the described technique. Three patients were primary augmentations while the remaining patients were two secondary breast augmentation and one augmentation mastopexy. No complications were reported. No additional pain was referred at the side of rib remodelling in comparison with the contralateral breast. All the patients were satisfied with cosmetic results. CONCLUSIONS The described technique for contouring of isolated chondrocostal deformities is fast, easy reproducible and offers advantages over the standard partial rib reduction technique. It can prevent implant malposition and projection asymmetry, eventually enhancing breast augmentation outcomes. LEVEL OF EVIDENCE V 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)
- Leonardo Ioppolo
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic and Reconstructive Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Antonio Amenta
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | | | - Paolo Veronesi
- Department of Breast Surgery, European Institute of Oncology, IRCCS, University of Milan, Via Ripamonti 435, 20141, Milan, Italy
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
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Liu HY, Alessandri Bonetti M, Egro FM. Comment on: Exploring the Potential of ChatGPT-4 in Responding to Common Questions About Abdominoplasty: An AI-Based Case Study of a Plastic Surgery Consultation. Aesthetic Plast Surg 2024; 48:1584-1588. [PMID: 38102418 DOI: 10.1007/s00266-023-03772-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15213, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15213, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15213, USA.
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Alessandri Bonetti M, Giorgino R, Gallo Afflitto G, De Lorenzi F, Egro FM. How Does ChatGPT Perform on the Italian Residency Admission National Exam Compared to 15,869 Medical Graduates? Ann Biomed Eng 2024; 52:745-749. [PMID: 37490183 DOI: 10.1007/s10439-023-03318-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The study aims to assess ChatGPT performance on the Residency Admission National Exam to evaluate ChatGPT's level of medical knowledge compared to graduate medical doctors in Italy. METHODS ChatGPT3 was used in June 2023 to undertake the 2022 Italian Residency Admission National Exam-a 140 multiple choice questions computer-based exam taken by all Italian medical graduates yearly, used to assess basic science and applied medical knowledge. The exam was scored using the same criteria defined by the national educational governing body. The performance of ChatGPT was compared to the performance of the 15,869 medical graduates who took the exam in July 2022. Lastly, the integrity and quality of ChatGPT's responses were evaluated. RESULTS ChatGPT answered correctly 122 out of 140 questions. The score ranked in the top 98.8th percentile among 15,869 medical graduates. Among the 18 incorrect answers, 10 were evaluating direct questions on basic science medical knowledge, while 8 were evaluating candidates' applied clinical knowledge and reasoning under the form of case presentation. Errors were logical (2 incorrect answers) and informational in nature (16 incorrect answers). Explanations to the correct answers were all evaluated as "appropriate." Comparison to national statistics related to the minimal score needed to match into each specialty, demonstrated that the performance of ChatGPT would have granted the candidate a match into any specialty. CONCLUSION ChatGPT proved to be proficient in basic science medical knowledge and applied clinical knowledge. Future research should assess the impact and reliability of ChatGPT in clinical practice.
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Affiliation(s)
- Mario Alessandri Bonetti
- Residency Program in Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Gabriele Gallo Afflitto
- Residency Program in Ophthalmology, Università di Roma "Tor Vergata", Via Cracovia 50, 00133, Rome, Italy
| | - Francesca De Lorenzi
- Department of Plastic Surgery, European Institute of Oncology, Via Giuseppe Ripamonti 345, 20122, Milan, Italy
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street 6B Scaife Hall, Pittsburgh, PA, 15261, USA.
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Bonetti MA, Arellano JA, Scarabosio A, Liu HY, Giorgino R, Ejaz A, Rubin JP, Egro FM. Correction: The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:1508. [PMID: 38409348 DOI: 10.1007/s00266-024-03916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Jose Antonio Arellano
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Anna Scarabosio
- Department of Plastic Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy
| | - Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20141, Milan, Italy
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA.
