Acceptable Cosmetic Results Research Articles

Management of Frontal Bone Exposure Following Paramedian Forehead Flap for Nasal Reconstruction.

The paramedian forehead flap is renowned for its versatility and can cover a wide range of nasal defect sizes. Most of the literature discussing outcomes of paramedian forehead flap reconstructions focuses on morbidity at the recipient site. Frontal bone exposure resulting from the use of the paramedian forehead flap is a rare but possible complication, especially when periosteum overlying the bone is damaged during surgery or during healing by secondary intention due to desiccation. In this case, a 53-year-old female underwent nasal reconstruction with a paramedian forehead flap for an extensive nasal defect after Mohs surgery and resection of residual basal cell carcinoma. She missed her postoperative follow-up visit, and her frontal bone was noted to be exposed before the division of the pedicle procedure. During the division of the pedicle, the frontal bone was burred, and a bilayer dermal regeneration matrix was applied. She underwent a split-thickness skin grafting from her thigh at 4 weeks. The graft take was 100%, and wound closure was achieved with an acceptable cosmetic outcome. The successful resolution of the complication through innovative surgical interventions highlights the importance of adaptive surgical strategies and thorough postoperative care, aiming to contribute to the existing body of knowledge and improve future clinical practices in reconstructive surgery.

Scalp Arteriovenous Malformation. Percutaneous Multistage Ligature under Ultrasound Guidance: Palliative Technique to be Considered. Case report.

Background: Scalp arteriovenous malformations (AVMs) are fast-flow malformations characterized by the presence of arteriovenous shunting without an intervening capillary bed within the subcutaneous layer. Aim: To report a case of AVMs managed by percutaneous multistage ligature under ultrasound guidance. Case report: A 68-year-old patient with a AVMs was managed by percutaneous multistage ligature under ultrasound guidance with acceptable cosmetic and functional results. Conclusion: Some patients with bad health conditions and a high risk of anesthesia with comorbidities can benefit from multistage transcutaneous ligation of the principal arterial pedicular under ultrasound guidance. This simple and palliative technique must be considered in some cases.

Shave procedures in the management of skin lesions where melanoma is a differential diagnosis.

Australia has the world's highest melanoma incidence. Diagnostic aids improve melanoma diagnosis, but most lesions excised on suspicion of being melanoma are benign. Reliance on formal ellipse is common. We explore the utility of shave procedures in melanoma management. The topic of shave procedures in the management of melanoma is controversial and attracts strongly held views both for and against. The available data shows that shaves can be employed safely and produce an acceptable cosmetic outcome with low financial costs while also being a time-efficient procedure both for the patient and the clinician alike.

Staged Excision Technique for Periocular Cutaneous Melanoma: Long-Term Outcomes of the Square Procedure.

To examine the long-term outcome of the staged excision via the square procedure for the treatment of periocular thin cutaneous melanoma. A retrospective chart review of 95 periocular cutaneous melanoma-in-situ and microinvasive melanoma tumors that were treated with the square procedure between April 1, 1994 and December 31, 2018 at the University of Michigan. Demographic and clinical data were evaluated. Of 95 cases, 19 (20%) were atypical junctional melanocytic proliferation with features of early melanoma-in-situ, 63 (66.3%) were melanoma-in-situ and 13 (13.7) were microinvasive melanoma with Breslow depth less than 1 mm. Tumor-free margins were achieved with a median margin of 10 mm (range 5-40 mm). Most cases (68.4%) required multiple excision stages. Surgical revision was necessary in 17.9% of cases and was associated with larger defect size. Local recurrence was noted in 8 patients (8.4%) at a median of 42 months postreconstruction. No tumor characteristics were found to predict recurrence. The square procedure for periocular melanoma offers an 8.4% recurrence rate, consistent with literature reports on similar staged excision approaches. The staged excision provides an excellent option for comprehensive margin review and tumor control with acceptable cosmetic results after reconstruction.

