Acceptable Cosmetic Results Research Articles

Temporoparietal Fascia Flap for Complex Eyelid Reconstruction: A Case Series and Literature Review

Purpose: Large, complex eyelid defects involving all layers of the upper and/or lower eyelids still present a challenging problem. Temporoparietal fascia (TPF) flap can be used in some of these cases for reconstruction. The authors review the etiology, presentation, surgical technique, and results of this procedure and review the literature to date. Recommendations are made for optimizing surgical technique and guidelines for when to use the flap. Methods: The authors present a series of 4 cases of large eyelid defects reconstructed using the TPF flap. The etiology of these defects were: congenital, trauma, tumor and complication of maxillofacial surgery. Outcomes reviewed include functional and cosmetic results, and complications. Literature review of eyelid reconstruction using TPF flap is performed. Results: All patients achieved an acceptable cosmetic and functional outcome. There was resolution of both lagophthalmos and severe exposure keratopathy in all patients. Post-operative complication occurred in one patient and involved necrosis of the skin graft over the TPF flap. This was managed with a second skin graft several weeks later with satisfactory results. Conclusion: Trauma, tumors, congenital craniofacial anomalies and maxillofacial surgery for resection of sinus tumors can cause large eyelid defects. Small eyelid defects can be repaired with lid sharing procedures but for exceptionally large defects, these techniques become insufficient. TPF flap is an excellent option and can be used in these cases to achieve an acceptable cosmetic and functional outcome with preservation of the globe. TPF flap is a versatile option which can reconstruct a large eyelid defect with one procedure. Complications can be avoided with meticulous attention to detail. TPF flap is best suited for upper and/or lower eyelid defects which are categorized as Type III or Type IV.

Cosmetic Surgery and the Diversity of Cultural and Ethnic Perceptions of Facial, Breast, and Gluteal Aesthetics in Women: A Comprehensive Review.

An increasing number of people are opting for cosmetic surgeries. For many years, the physical and aesthetic appearance of Caucasians has been considered to be ideal. However, it is now commonly acknowledged that attractiveness and aesthetic standards vary among cultural backgrounds and ethnic groups and that Western attractiveness criteria no longer apply to all. Herein, we conducted a comprehensive review of studies that examined cultural and ethnic variations in preferences for facial, breast, and gluteal aesthetics, as well as reviewed studies that investigated ethnic disparities in attitudes and motivations for cosmetic surgery. A total of 4532 references were identified, 66 of which met the inclusion criteria. Several studies have reported that facial golden ratios are invalid for representing perceived attractiveness standards among different ethnicities. The majority of studies also indicated that facial aesthetic interventions should not aim to Westernize but to optimize ethnic traits. Significant ethnic differences in preferences for upper- and lower-pole breast proportions have been reported. The size of the buttocks and waist-to-hip ratio were identified as the main factors of buttock aesthetics, with buttock size preferences having a high ethnic diversity. Interest in cosmetic surgical procedures while maintaining ethnic identity continues to grow among young women worldwide. This comprehensive review strongly suggests that accommodating cultural and ethnic differences in aesthetic standards in cosmetic surgery planning can lead to more acceptable cosmetic outcomes.

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.

Application of vertical transposition flap in closure for large facial soft tissue defects in children.

While transposition flap is widely used for the repairs of facial defects, few studies has reported its application among children with large defects. In this study, we aimed to investigate the surgical techniques and principles in different locations on face of vertical transposition flap in children. We retrospectively reviewed our hospital database and identified children who were treated with vertical transposition flap for large facial defects between January 2014 and December 2021. Information was collected including patients' demographics, location and dimension of the lesion, surgical procedure, additional surgeries, complications, and outcomes. A total of 122 patients (77 boys, 63.1%) were included in this study. The average age for participants was 3.3 years (3 months to 9 years). One hundred and four (85.3%) patients had melanin nevus and 18 (14.8%) had sebaceous nevus. The average size of defects was 5.8 cm2 (ranging from 0.8-16.5 cm2). Ten patients (8.2%) suffered from dermal layer or full-thickness necrosis in the distal part of their flaps, They all recovered after conservative treatment and there were noticeable scars at discharge. Five patients (4.1%) had slight traction of the mouth and eyelid, all recovered about 2 week after surgery. An acceptable cosmetic outcome was achieved for all the patients at last time follow-up. Repairing large facial defects with vertical transposition flap is effective in Children, especially on forehead, cheek and mandible. However, this technique is far from perfect. Careful selection of appropriate patients and flap design might be needed.