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Pandya S, Alessandri Bonetti M, Liu HY, Jeong T, Egro FM. Comment on: Comparison of Patient Education Materials Generated by Chat Generative Pretrained Transformer Versus Experts: An Innovative Way to Increase Readability of Patient Education Materials. Ann Plast Surg 2024; 92:485-486. [PMID: 38527357 DOI: 10.1097/sap.0000000000003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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Carbonaro R, Menean M, Cottone G, Alessandri Bonetti M, Vaienti L, Miserocchi E, Bandello F. Endogenous Endophthalmitis Secondary to Infected Cutaneous Basal Cell Carcinoma: A Case Report. Ocul Immunol Inflamm 2024; 32:355-357. [PMID: 36696367 DOI: 10.1080/09273948.2023.2165951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Endogenous endophthalmitis (EE) is a severe intraocular infection due to hematogenous spread of bacteria from an extraocular site. Recognition of the primary source of hematogenous spread of bacteria is essential to establish an adequate therapy and avoid other major complications. Infected cutaneous tumor has never been reported as a possible source of EE. PURPOSE To describe the first case of EE due to hematogenous spread of methicillin-sensitive Staphylococcus aureus from an infected cutaneous basal cell carcinoma. Systemic antibiotic therapy and surgical excision of the cutaneous lesion were performed. CONCLUSION Severe and long-standing skin infections should be considered as a rare cause of EE.
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Affiliation(s)
- Riccardo Carbonaro
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Matteo Menean
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cottone
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Mario Alessandri Bonetti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Luca Vaienti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Zhang C, Pandya S, Alessandri Bonetti M, Costantino A, Egro FM. Comparison of split thickness skin graft versus full thickness skin graft for radial forearm flap donor site closure: A systematic review and Meta-analysis. Am J Otolaryngol 2024; 45:104156. [PMID: 38142610 DOI: 10.1016/j.amjoto.2023.104156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The radial forearm flap (RFF) is one of the most commonly used flaps in reconstructive surgery. Split-thickness skin grafting (STSG) has traditionally been used for closure of the forearm. However, full-thickness skin grafting (FTSG) has gained in popularity to achieve more satisfactory results. The aim of the study is to identify the best RFF donor site closure technique by comparing the functional and aesthetic outcomes of STSG and FTSG. METHODS PubMed and EMBASE databases were queried. Only studies comparing complications rate, functional and aesthetic outcomes between STSG and FTSG were included. The primary outcome was graft failure rate. Secondary outcomes included the aesthetic result and functionality of the forearm/wrist. RESULTS A total of 13 studies were included in this review, accounting for a total of 712 patients with mean age of 60.7 years. Overall, 348 patients underwent FTSG and 377 underwent STSG. The mean follow-up was 14.7 months. The rate of graft failure in FTSG was significantly higher compared to STSG (OR: 2.79, 95 % CI 1.38-5.65, p = 0.004). There was no significant difference in rate of tendon exposure (OR: 0.83, p = 0.65) and infection (OR: 1.37, p = 0.42). Regarding the aesthetic outcome, no significant difference between FTSG and STSG based on observer (SMD = -0.37, p = 0.17) and patient (SMD = -0.016, p = 0.93) assessment, respectively. Overall postoperative functional assessment showed a not severely impaired hand and arm function in both groups. Subjective evaluation of pain was similar between groups. CONCLUSION FTSG is associated with higher risk of graft failure than STSG in RFF donor site closure, without significant improvement in aesthetic results.
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Affiliation(s)
- Casey Zhang
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | - Sumaarg Pandya
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
| | | | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Francesco M Egro
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA.
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Alessandri Bonetti M, Arellano JA, Scarabosio A, Liu HY, Giorgino R, Ejaz A, Rubin JP, Egro FM. The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:989-998. [PMID: 38286897 DOI: 10.1007/s00266-023-03828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation. METHODS A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool. RESULTS A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations. CONCLUSIONS Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required. LEVEL OF EVIDENCE IV 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)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Jose Antonio Arellano
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Anna Scarabosio
- Department of Plastic Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy
| | - Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20141, Milan, Italy
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA.
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Guyuron B, Alessandri Bonetti M, Caretto AA. Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches. JPRAS Open 2024; 39:212-216. [PMID: 38288373 PMCID: PMC10823029 DOI: 10.1016/j.jpra.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/31/2024] Open
Abstract
The differential diagnoses and nuances of the surgical management of occipital migraine and occipital neuralgia have not been clearly discussed in the available literature. This study aims to highlight additional diagnostic features and offers an algorithm for the surgical treatment of occipital migraine and occipital neuralgia based on the vast experience of the senior author spanning over 23 years. A retrospective cohort study was conducted to review the number and distribution of patients who underwent surgical treatment for occipital migraine headaches and neuralgia and the signs and symptoms observed. Among the 660 patients who underwent surgical treatment for headaches within the territory of the greater occipital nerves, 86 patients underwent isolated deactivation of the greater occipital site (site IV) or combined greater and lesser occipital sites (site IV and site VI surgical). Within the isolated occipital headache group, 43 patients met the criteria for migraine headaches and 43 for occipital neuralgia. Our additional observation on the differences between the occipital neuralgia and migraine groups included that occipital neuralgia is more commonly unilateral, less commonly familial, and more commonly associated with a whiplash-type injury. In addition, the patient with occipital neuralgia can consistently identify the distinct point of pain using the index finger. An ultrasound Doppler signal can also be detected at the pain site and a pulse is often palpable in the site identified by the patient. Occipital neuralgia is also commonly continuous and unrelenting, with occasional spikes of shooting pain, and is less likely to respond to botulinum toxin-A injection. Patients with occipital neuralgia often have a single-site headache while patients with migraine headaches often suffer from headaches in multiple sites. Additional clinical criteria are offered for the differential diagnosis of occipital migraine headaches and occipital neuralgia based on the vast experience of the senior author and the developed surgical management algorithm.