“Mosaic graft” technique and surgical dermal glue in Mohs micrographic surgery and general dermatologic surgery

After Mohs Micrographic Surgery dermsurgeons utilise local flaps, full or partial thickness grafts, with good or acceptable cosmetic results. When we are dealing with older and problematic patients, blood thinner users, and non-collaborative people with large facial neoplasms, using flaps may be very difficult and grafts become the best choice. Our aim was to assess a technique to graft very easily, quickly and safely, full thickness skin grafts in facial wounds and have good cosmetic results in those older and problematic people. Ten elderly patients who underwent Mohs Surgery or other surgical procedures have been grafted with this technique that we called “Mosaic graft”, made possible using a dermal glue in a new way. In some cases, for bigger defects, we also assessed the “Stripes” variant of this technique. Graft survival was almost always complete in all cases and after 6 months the cosmetic outcomes were good. This “Mosaic graft” technique and its “Stripes” variant showed good reliability, fast execution, easy harvesting with tissue saving, good cosmetic outcomes, making this technique a very good choice for older and problematic patients.

Prospective Analysis of Incisional Morbidity Associated With Anterior Surgical Approaches to the Lumbar Spine.

Anterior approaches to the lumbar spine have been used extensively for various indications but they are also associated with unique complications and have been linked with higher incisional morbidity.This study aimsto evaluate incisional morbidity related to anterior lumbar surgeries and to assess how incisional outcomes correlate with patient and surgery-related factors. Patients ≥18 years old and with planned anterior lumbar fusions from L1 to S1 were prospectively enrolled. Follow-up ended at two years, and patients who did not complete the follow-upwere excluded. Incision was assessed for general appearance, width, color, cross-hatching, hypertrophy, and pain by using a validated scoring system and a visual analog scale (VAS). Patient and surgery-related factors were analyzed for possible correlations with complications or wound-related parameters. A total of 205 patients with a mean age of 54.4 ± 11.5 were included. Significant improvements were seen in color, hypertrophy, pain, and appearance of the incision. At two years, the mean patient-based VAS for appearance was 8.6 while surgeon-based VAS was 8.8. The total rate of complications was 9%, with no incisional hernia or bulging. No significant relation was found between incision-related parameters and the demographic and surgical variables. This study reports acceptable cosmetic results and no chronic pain after anterior lumbar surgery, which is contrary to previous reports. Together with a low total rate of complications, anterior approaches are safe when carefully executed, and have low morbidity.

Comparative evaluation and co-relation in variation of curve of Spee and curve of Wilson in Class II div. 1, Class II div. 2, and Class III as against Class I malocclusion in central India population- an in vitro study

Introduction Getting acceptable cosmetic results in the soft tissues of the face serves as the foundation for orthodontic treatment planning. Also, in order to achieve healthy static and dynamic occlusal interactions, the teeth must be positioned within the basal bone at the correct position, angle, and inclination. To avoid periodontal issues, provide stability, and achieve a functional occlusion, it is essential to ascertain the individual’s dental arch form before starting of treatment and thus to utilise the mechanics that follow throughout the treatment. Objectives To evaluate and compare variation in Curve of Spee and Curve of Wilson in Class II Div.-1, Class II-Div-2 and Class-III as against Class I malocclusion in central India population. Methodology Irreversible hydrocolloid impression will be taken with perforated metal stock trays and stone cast will be poured. This will be scanned using CAD CAM machine and curve of Spee and Wilson will be measured using reverse engineering. Expected Result It will assist us in treatment planning for preventing periodontal issues, assuring stability, and achieving functional occlusion by evaluating and comparing the Spee and Wilson curves in Class II Divison-1, Class II Divison-2, and Class-III malocclusion with Class-I malocclusion. Conclusion Every single patient receiving orthodontic treatment has the COS, which is crucial to achieving a stable occlusion. Almost every patient who receives orthodontic treatment eventually experiences the Spee Curve. Since there aren’t many studies examining the relationship between the Curves of Spee and Wilson, their impact on dentoskeletal morphology, and their role in occlusal stability.

Nipple reconstruction using spiral-peeling technique during oncoplastic breast-conserving surgery for a patient with small breasts.