Snodgrass Hypospadias Repair At Ayub Teaching Hospital: An Audit Of Complications And Outcomes.

There are many reported techniques for the repair of hypospadias, and new ones are being reported, which suggests that none is perfect. This study reports the anatomical success rate when using Snodgrass Technique. In this descriptive case series, 296 patients who fulfilled the inclusion criteria, by being treated by Snodgrass urethroplasty, were enrolled. The study was conducted at the Department of Surgery, Unit-C, MTI, Ayub Teaching Hospital Abbottabad between May 2008 and June 2021. Mean age of the patients was 2.4±.8 years, 79.7% (n=236) had anterior (glanular, coronal, sub coronal) meatal location and 20.3 % (n=60) had middle urethral meatus (distal & mid-shaft). The mean operative time was 52 min. 5.1% of patients developed neo-meatal stenosis (n=15), 7.1% (n=21) patients develop a urethral cutaneous fistula (compared to 5% in larger centers, 16% from smaller centers), 11.8% (n=35) developed wound infection, 2% (n=6) had complete disruption. The cosmetic appearance of the penis was "excellent"/good (shape of meatus was slit-like and vertically oriented) in 60.1% (n=178) patients, "acceptable" in 30.1% (n=89), and "not acceptable" in 9.8% (n=29). Snodgrass technique has a low complication rate, offers an acceptable cosmetic outcome and can be successfully applied to a wide range of defects from distal to mid-shaft hypospadias. Common complications include urethral-cutaneous fistula and meatal stenosis; both occur in a low and acceptable number of patients.

PD06-05 MANAGEMENT OF SERIOUS COMPLICATIONS AND TISSUE LOSS FOLLOWING HYPOSPADIAS SURGERY

You have accessJournal of UrologyCME1 Apr 2023PD06-05 MANAGEMENT OF SERIOUS COMPLICATIONS AND TISSUE LOSS FOLLOWING HYPOSPADIAS SURGERY Tenny Zhang, Peter Cai, Ashraf Gamal, Cairo Egypt, and Moneer Hanna Tenny ZhangTenny Zhang More articles by this author , Peter CaiPeter Cai More articles by this author , Ashraf GamalAshraf Gamal More articles by this author , Cairo EgyptCairo Egypt More articles by this author , and Moneer HannaMoneer Hanna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite the high re-operation rates after proximal hypospadias repairs, surgeons have rarely reported disastrous complications of hypospadias surgery. Herein we report on 16 patients who sustained partial or total glandular or penile loss after hypospadias surgery and were referred to us for further management over the last 40 years (Figure 1). METHODS: Operative details of the primary surgery were not available in the majority of cases as six cases were from Egypt, one from Portugal, and one from Iraq. Forty-four percent (7/16) of the index operations utilized epinephrine mixed with local anesthetic. The surgical repairs we performed included Bevan-DeCastro phalloplasty (4), forearm flap phalloplasty (1), and penile lengthening by cutting the suspensory ligament (6) followed by resurfacing using either rotational scrotal flap (3) or staged Cecil-Culp repair (3) (Figure 2). Four patients underwent contouring of the glans penis. One patient declined treatment. RESULTS: Significant penile lengthening was achieved in all patients ranging from 5 to 8 cm (75-150% of the preoperative penile length). Phalloplasty was technically successful in all patients however we deferred urethroplasty in the four Bevan-DeCastro repairs to a later date during adolescence when forearm flap phalloplasty and penile prosthetic implant are practical. All five phalloplasty patients had acceptable cosmetic result in the absence of erectile function. CONCLUSIONS: Partial or total glandular or penile loss subsequent to hypospadias repair is a rare and disastrous complication. Subsequent surgical repair provides some value in improving outcomes. We discourage the use of epinephrine injections during hypospadias repairs and emphasize the importance of leaving the glans exposed to allow for postoperative visual examination and early recognition of vascular compromise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e157 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tenny Zhang More articles by this author Peter Cai More articles by this author Ashraf Gamal More articles by this author Cairo Egypt More articles by this author Moneer Hanna More articles by this author Expand All Advertisement PDF downloadLoading ...