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Affiliation(s)
- Bahman Guyuron
- Zeeba Clinic, 29017 Cedar Road Lyndhurst, Cleveland, OH, 44124, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Anna Amelia Caretto
- Department of Plastic Surgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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Pandya S, Liu HY, Alessandri Bonetti M, Jeong T, Egro F. Plastic Surgery in Burn Care: A Call for Enhanced Burn Surgery Training Within Plastic Surgery Residency Programs. Ann Plast Surg 2024; 92:285-286. [PMID: 38394269 DOI: 10.1097/sap.0000000000003845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
ABSTRACT A 10 year cohort of patients admitted to a verified burn unit were analyzed to assess the role of plastic surgeons in the operative management of those patients. All 3843patients were admitted during this study period. Of these, 1509 of those patients underwent surgical procedures. Plastic surgeons performed 658 operations on these patients, including acute and delayed reconstruction of hand and facial burn injuries. In this population, plastic surgeons played a critical role in acute and reconstructive burn injuries in anatomically complex areas. This series illustrates the need for plastic surgery training in burn care.
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Affiliation(s)
- Sumaarg Pandya
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Hilary Y Liu
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | | | - Tiffany Jeong
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh
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Alessandri Bonetti M, Egro FM. Comment on: "Efficacy and Safety of Transplantation of Autologous Fat, Platelet-Rich Plasma (PRP) and Stromal Vascular Fraction (SVF) in the Treatment of Acne Scar: Systematic Review and Meta-analysis". Aesthetic Plast Surg 2024; 48:1054-1055. [PMID: 37118335 DOI: 10.1007/s00266-023-03350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15213, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15213, USA.
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Ioppolo L, Alessandri Bonetti M, De Lorenzi F. Reply to: A Two-Step Approach for Breast Augmentation with Chest Wall Deformity? Aesthetic Plast Surg 2024:10.1007/s00266-024-03925-2. [PMID: 38424307 DOI: 10.1007/s00266-024-03925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Patients asking for cosmetic breast surgery often appreciate that their breasts have an unpleasing appearance, but they often do not have a full appreciation of the degree of potential anatomic abnormalities of the chest wall and of the specific anatomical characteristics, which require a meticulous surgical planning and techniques in comparison with a standard breast cosmetic surgery. Failure to recognize this will predispose the patient to an unsatisfactory outcome and secondary deformities. To maximize surgical predictability and patients' satisfaction, the authors proposed a two-stage approach in the scenario of patients presenting with chest wall deformities and asking for breast augmentation. However, as we contemplate adopting the authors' approach to our case, we anticipate encountering two primary challenges. Firstly, utilizing custom-made 3D silicone implants might exacerbate the projection of the chondrocostal prominence present in our patient. Indeed, we believe that these implants are more beneficial for addressing concave defects (such as pectus excavatum) rather than convex prominences, as observed in our case.Level of Evidence V 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)
- Leonardo Ioppolo
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Francesca De Lorenzi
- Department of Plastic Surgery, European Institute of Oncology - IRCCS, Via Ripamonti 435, 20141, Milan, Italy
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Ioppolo L, Alessandri Bonetti M, De Lorenzi F. Reply to Comment to: Tuberous Breast Associated with Chest Wall Deformity: A Challenging Planning for Breast Augmentation. Aesthetic Plast Surg 2024:10.1007/s00266-024-03926-1. [PMID: 38413443 DOI: 10.1007/s00266-024-03926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