Treatment of early breast cancer using breast-conserving surgery (BCS) commonly leads to local control and acceptable cosmetic results. We report a useful technique to achieve symmetry of the breast shape and nipple-areola, with excellent results. A Japanese patient with early breast cancer located in the inner central area of the breast was enrolled in this study. Intraductal spread of breast cancer to the nipple was suspected; however, no invasion was observed outside the nipple wall. We preserved the cylindrical surface, but resected the inner tissue with the top surface of the nipple. After coring the nipple, the remnant cylindrical surface was cut into a spiral shape. Nipple reconstruction using the spiral-peeling technique during oncoplastic breast-conserving surgery (OPBCS) may be useful for patients who desire nipple preservation.

Comparative evaluation and co-relation in variation of curve of Spee and curve of Wilson in Class II div. 1, Class II div. 2, and Class III as against Class I malocclusion in central India population- an in vitro study.

Getting acceptable cosmetic results in the soft tissues of the face serves as the foundation for orthodontic treatment planning. Also, in order to achieve healthy static and dynamic occlusal interactions, the teeth must be positioned within the basal bone at the correct position, angle, and inclination. To avoid periodontal issues, provide stability, and achieve a functional occlusion, it is essential to ascertain the individual's dental arch form before starting of treatment and thus to utilise the mechanics that follow throughout the treatment. To evaluate and compare variation in Curve of Spee and Curve of Wilson in Class II Div.-1, Class II-Div-2 and Class-III as against Class I malocclusion in central India population. Irreversible hydrocolloid impression will be taken with perforated metal stock trays and stone cast will be poured. This will be scanned using CAD CAM machine and curve of Spee and Wilson will be measured using reverse engineering. It will assist us in treatment planning for preventing periodontal issues, assuring stability, and achieving functional occlusion by evaluating and comparing the Spee and Wilson curves in Class II Divison-1, Class II Divison-2, and Class-III malocclusion with Class-I malocclusion. Every single patient receiving orthodontic treatment has the COS, which is crucial to achieving a stable occlusion. Almost every patient who receives orthodontic treatment eventually experiences the Spee Curve. Since there aren't many studies examining the relationship between the Curves of Spee and Wilson, their impact on dentoskeletal morphology, and their role in occlusal stability.

Inferior Alveolar Nerve Repositioning With the Computer-Aided Design in Hemimandibular Hyperplasia.

A 34-year-old man presented with facial asymmetry and was diagnosed with left-sided hemimandibular hyperplasia. Orthognathic surgery and mandibular angle osteotomy combined with inferior alveolar nerve repositioning were performed with computer-aided design. The facial asymmetry was successfully corrected with acceptable cosmetic results. Inferior alveolar nerve repositioning provided sufficient space for the osteotomy of the affected side with the abnormal mandibular canal. Inferior alveolar nerve repositioning with computer-aided design can be used as an effective and reliable technique for hemimandibular hyperplasia.

Skin Expander for Scalp Reconstruction: Reappraisal of a Reconstructive Procedure for Aplasia Cutis Congenita.

Aplasia cutis congenita (ACC) is a heterogeneous group of congenital disorders characterized by the absence of epidermis, dermis, appendages, subcutaneous tissue, and bone. The aim of the study is to describe a clinical report of ACC of the scalp treated with skin expanders. In October 2019, a 16-year-old female patient underwent scalp expansion with 2 rectangular devices (150 and 250cm3; Radovan Mentor-Johnson&Johnson). The inflation started 30 days after surgery and continued once every 7 to 10 days to gain 10% of overexpansion. After 3 months, the patient underwent the second surgical step with the expanded scalp transposed to close the defect. Clinical examination 6 months after surgery revealed an acceptable cosmetic result with a hidden surgical scar and hair growth in the previous area of frontoparietal alopecia. Skin expander for the reconstruction of extensive ACC defects of the scalp is a valid procedure.