Superior Antihelix Composite Graft for Repair of Nasal Ala and Lateral Nasal Tip Defects: A Retrospective Case Series.

Deep defects on the nasal ala and lateral nasal tip may result in nasal valve insufficiency or alar notching and are often repaired with a 2-stage reconstruction. Previous literature has demonstrated high failure rates of composite grafts. Identify survival rates and cosmetic outcomes of nasal composite grafts harvested from the antihelix. A retrospective review of 52 patients who underwent ala or lateral nasal tip composite graft repair from April 2019 through May 2022, with statistical analysis of cosmetic outcomes graded by 2 surgeons. Defect size ranged from 0.7 cm × 0.8 cm to 1.9 cm × 2.5 cm. 48 grafts survived (92.3% survival rate). Four patients sustained at least partial integument sloughing (epidermal necrosis), but the cartilage survived in all 52 cases. Overall, aesthetic results yielded the following: excellent (19.5%), very good (35.5%), good (11.5%), decent (16.5%), and poor (6%). In 93% of cases, there was no evidence of nasal collapse or retraction. Two patients (3.8%) required surgical revision. Donor site morbidity was low. The antihelical composite skin graft is a 1-step reliable repair option for ala and lateral nasal tip defects with an acceptable cosmetic outcome.

Modified Lateral Intercostal Artery Perforator Flap in Immediate Partial Breast Reconstruction for Breast Cancer: A Retrospective Cohort Study

Introduction: The primary surgical options for treating breast cancer involve mastectomy or Breast Conservative Surgery (BCS), which may or may not include reconstruction procedures. BCS helps achieve complete tumour excision with an acceptable cosmetic result. Contour deformities and asymmetry are associated with tissue excision in the lateral aspect of the breast. To address this issue, various techniques of volume replacement, such as the modified Lateral Intercostal Artery Perforator (LICAP) flap, can be performed. Aim: To demonstrate the outcomes of a modified LICAP flap when a muscle flap is not available or desired. Materials and Methods: A retrospective cohort study was conducted, reviewing all modified LICAP flaps performed for breast tumours in Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, a tertiary-level cancer centre, from June 2018 to August 2020. Patient demographics, surgical details, histopathology reports, and postoperative complications were collected. Results: Ten patients underwent modified LICAP flaps over a two-year period. All patients had pT2 tumours with marginnegative resection, and the mean resection volume of the specimen was 370 cm3 . Intraoperative patient repositioning was not necessary during the modified LICAP flap procedure. One patient experienced marginal wound necrosis, which was managed conservatively. No patients had scars extending beyond the posterior axillary line, and axillary dissection was performed without a separate incision. Conclusion: The present study demonstrates the advantages of using a modified LICAP flap for breast reconstruction. The modified LICAP flap can be considered as an option for tumours located in the outer aspect of the breast, providing good access to the breast as well as the axilla, with an aesthetically acceptable scar.

Fournier gangrene - would you KISS it?

Fournier gangrene is a disease characterized by necrotizing fasciitis of the perineal and genital region, resulting from synergistic polymicrobiotic infection. Most infections can be localized to a cutaneous, urethral, or rectal source and can culminate in a fulminant sepsis. Current state of the art is systemic broad-spectrum antibiotics and serial aggressive debridement which result in superficial perineal defect of wide dimensions. We compiled all the cases of Fournier gangrene that required reconstruction after debridement in Centro Hospitalar Universitário Lisboa Central from 2018 to 2022. Inclusion criteria were reconstruction for Fournier defects and patients' age 18 to 90 years old. Exclusion criteria were patients who didn't require reconstruction or didn't complete it due to death or transfer to another healthcare institution. Reconstructive procedures and complication rates are reported as whole numbers and percentages of total. The initial search yielded 32 patients. There were 2 (6.2%) patients with defects that healed by secondary intention, 6 (18.7%) with delayed primary closure, 4 (12.5%) with implantation of the testicle in a medial thigh pocket, 12 (37.5%) with skin grafts, 4 (12.5%) with scrotal advancement flaps, 2 (6.2%) with flaps, and 2 (6.2%) with flaps and skin grafts in combination. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. The reconstructive options need to be patient tailored in order to achieve long lasting results with a minimum of postoperative morbidity.