Even in cases of noticeable breasts asymmetry, such as in our case, it is advisable to use implants with the same volume and projection, in order to maintain a similar breast footprint and allow a similar aging behavior over time. This can be achieved by reducing the size of the larger breast, thereby addressing the volume discrepancy before the placement of the implants. However, in our case, the skeletal deformities resulted in a significant disparity in the projection of the right and left sides of the chest wall, hindering the use of breast implants with identical projection. Therefore, due to this asymmetrical chest wall deformity, the left prosthesis was placed behind the central and lateral glandular parenchyma, avoiding hyper-projection in the medial part of the breast.Level of Evidence V 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)
- Leonardo Ioppolo
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Francesca De Lorenzi
- Department of Plastic Surgery, European Institute of Oncology - IRCCS, Via Ripamonti 435, 20141, Milan, Italy
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Liu HY, Alessandri Bonetti M, De Lorenzi F, Gimbel ML, Nguyen VT, Egro FM. Consulting the Digital Doctor: Google Versus ChatGPT as Sources of Information on Breast Implant-Associated Anaplastic Large Cell Lymphoma and Breast Implant Illness. Aesthetic Plast Surg 2024; 48:590-607. [PMID: 37903939 DOI: 10.1007/s00266-023-03713-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/10/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare complication associated with the use of breast implants. Breast implant illness (BII) is another potentially concerning issue related to breast implants. This study aims to assess the quality of ChatGPT as a potential source of patient education by comparing the answers to frequently asked questions on BIA-ALCL and BII provided by ChatGPT and Google. METHODS The Google and ChatGPT answers to the 10 most frequently asked questions on the search terms "breast implant associated anaplastic large cell lymphoma" and "breast implant illness" were recorded. Five blinded breast plastic surgeons were then asked to grade the quality of the answers according to the Global Quality Score (GQS). A Wilcoxon paired t-test was performed to evaluate the difference in GQS ratings for Google and ChatGPT answers. The sources provided by Google and ChatGPT were also categorized and assessed. RESULTS In a comparison of answers provided by Google and ChatGPT on BIA-ALCL and BII, ChatGPT significantly outperformed Google. For BIA-ALCL, Google's average score was 2.72 ± 1.44, whereas ChatGPT scored an average of 4.18 ± 1.04 (p < 0.01). For BII, Google's average score was 2.66 ± 1.24, while ChatGPT scored an average of 4.28 ± 0.97 (p < 0.01). The superiority of ChatGPT's responses was attributed to their comprehensive nature and recognition of existing knowledge gaps. However, some of ChatGPT's answers had inaccessible sources. CONCLUSION ChatGPT outperforms Google in providing high-quality answers to commonly asked questions on BIA-ALCL and BII, highlighting the potential of AI technologies in patient education. LEVEL OF EVIDENCE Level III, comparative study LEVEL OF EVIDENCE III: 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)
- Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Francesca De Lorenzi
- Department of Plastic Surgery, IRCCS European Institute of Oncology, Via Giuseppe Ripamonti 345, 20122, Milan, Italy
| | - Michael L Gimbel
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Vu T Nguyen
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA, 15219, USA.
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Liu HY, Alessandri Bonetti M, Egro FM. Invited Commentary: "Consulting the Digital Doctor: Google Versus ChatGPT as Sources of Information on Breast Implant-Associated Anaplastic Large Cell Lymphoma and Breast Implant Illness". Aesthetic Plast Surg 2024; 48:610-611. [PMID: 38168823 DOI: 10.1007/s00266-023-03816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15219, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15219, USA.