Extended Unifrontal craniotomy for midline anterior cranial fossa meningiomas: A better shot at preservation of neurovascular structures

Numerous surgical approaches have been described for the resection of anterior cranial fossa meningioma. The common problems associated with these approaches are excessive brain retraction, injury to neurovascular structures, transection of superior sagittal sinus (SSS), and a higher risk of new-onset anosmia. The authors describe a unilateral extended frontal approach with the aim to minimize brain handling without the need for SSS transection and possibly better olfaction preservation. Methods: Thirteen patients with anterior cranial fossa meningioma were operated on using the novel technique of unilateral extended frontal skull base approach. The clinical presentation, radiological studies, intraoperative findings, and outcome at follow-up were recorded. Results: Gross total tumor resection could be achieved in 12 out of 13 patients. At least one of the olfactory tracts could be anatomically preserved in all patients, and superior sagittal sinus was preserved in all patients. Functional olfaction preservation was achieved in 8 patients. No patient developed new-onset anosmia. Conclusions: The extended unilateral frontal approach is a viable and reliable alternative for extended bifrontal technique for the resection of large midline anterior cranial fossa meningiomas with avoidance of SSS ligation, decreased brain handling with better olfaction preservation while achieving comparable tumor resection and acceptable cosmetic outcomes.

Dermoscopic-Guided Shave Removal of Acquired Facial Melanocytic Nevi in Dark-Skinned Individuals.

Acquired melanocytic nevi are common benign skin lesions that require removal under certain circumstances. Shave removal is a straightforward treatment modality with a risk of recurrence. To evaluate the outcome of dermoscopy-guided shave removal of acquired melanocytic nevi in the face of dark-skinned individuals who are more liable to postsurgical complications. The study was conducted on 64 patients with acquired facial melanocytic nevi. Serial shave removal using a razor blade guided by dermoscopic examination was done until nevus-free tissue was seen, followed by electrocauterization of the base. Cosmetic outcome, patients' satisfaction, and recurrence rate were evaluated during follow-up. Excellent cosmetic outcome was achieved in 54.69% of patients, while 39.06% had an acceptable outcome, and 6.25% of patients had poor cosmetic outcome. Meanwhile, the recurrence rate was noticed in 5 cases only (7.8%). Dermoscopic-guided shave removal provides an easy procedure of treating common melanocytic nevi with an acceptable cosmetic result and a lower rate of recurrence even in patients with darker skin phenotypes.

Current trends in breast cancer surgery.

The incidence of breast cancer has been increasing significantly over the past decades, while the mortality rate has, actually, been decreasing. Behind this favorable trend in the decrease in mortality are not only high-quality screening programs, but also undoubtedly advances in therapy, especially new methods in surgical treatment. The importance of oncoplastic approach integrating resection and reconstruction procedures is obvious. Our efforts continue to maximize breast-conserving therapy, which is being improved in parallel with the development of new localization methods of non-palpable lesions. Breast-conserving therapy indication spectrum is also increasing with the use of oncoplastic approach allowing the resection of a significant part of the mammary gland while achieving an acceptable cosmetic result. We improve guidelines for skin-sparing procedures and also possibilities and availability of breast reconstruction. Most popular is breast reconstruction with free abdominal flap transfer. However, due to such demanding complex procedure with limited availability, there is also a significant development of silicone-implant-based reconstruction or methods of fat transfer. Constant attention is focused on axillary surgery, now especially in cases of initial nodal involvement that responds favorably to neoadjuvant systemic treatment. Current findings indicate tendency to modify and differentiate surgical indications according to the tumor phenotype. Complex lymphedema prevention surgery, such as lymphatic mapping or restoring lymphatic flow via microsurgical lymphaticovenous anastomosis, can provide effective and long-term improvement and is challenging. Recently in the Czech Republic, we reopened the discussion about the optimal concentration ofmedical care in a smaller number of specialized breast centers, which we think is one of a number of steps on the constant path to improve medical results.