A PROSPECTIVE COMPARATIVESTUDY OF OPEN VERSUS LAPAROSCOPIC APPENDECTOMY: A SINGLE UNIT STUDY

Introduction: Acute appendicitis is the most common general surgical emergency. Appendicectomy is the treatment of choice for acute appendicitis and the most commonly performed emergency abdominal operation. Open appendectomy is found safe and effective operation with low morbidity but found to be associated with post operative pain, wound infection and complications like intestinal obstruction which may delay recovery. Laparoscopic appendectomy emerged as a good option for treatment of appendicitis. The purpose of this study was to compare the laparoscopic versus open approach among patients with appendicitis in our centre. Materials And Methods: This study was a prospective study of 100 patients with clinically diagnosed as appendicitis admitted in the department of General Surgery, Unit II, Zoram Medical College for a period of two years during November 2019 to October 2021. They were divided into two groups - Open Appendectomy (OA) group and Laparoscopic Appendectomy (LA) group of 50 patients each. Age ranges from 10yrs to 75yrs. Exclusion criteria were pregnant female, chronic medical problems, haemodynamically unstable or psychiatric illness, cirrhosis, coagulation disorders, patients on steroid, immuno-compromised patients, patients on chemotherapy for malignancy and those who are not willing to participate. OA was performed through standard Mc Burney incision. LA was performed through a standard 3 ports technique. Results: The most common presentation of appendicitis is abdominal pain followed by nausea/vomiting and common in younger age group of 10-20 years. Laparoscopic Appendectomy was found as safe and effective as Open Appendectomy. LA has more acceptable cosmetic result, shorter hospital stay and less postoperative pain. The pain score was significantly reduced in LA group (3.2+-1.4) and in OA (4.1+-1.8). Conclusion: LA was found as safe and effective as OA. LA has more acceptable cosmetic result, shorter hospital stay and less postoperative pain.

Window Deroofing with Dental Roll Suturing for Pseudocyst Pinna, Simple Solution for Notorious Disease

Background: Pseudocyst of the pinna is a benign cystic lesion on the lateral surface of the pinna with no definitive etiology or treatment. Various methods are currently used to manage this disease. Most of the treatment options are prone to disease recurrence and are associated with cosmetic sequelae. We report 16 cases of unilateral pseudocyst that were treated with window deroofing and pressure dressing with dental roll suturing. Aim: This study aimed to study the effectiveness of window deroofing with dental roll suturing in the treatment of pseudocyst of the auricle with respect to recurrence and postprocedural sequelae. Materials and Methods: A prospective study at a tertiary care center for 2 years, which included 16 patients with a diagnosis of pseudocyst pinna. All the patients were treated by excising a small triangular piece of skin along with perichondrium, followed by dental roll suturing for pressure dressing; and were followed up after 1 week and 1 month of surgery. Results: All 16 cases were completely relieved of the disease at the end of 1 month. None of our patients had a recurrence and only 2 cases (12.5%) showed thickening of the pinna skin. Conclusions: The surgical treatment by window deroofing with dental roll suturing technique gave a reliable result in all cases of pseudocyst pinna with no evidence of recurrence and acceptable cosmetic results.

Furuncular cutaneous myiasis in Saudi Arabia

Myiasis is the infestation of a living vertebrate by a fly's larva, completing its obligate life cycle. Exposed skin remains the most affected site. The botfly, Dermatobia hominis , is the most common cause of cutaneous furuncular myiasis in tropical areas. Few cases have been reported in Saudi Arabia, mainly in the Southern region. A one-year-old medically free child presented to our pediatric surgery clinic with a painful, itchy discharging nodule on the inner aspect of his right forearm for one-week. The patient's mother and sibling had a similar former presentation after visiting Taif city. We dilated the central punctum and extracted the larva fully intact. The larva was identified morphologically as Dermatobia hominis by a parasitologist. The lesion was left to heal secondarily, which resulted in an acceptable cosmetic result and minimal scarring. Raising this clinical entity's awareness between pediatric surgeons will set aside misdiagnosis, delayed management, and possible complications. A high level of suspicion and careful history taking are required to recognize myiasis, particularly in patients with a recent history of global traveling or those with close contact with cattle.