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Ioppolo L, Alessandri Bonetti M, De Lorenzi F. Tuberous Breasts Associated with Chest Wall Deformity: A Challenging Planning for Breast Augmentation. Aesthetic Plast Surg 2024; 48:282-284. [PMID: 38157013 DOI: 10.1007/s00266-023-03784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
Tuberous breast deformity is characterized by a deficiency in the vertical and horizontal dimensions of the breast, as well as breast underdevelopment and asymmetry. Concomitant chest wall deformities are not uncommon and increase the difficulty when planning breast augmentation in such patients. We present a unique case of tuberous breasts and chest wall deformity successfully treated employing a novel technique that incorporated breast implants and fat grafting. A 24-year-old patient with no significant past medical history presented to the plastic surgery clinic seeking correction of a severe breast asymmetry and desiring increase in breast volume. The right breast was Grolleau type 1 cup A, while the left breast was Grolleau type 3 cup C. The left hemithorax presented an accentuated prominence of the costochondral junction of 4th left rib, along with minor prominence of the 3rd and 5th left ribs. In addition, the 5th and 6th ribs were fused together. The surgical plan involved bilateral augmentation with implant and fat grafting. A 285 cc Motiva implant was placed subfascial on the right. Multiple refinements were necessary to the left breast, including areolar reduction, inframammary fold adjustment, and medial glandular modifications. A 140 cc Motiva implant was placed subfascial. Fat grafting was used in both breasts to enhance contour, projection and conceal the chest wall deformity. Postoperative recovery was uneventful, and results at 3-month follow-up showed improved breast symmetry and aesthetics.Level of Evidence V 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)
- Leonardo Ioppolo
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Francesca De Lorenzi
- Department of Plastic Surgery, European Institute of Oncology - IRCCS, Via Ripamonti 435, 20141, Milan, Italy
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Liu HY, Alessandri Bonetti M, Egro FM. Invited Commentary: "Dr. GAI-Significance of Generative AI in Plastic Surgery". Aesthetic Plast Surg 2024:10.1007/s00266-024-03849-x. [PMID: 38273151 DOI: 10.1007/s00266-024-03849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15219, USA
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust St, Suite G103, Pittsburgh, PA, 15219, USA.
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Alessandri Bonetti M, Jeong T, Stofman GM, Egro FM. A 10-Year Single-Burn Center Review of Free Tissue Transfer for Burn-Related Injuries. J Burn Care Res 2024; 45:130-135. [PMID: 37703393 DOI: 10.1093/jbcr/irad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 09/15/2023]
Abstract
Skin grafting is the mainstay treatment in burn patients. However, in the scenario of soft tissue deficit along with exposure of critical structures, free flap is the only reconstructive option to provide adequate coverage. The aim of the study is to review indications and surgical outcomes of burn patients requiring free tissue transfer. A retrospective cohort study was conducted to review all patients who underwent free tissue transfer for burn-related injuries between March 2012 and June 2023. A total of 13 patients required a free flap for their reconstruction. Eleven flaps were performed during the acute care and 2 were performed for delayed reconstruction. Patients were 69% males and 31% females, with a mean age of 45.5 ± 16 years and a mean BMI of 25.4 ± 6.5. The mean follow-up was 13.5 ± 13.9 months. Indications for free tissue transfer were bone exposure (92%) and severe neck burn contracture (8%). Overall complications rate was 54%. Complications included free flap loss (15%), hematoma (15%), vein thrombosis of the anastomosis (15%), infection (8%), amputation (8%), and wound healing issues (23%). Overall, 38% of the patients required re-operations including venous anastomosis revision, hematoma evacuation, debridement, skin grafting, and debulking. Although sometimes free flap remains the only reconstructive option in severe burn-related injuries, it is only rarely used. However, they carry a high risk of complications and should be considered only as the last resort for limb or life-threatening situations.
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Department of Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Tiffany Jeong
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Guy M Stofman
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Liu HY, Alessandri Bonetti M, Jeong T, Pandya S, Nguyen VT, Egro FM. Dr. ChatGPT will see you now: How do Google and ChatGPT compare in answering patient questions on breast reconstruction? J Plast Reconstr Aesthet Surg 2023; 85:488-497. [PMID: 37598590 DOI: 10.1016/j.bjps.2023.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA 15213, United States
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA 15213, United States
| | - Tiffany Jeong
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA 15213, United States
| | - Sumaarg Pandya
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA 15213, United States
| | - Vu T Nguyen
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA 15213, United States
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, G103, Pittsburgh, PA 15213, United States.
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De Lorenzi F, Alessandri Bonetti M, Borelli F. Reply to comment on 'postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome'. Eur J Cancer Prev 2023; 32:410-414. [PMID: 37302019 DOI: 10.1097/cej.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS
| | | | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS
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Ceccarelli F, Afflitto GG, Bonetti MA, Cesareo M, Aiello F, Nucci C. lax eyelid condition and floppy eyelid syndrome prevalence in obstructive sleep apnoea syndrome patients: A systematic review and meta‐analysis. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.0750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
| | - Gabriele Gallo Afflitto
- Experimental medicine University of Rome "Tor Vergata" Rome Italy
- University of Miami Miller School of Medicine Bascom Palmer Eye Institute Miami Florida USA
| | | | - Massimo Cesareo
- Experimental medicine University of Rome "Tor Vergata" Rome Italy
| | - Francesco Aiello
- Experimental medicine University of Rome "Tor Vergata" Rome Italy
| | - Carlo Nucci
- Experimental medicine University of Rome "Tor Vergata" Rome Italy
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Aiello F, Gallo Afflitto G, Alessandri Bonetti M, Ceccarelli F, Cesareo M, Nucci C. Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) prevalence in obstructive sleep apnea syndrome (OSA) patients: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2022; 261:1505-1514. [DOI: 10.1007/s00417-022-05890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Purpose
Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) represent two distinct conditions which have been associated with several ocular and systemic comorbidities. The main aim of this systematic review and meta-analysis is to explore the available literature to estimate the prevalence rate of LEC and FES in obstructive sleep apnea (OSA).