Percutaneous Sclerotherapy as Therapeutic Option in Benign Vascular Lesions: A Retrospective Study

Introduction:Sclerotherapy, a minimally invasive approach, has gained prominence as a therapeutic modality for the treatment of these lesions. The objective of this article is to assess clinical success, complications and periprocedural pain score of sclerotherapy and their variation with the nature of the lesion and choice of sclerosants. Methods: This was a hospital record-based retrospective study in a tertiary care centre in Kathmandu. Sclerotherapy done in the institute from January 2019 to December 2022 was evaluated for the nature of the lesion, clinical success, number of sessions, periprocedural pain score and complications. All sclerotherapy was performed under combined USG and fluoroscopic guidance by an interventional radiologist. Data was entered in predesigned proforma and data analysis was done using SPSS 25.0. Results: A total of 33 patients underwent 61 sessions of sclerotherapy during the study period. Venous malformation (72.2%) was the most common vascular lesion followed by hemangioma. There was significant resolution of symptoms post sclerotherapy pain relief in 95% complete resolution of swelling in 65.38 % and partial resolution with acceptable cosmetic results in 26.92% of cases. Only minor complications were seen in 6.5% of cases. The median periprocedural pain score was 5 with an interquartile range of 2. Periprocedural pain was significantly less with sodium tetradecyl sulphate than with alcohol(P-0.002). The resolution of swelling was less in hemangiomas than in other lesions, while pain relief was similar for all lesions. Complications were seen only in the alcohol group. Conclusions: Sclerotherapy is a safe and effective procedure for benign vascular lesions. Complications and periprocedural pain are less with sodium tetradecyl sulphate as compared to alcohol.

Surgical Outcomes After Frontalis Suspension Using Expanded Polytetrafluoroethylene Sling for Congenital Ptosis.

Purpose The purpose of the study is to assess short- and long-term functional outcomes after frontalis suspension using expanded polytetrafluoroethylene (ePTFE) sling for congenital ptosis repair. Methods A retrospective, observational case review was conducted on pediatric patients who underwent frontalis suspension using ePTFE sling from 2008 to 2020. Functional success was assessed by lid height, lid symmetry, and parental satisfaction with the cosmetic outcome.Clinical course and long-term functional outcomes after surgery were assessed. Results Twenty-one cases met the inclusion criteria and were assessed. The follow-up time ranged from 13 monthsto 11 years (mean: six years). Functional success after one surgery was 62% at early and late postoperative periods. Six of 21 cases (29%) required revisional surgery in the early postoperative period due to undercorrection. Three cases (14%) were complicated by infection and/or granuloma formation. There were no cases of ptosis recurrence in the long term if success was seen in the early postoperative period. Conclusion ePTFE slings remain an excellent option for severe congenital ptosis repair with frontalis sling, demonstrating long-term functional success, with satisfactory lid symmetry and acceptable cosmetic outcome. This is of important consideration in patients younger than three years of age, where autogenous materials may not be recommended. The need for early revisional surgery for undercorrection is not uncommon. The current authors also demonstrate a low but considerable risk for infection and/or granuloma formation.

The Central Facial Defect Reconstruction Using a Radial Forearm Free Flap after Malignant Cutaneous Tumor Ablation.

Acquired defects of the central face pose significant challenges in achieving acceptable cosmetic and functional outcomes. The site, size, and depth of tissue loss often render local tissues inadequate for the repair of major nasal defects. In this article, we aim to demonstrate the efficacy of radial forearm-free flaps as an ideal choice for various central facial unit reconstructions. This study encompassed patients treated between 2020 and 2022 who underwent facial reconstruction using radial forearm flaps. These flaps were employed in eleven patients with defects involving the lower lid, nose, upper lip, and lower lip. Additionally, we used osteocutaneous flaps in one patient to reconstruct a right nasal bone defect. In three patients requiring medial and lateral canthal tendon reconstruction in one case and oral sphincter reconstruction in two cases, the palmaris longus tendon was included with the flap. In the majority of cases, we achieved good to excellent aesthetic and functional results. Notably, there were no instances of flap failure or partial necrosis in this series. All patients experienced uneventful healing at the donor site. The radial forearm-free flap stands as an ideal and reliable method for reconstructing various facial defects. It offers efficient and thin-conforming skin coverage.