Evaluation of double faced transverse preputial (onlay) island flap for hypospadias repair in pediatrics: a randomized controlled study

BackgroundThe preputial onlay island flap technique has been popularized for hypospadias repair as a result of offering a consistent combination of acceptable functional and cosmetic results. Like other techniques, urethrocutaneous fistulae and stricture continues to be the most common complications, in addition to other complications, which could be attributed to the compromise in flaps vascularity. Some authors describe a technique that resolves some of these problems by combining the unique benefits of the double faced preputial flaps. The aim of this study:- to evaluate double faced preputial onlay island flap technique for complications rate, outcomes of surgical procedure, and cosmetic results in comparison to transverse inner preputial flap technique.Patients and methodsThis was a prospective randomized controlled study that included 68 patients with anterior, mid-penile, and posterior penile hypospadias, with shallow and narrow urethral plate of size less than 6 mm, who underwent single-stage repair using preputial flaps, conducted at the department of pediatric surgery (Al-Azhar University, Cairo, Egypt), between May 2019 and October 2021, to evaluate double faced transverse preputial onlay island flap technique. Thirty-four patients underwent double faced transverse preputial onlay island flap (group A) and another 34 patients underwent inner transverse preputial onlay island flap (control group) (group B). The follow-up period ranged from 12 to 26 months.ResultsThe overall complication rate was 20.5% (14 of 68 children). Complications developed in 5 cases (14.7%) in group A who underwent double face onlay island flap (2 glannular dehiscence, 1 penile rotation, 1 fistula, and 1 diverticulum), as opposed to 9 patients in group B (26.4%) who underwent transverse inner preputial flap (3 developed glannular dehiscence, 2 skin flap necrosis, 3 fistulae, and 1 diverticulum). After management of the complications, all patients had good surgical outcomes with satisfactory cosmetic results.ConclusionDouble faced transverse preputial onlay island flap is an alternative option to reconstruct narrow urethral plate hypospadias. So that double faced transverse preputial onlay island flap technique appears to achieve satisfactory surgical outcomes with lower complication rate.

Treatment with Hyaluronic Acid Injections in a Patient with Craniosynostosis

A case of a 25-year-old White female left with residual bone deformity after surgical correction of craniosynostosis during childhood is presented here. The significant psychological discomfort from her deformity caused the patient to experience clinical depression and social phobia. Objectives: The use of soft tissue fillers has grown in popularity for minimally invasive cosmetic procedures. The authors discuss the use of hyaluronic acid (HA) as an available treatment option for the reconstructive volumisation of postsurgical bony deformities in patients with congenital craniosynostosis. Discussion: Although fat graft techniques have previously been described, to the best of the authors’ knowledge, this is the first report of HA fillers as an available treatment option for the reconstructive volumisation of residual bony deformities in patients with craniosynostosis. The negative emotional impact of facial deformities can be dramatically improved by these procedures, making HA a valuable option in providing patients with a highly acceptable cosmetic result. Conclusions: HA can be successfully used as a non-surgical alternative to correct bone deformities of any aetiology. It is a relatively simple and effective technique that leads to cosmetically acceptable results. The authors emphasise the importance of training to gain an in-depth knowledge of the facial anatomy. Intravascular injections in the forehead and temporal fossa can lead to skin necrosis or blindness, therefore it is imperative to perform safe and proper facial aesthetics injections and to manage possible complications before injections.

Abstract P4-11-35: Patient-reported outcome after oncoplastic breast conservation surgery using level I or II techniques without contralateral symmetrization