Methods
The protocol of this systematic review and meta-analysis has been registered in PROSPERO. Four electronic databases (PubMed/MEDLINE, Google Scholar, Cochrane Library, Web of Science) were searched from inception to December 24, 2021. A random intercept logistic regression model was carried out for the analysis of overall proportions. Odds ratio and mean difference were reported as measures of the effect size in the presence of binary and continuous outcomes, respectively. The estimated numbers of LEC/FES patients in OSA were calculated by multiplying the prevalence rate determined by our random-effects model and the corresponding Benjafield et al.’s population prospect.
Results
We included 11 studies comprising 1225 OSA patients of whom 431 and 153 affected by LEC and FES, respectively. Our model estimated a pooled prevalence rate for LEC and FES in OSA patients of 40.2% (95%CI: 28.6–53.1%) and of 22.4% (95%CI: 13.8–34.2%), respectively. The number of LEC/FES affected individuals among OSA patients is expected to peak up to 376 and to 210 million, respectively. OSA patients appeared to have a 3.4 (95%CI: 2.2–5.2) and a 3.0 (95%CI: 1.7–5.5) increased risk of developing LEC and FES than the healthy counterpart.
Conclusion
Prevalence of LEC and FES is higher in OSA-affected patients compared to controls. More studies are warranted to investigate the mechanisms leading to the development of LEC and/or FES in OSA patients, as well as the feasibility of the adoption of these clinical findings as screening tools for OSA.
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Santanelli Di Pompeo F, Barone M, Salzillo R, Cogliandro A, Brunetti B, Ciarrocchi S, Alessandri Bonetti M, Tenna S, Sorotos M, Persichetti P. Predictive Factors of Satisfaction Following Breast Reconstruction: Do they Influence Patients? Aesthetic Plast Surg 2022; 46:610-618. [PMID: 34559281 DOI: 10.1007/s00266-021-02584-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/06/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION This study aims to analyze whether there is any patient- or treatment-related factor that can influence patients' body perception after mastectomy and autologous or implant-based breast reconstruction. MATERIALS AND METHODS This retrospective cohort study included patients who underwent immediate implant-based or DIEP flap breast reconstruction. Predictive factors analyzed included chemotherapy, radiotherapy, hormone therapy, body mass index, age, type of mastectomy, and follow-up length. The BREAST-Q was administered postoperatively almost 2 years from the last surgical procedure. Mean BREAST-Q scores were reported for the overall cohort and by modality for the postoperative period. A linear regression model was applied to all BREAST-Q scores with all predictor factors. RESULTS In total, 325 patients were enrolled in this study (133 DIEP flap and 192 implant-based reconstructions). The DIEP flap reconstruction group with a previous nipple sparing mastectomy showed the highest scores. Patients with a longer follow-up were less satisfied than the ones with a shorter follow-up, which could be considered as an assessment of the outcome. No significant difference was reported between patients who underwent radiotherapy, chemotherapy or hormone therapy and those who did not. Furthermore, age and BMI had no influence on patient satisfaction. CONCLUSION This study is the first that groups a large number of patients and analyzes predictive factors of long-term satisfaction of patients undergoing breast reconstruction. This can be regarded as a pilot study to raise the awareness of everyone's clinical practice to predict the attitude that patients have after surgery and to prepare them in the best possible way. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Fabio Santanelli Di Pompeo
- Chair of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Mauro Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy.
- Research group ``To be and to appear: Objective indication to Plastic Surgery'' of Campus Bio-Medico University in Rome, Rome, Italy.