Kolostomi Kapatılmasında daha kabul edilebilir görünüm için farklı yaklaşımlar

Background: Colostomy can be performed in various cases in which the gastrointestinal tract cannot be kept intact in children. Conventional colostomy closure approaches can cause serious aesthetic concerns. In order to avoid wound closure problems and to obtain cosmetically better results, new methods such as elliptical excision, S-shape flap, M-shape flap or Z-plasty can be used. In this study, we would like to assess the colostomy closure techniques which can provide more acceptable cosmetic results. 
 Material and Method: 24 colostomy patients who were operated between May 2017 and December 2017 include to study. Patients were evaluated prospectively and randomized. During study period, 12 patients were treated with CM (Group 1) whereas other 12 patients were treated with NM (Group 2). Results in skin healing and skin scar were assessed and photographed in certain periods. 3 surgeons, who were blind in closure technique, were asked to assess the photographic results in terms of healing and final scar. The data obtained was statistically reviewed.
 Results: 24 (14 male – 10 female) patients with a mean age of 19 (Range: 6 – 36) months were included in the study. Following surgery, skin closure and appearance in Group 2 was significantly better than Group 1 (p

Evaluation of Daylight Methylene Blue Photodynamic Therapy in Multiple Recurrent Molluscum Contagiosum

Abstract Background Molluscum contagiosum is a common viral infection caused by DNA Poxvirus. Daylight-photodynamic therapy (DL-PDT) is defined as a photochemical reaction used to selectively destroy tissue. Objectives To evaluate the efficacy and safety of daylight methylene blue photodynamic therapy in treatment of multiple recurrent molluscum contagiosum. Subject and methods This is a single blinded controlled prospective interventional clinical study including 20 patients with molluscum contagiosum diagnosed clinically and by dermoscopy. Patients subjected to daylight methylene blue-mediated photodynamic therapy. Topical MB liposomal loaded 10% cream was applied over the lesions area with occlusion and left for 15 minutes. Two leisons were left as control in each studied patient. Patients were instructed to stay outdoors exposing their lesions and the adjacent area to daylight continuously for at least 90 minutes (if it was a sunny day) or 120 minutes (if it was an overcast or partially sunny day) between 11:00 am to 02:00 pm. Treatment sessions were done weekly for 10 weeks or till complete clearance. Follow up of the patients for 6 months after end of study to detect recurrence or appearance of new lesions. Results Daylight MB Mediated PDT response in a total of 20 (100%) studied patients showed Excellent response to treatment shown as complete clearance in 65%( no.=13) of patients, very good response to treatment in 15.0%( no.=3), good response to treatment in 10.0%( no.=2) and poor response to treatment in 10.0%( no.=2). The total number of lesions was 313. Response of the lesions in studied patents to MB-PDT was monitored by dermoscopic follow up of lesions. Lesions showed complete response in 66.5% (no. = 208) of lesions, partial response in 25.2% (no. = 79) of lesions and no response in 8.3% (no. = 26) of lesions. No serious side effects and also MB-DL/PDT is a painless treatment. No relapse was detected at the site of cleared MC or at a near site during the follow-up period of 6 months following the procedure. Conclusion Daylight-PDT using MB is effective in clearing MC lesions, also is safe, easy to carry out, economic, acceptable cosmetic results with no recurrence, convenient especially for children as it is a painless treatment.

Simplifying Forehead and Temple Reconstruction: A Narrative Review.

The forehead and temporal region are frequent areas of skin cancer development. After tumor removal, reconstruction must be performed, maintaining the frontal-temporal line of the scalp and symmetry of the eyebrows in an attempt to hide the scars within these marks or natural folds and wrinkles. Second wound healing and skin grafts generally do not produce an acceptable cosmetic result. When direct closure is not possible, the technique of choice is skin flaps. In the midfrontal line continuation of the glabella, there is a remnant of skin to be used as a donor area for local flaps; similarly, it occurs in the preauricular cheek, which can move toward the temple. In addition to the classic advancement and rotation flaps, the frontalis myocutaneous transposition flap is an excellent technique for closing defects which are wider than higher on the forehead. Its design is very versatile and can be performed between the two pupil lines at different heights depending on the location of the defect. On the other hand, the preauricular skin advancement flap with an infralobular Burow's triangle is also an excellent option for reconstructing tumors in the temporal area.