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Rosa Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Annalisa Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
- Research group ``To be and to appear: Objective indication to Plastic Surgery'' of Campus Bio-Medico University in Rome, Rome, Italy
| | - Beniamino Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Silvia Ciarrocchi
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, I.R.C.C.S. Istituto Galezzi, University of Milan, Milan, Italy
| | - Stefania Tenna
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
- Research group ``To be and to appear: Objective indication to Plastic Surgery'' of Campus Bio-Medico University in Rome, Rome, Italy
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Persichetti P, Barone M, Salzillo R, Cogliandro A, Brunetti B, Ciarrocchi S, Alessandri Bonetti M, Tenna S, Sorotos M, Santanelli Di Pompeo F. Impact on Patient's Appearance Perception of Autologous and Implant Based Breast Reconstruction Following Mastectomy Using BREAST-Q. Aesthetic Plast Surg 2022; 46:1153-1163. [PMID: 35229192 PMCID: PMC9411234 DOI: 10.1007/s00266-022-02776-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023]
Abstract
Introduction The purpose of this study is to determine if there is a better quality of life with one of the two techniques and if the results are in line with those already present in the literature. The hypothesis from which we started is to demonstrate that cancer patients who undergo a deep inferior epigastric perforator flap (DIEP) breast reconstruction surgery are more satisfied and have a higher level of quality of life compared to those subjected to an intervention of reconstruction with prosthesis. Materials and Methods All patients undergoing reconstruction from January 2010 to July 2018 were eligible for inclusion. This is a retrospective cohort study carried out using the patients of two plastic surgery departments who have undergone monolateral or bilateral implant-based or DIEP flap breast reconstruction. We administered BREAST-Q questionnaire electronically almost 2 year after surgery. Patients were divided into two groups: implant-based and autologous breast reconstruction with DIEP flaps. Baseline demographics and patient characteristics were analyzed using a Students t-test (continuous variables) or Chi-square/Fisher’s exact test (categorical variables). Mean standard deviation BREAST-Q scores were reported for the overall cohort and by modality for the postoperative period. The linear regression model was applied to all BREAST-Q score with all predictor factors. Results Of the 1125 patients involved, only 325 met the inclusion criteria and were enrolled in this study; specifically, 133 (41%) DIEP and 192 (59%) prosthetic reconstructions. We summarized the results of the principal scales of BREAST-Q module: satisfaction with breast, psychosocial well-being, satisfaction with outcome, and sexual well-being in which the autologous group was always more satisfied. We reported results of all linear regression models with higher values for the DIEP group independently from predictors. Conclusion This is the first study performed on the Italian population that compares autologous surgical techniques with the implantation of breast implants. In this population, DIEP is considered the technique that leads to the highest satisfaction in all BREAST-Q scores. Level of Evidence IV 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)
- Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy
| | - Mauro Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rosa Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Annalisa Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Beniamino Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Silvia Ciarrocchi
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Milan, Italy
| | - Stefania Tenna
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
- Plastic and Reconstructive Surgery Unit, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Fabio Santanelli Di Pompeo
- Faculty of Medicine and Psychology, U.O.D. Chirurgia Plastica, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
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Brunetti B, Salzillo R, Tenna S, Brunetti B, Bonetti MA, Rivieccio A, Persichetti P. Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes. J Reconstr Microsurg 2021; 38:555-562. [PMID: 34921368 DOI: 10.1055/s-0041-1740925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. METHODS The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. RESULTS One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). CONCLUSION This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.
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Affiliation(s)
- Beniamino Brunetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Mario Alessandri Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Milan, Italy
| | - Antonia Rivieccio
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Fulchignoni C, Bonetti MA, Rovere G, Ziranu A, Maccauro G, Pataia E. Wide awake surgery for flexor tendon primary repair: A literature review. Orthop Rev (Pavia) 2020; 12:8668. [PMID: 32913601 PMCID: PMC7459365 DOI: 10.4081/or.2020.8668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022] Open
Abstract
Flexor tendon injuries are extremely challenging conditions to manage for hand surgeons. Over the last few years enormous progress has been made for the treatment of these lesions with new surgical approaches being performed. One of these is the wideawake local anesthesia no tourniquet (WALANT) technique, also known as Wide Awake Technique that allows tendon repair under local anesthesia, enabling the tendon to move actively during surgery. Dynamic movement of the tendon during surgery is crucial for the orthopedic surgeon in order to understand if the tendon has been correctly repaired before leaving the operatory table. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using ((Flexor tendon injury) OR (flexor tendon) OR (injury muscle tendon) OR (flexor pollicis longus tendon) AND ((wide awake repair) OR (wide awake) OR (wide awake hand surgery))as search terms. Authors believe that WALANT is an enormous add-on in the management of patients with flexor tendon injuries mainly because it allows direct visualization of the repair during flexion and extension movement of the fingers and also because it avoids general anesthesia or brachial plexus being more cost effective. The aim of these review was therefore to sum up the evidences available so far on the wade awake technique as an emerging treatment for patients with flexor tendon injuries.
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Affiliation(s)
- Camillo Fulchignoni
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Mario Alessandri Bonetti
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisabetta Pataia
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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Bonetti MA, Rovere G, Fulchignoni C, De Santis V, Ziranu A, Maccauro G, Pataia E. Autologous fat transplantation for the treatment of trapeziometacarpal joint osteoarthritis. Orthop Rev (Pavia) 2020; 12:8666. [PMID: 32913600 PMCID: PMC7459373 DOI: 10.4081/or.2020.8666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Rhizarthrosis is a progressive and disabling pathology affecting the carpometacarpal joint. It’s very common in elderly patients and typically affects postmenopausal women. The diagnosis of rhizarthrosis is mainly made by using different physical examination tests and by evaluating the type of pain and it’s then confirmed by imaging. Over the last few years increasing attention has been devoted to the assessment of new treatment techniques for rhizarthrosis. In this context intra-articular injection of autologous fat grafting for cartilage regeneration has demonstrated promising results in experimental settings as an alternative to open surgery procedures. The aim of this study was therefore to sum up the evidences available so far on autologous fat grafting as an emerging treatment for patients affected by carpometacarpal rizarthrosis. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using “fat grafting”, “fat graft”, “adipose”, “fat transfer” and “lipoaspirate” as search terms. Authors believe autologous fat grafting is an interesting technique, that hand surgeon should keep in mind especially in early stages of rhizarthrosis were pain has not been solved with non-surgical treatment.
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Camillo Fulchignoni
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Vincenzo De Santis
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisabetta Pataia
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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Barone M, Cogliandro A, Salzillo R, Colapietra A, Alessandri Bonetti M, Morelli Coppola M, List E, Ciarrocchi S, Tenna S, Persichetti P. Role of Spreader Flaps in Rhinoplasty: Analysis of Patients Undergoing Correction for Severe Septal Deviation with Long-Term Follow-Up. Aesthetic Plast Surg 2019; 43:1006-1013. [PMID: 30868305 DOI: 10.1007/s00266-019-01343-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/10/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The aim of this randomized controlled study was to analyze the long-term results of patients undergoing rhinoplasty because of severe septal deviation and to evaluate the stability of results. MATERIALS AND METHODS The study was performed with a randomized design. Patients were randomly divided into four groups: group 1, spreader flaps were used in combination with spreader grafts; group 2, spreader flaps were used alone; group 3, spreader grafts were used alone; and group 4, neither spreader flaps nor grafts flaps were used. Patients answered the Italian version of the FACE-Q rhinoplasty module. Anthropometric measurements were performed by AutoCAD for MAC. We determined the angle of deviation, and we compared the pre- and postoperative angles and compared patient satisfaction in the four groups using the Chi-squared test for unpaired data. Two plastic surgeons reviewed all the postoperative photographs of the study patients and rated the photographs on a scale of 1 to 5. RESULTS A total of 264 patients who underwent primary rhinoplasty between January 2010 and September 2016 satisfied the inclusion criteria and were finally enrolled in this study. Anthropometric measurements revealed statistically significant differences (P < 0.01) between the preoperative and postoperative values for the angle of septal deviation in group 1 versus the other groups. Over the long-term follow-up, group 1 maintained an angle close to 180 degrees (P < 0.01). Group 1 and group 3 were more satisfied compared with groups 2 and 4 (P < 0.01). According to evaluations by the 2 reviewers, group 1 and group 3 were the most satisfactory outcomes (P < 0.01). CONCLUSIONS This was the first randomized study to show that the combined use of the spreader flap and spreader graft is the best choice for a good long-term outcome and durable correction of septal deviation. LEVEL OF EVIDENCE IV 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)
- Mauro Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy.
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy.
| | - Annalisa Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
| | - Rosa Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Alfredo Colapietra
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Mario Alessandri Bonetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Marco Morelli Coppola
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Emile List
- Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Silvia Ciarrocchi
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Stefania Tenna
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
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Bonetti MA, del Arbol JL, Jiménez Alonso J. [Somatostatin and gastrointestinal hormones]. Rev Esp Enferm Apar Dig 1978; 54:649-90. [PMID: 746239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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