Abstract INTRODUCTION Oncoplastic breast surgery (OPS), has widened the scope of breast conserving surgery (BCS) enabling larger resections with acceptable oncological safety and cosmetic outcomes. It often involves longer incisions and additional contralateral symmetrization procedures on the normal breast. However, patient’s perceptions on outcome may differ from that of the clinician and it is essential to evaluate feedback from patients undergoing OPS to determine the acceptability of these complex procedures in clinical practice. In this regard Health-related quality of life measures (HR-QoL) are an excellent means of evaluating the outcome of medical care. Further, it is well known that socio-cultural differences may reflect on the attitude of patients to treatment outcome and most of the data on OPS and HR-QoL available reflect western thought processes. Based on the feedback of our patients we designed a simple and practical patient-reported outcome measure (PROM) questionnaire reflecting the important issues as voiced by our patients and validated it using the QQ-10, indicating good face validity and acceptability of our questionnaire. We undertook this study to understand the acceptability of OPS level I and II procedures and to determine the satisfaction with the cosmetic outcome as well as the need for contralateral symmetrization procedures in our patients. PATIENTS AND METHODS Based on patient feedback, a questionnaire (Q-IN) was developed and validated by the QQ-10. It includes 9 questions reflecting three domains of general acceptability of the procedure, satisfaction with cosmetic outcome and degree of functional impairment in terms of altered sensation. 126 patients with breast cancer who underwent OPS level I or II without contralateral symmetrization were included in the study. Q-IN was self-administered during routine follow-up, following surgery, between January 2017 and December 2018. It was validated by 31 patients (24.6%)who also answered the QQ-10, a questionnaire designed to assess patients’ views on their experience of using PROM questionnaires during their medical care. The mean value score of the Q-IN as per the QQ-10 was high (84.79%, SD 11.7%) and mean burden score was low (20.96%, SD 24.6%) indicating that it has good face validity and is relevant and acceptable to our patients.RESULTS Mean age of patients was 51 years (21-77 years) and median follow up was 41 months (2- 156 months) following OPS. Majority of patients 124 (98%) were happy about undergoing BCS and had no doubts about the procedure. Most, 115 (91%) were very happy with the cosmetic appearance (shape, size and overall appearance) of the breast after OPS, 10 (8%) were happy and 1 patient (1%) was unhappy. Although most, 103 (81.7%) women, noticed a difference in size the majority 92 (89.3%) felt it was minimal and only 8 (7.8%) found a major difference in size. Of the 78 (61.9%) women that felt a difference in shape, 63 (80.8%) felt it was minimal and 11 (14.1%) reported a major difference. The quality of life of 23 (18.3%) patients was affected by the change in shape and size of the breast. Of these 17(74 %) only thought about the change in appearance, and in 6 (26%) it made a minor difference. Breast sensation was altered in 76 (63.3%) women and that of the nipple-areola complex (NAC) in 77 (58.7%). Of them, 25 (32.9%) reported no sensation in the breast and 30 (40.5%) felt no sensation in the NAC. When asked about a contralateral symmetrization procedure on the normal breast, only 2 (2%) said they would want to undergo symmetrization surgery. CONCLUSIONS Most patients undergoing level I or II oncoplastic breast surgery are happy and satisfied with the overall cosmetic and functional outcome. Only 2% of patients would like to undergo a contralateral symmetrization procedure to match the operated breast. Citation Format: Vinay Deshmane, Anuja Raniwala, Clotilda Cardoza. Patient-reported outcome after oncoplastic breast conservation surgery using level I or II techniques without contralateral symmetrization [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-35.

Modification of oncoplastic breast surgery with immediate volume replacement using a thoracodorsal adipofascial flap

BackgroundThe treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We report a useful technique including the use of a thoracodorsal adipofascial cutaneous flap for reconstructing defects in the outer quadrant area after partial mastectomy, which achieved excellent results.MethodsDuring the past 15 years, some modifications have been added to the original method at a rate of one modification every 2–5 years. We classified these modifications into the original method and four modified methods. Modification I: addition of a crescent-shaped dermis on the distant edge of the thoracodorsal adipofascial flap (TDAFF), Modification II: addition of a crescent-shaped dermis on the proximal edge of the TDAFF, Modification III: addition of inframammary formation plus Modification II, and Modification IV: change of a crescent-shaped dermis to a Benz-shaped (shaped like the Mercedes Benz logo) one plus Modification III. We compared the plastic period, postoperative complications, oncological results, and cosmetic results among the original and four modified groups.ResultsThe patient number was 26, 9, 15, 23, and 10 in the original and Modification I, II, III, and IV groups, respectively. The median observation period was 115, 92, 67, 51, and 32 months, respectively. Postoperative complications were seen in 5 (19%), 0, 2 (13%), 1 (5%), and 0 patients, respectively. Local recurrence was seen in 3 (12%), 0, 0, 0, and 0 patients, respectively. Distant recurrence was seen in 1 (4%), 1 (11%), 3 (20%), 0, and 0 patients, respectively. Cosmetic results evaluated as good–excellent were seen in 19 (73%), 5 (56%), 11 (73%), 19 (83%), and 10 (100%) patients, respectively.ConclusionsOncoplastic surgery using an immediate volume replacement technique with a thoracodorsal adipofascial flap was improved by adding some modifications.

Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases

BackgroundThe safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined.MethodsClinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. The sensory change and paralysis results from this technique and patients’ satisfaction with the cosmesis were also studied.ResultsFifty-one patients (49 females and 2 males) received operations by gasless, endoscopic trans-axillary approaches with one patient whose operation was converted to open surgery because of internal jugular vein injury. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. The alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. No evidence of recurrence was found during the follow-up period.ConclusionsGasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients.

Feasibility and Efficacy of Single-Port Robotic Cholecystectomy Using the da Vinci SP® Platform.

Background:Single-incision laparoscopic cholecystectomy, first introduced in 1995, features acceptable cosmetic outcomes and postoperative pain control. The outcomes of single-port cholecystectomy by laparoscopy and robots were recently examined in many studies owing to surgeon and patient preference for minimally invasive surgery. A next-level da Vinci robotic platform was recently released. This study aimed to evaluate the feasibility and efficacy of robotic cholecystectomy (RC) using the da Vinci SP® system.Methods:In this retrospective observational single-center study, we analyzed the medical records of 304 patients who underwent RC between March 1, 2017 and May 31, 2021.Results:Of the 304 patients, the da Vinci Xi® (Xi) was used in 159 and the da Vinci SP® (SP) was used in 145. The mean operation time was 45.7 mins in the SP group versus 49.8 mins in the Xi group. The mean docking time of the SP group was shorter than that of the Xi group (5.7 min vs 8.8 min; p = 0.024). The mean immediate postoperative numerical rating scale (NRS) score was 4.0 in the SP group and 4.3 in the Xi group, showing a significant difference (p = 0.003). A separate analysis of only patients with acute cholecystitis treated with the da Vinci SP® showed that the immediate postoperative NRS score in the acute group was higher than that in the nonacute group.Conclusions:This study demonstrated acceptable results of single-site cholecystectomy using da Vinci SP®. Thus, pure single-port RC using the da Vinci SP® for various benign gallbladder diseases may be an excellent treatment option.

Surgical and Oncologic Outcomes With Intraoperative Radiation Therapy for Early Breast Cancer.

For selected patients with early-stage breast cancer (BC), intraoperative radiation therapy (IORT) has emerged as a convenient alternative to standard whole breast irradiation (WBI). We report a single institution experience with IORT in terms of oncologic outcomes, toxicities, and cosmesis. Clinicopathological and perioperative outcomes of patients who underwent IORT for early-stage BC at a public hospital from 2017 to 2020 were retrospectively retrieved. Toxicity was categorized to acute or chronic based on 6 months post-IORT cutoff. 85 patients underwent IORT and had complete data, aged 49-85 years (mean 62). Intraoperative radiation therapy added 23 minutes on average to the total operative time. Final stage was 0, I, and II in 40%, 58.9%, and 1.1% of patients, respectively. Mean tumor size was 0.8cm (range .1-2.1), with ductal histology comprising 94% of cases. Surgical margins were positive in 2 patients, and adjuvant WBI was required in 5 patients. After a median follow-up of 17 months (range 3-41), none of the patients had local recurrence and no mortality was recorded. Early wound complications included wound dehiscence (n = 1), seroma/hematoma (n = 15), and re-operation with loss of nipple-areola complex (n = 1). Chronic skin toxicities were reported in 10 (12%) patients and good or excellent cosmetic outcome was reported in 93% of patients. Utilizing IORT among low-risk early BC patients may be a safe and more convenient alternative to traditional WBI, with low toxicity rate, acceptable cosmetic results, and good oncologic outcomes at 17 months. Longer follow-up and further prospective controlled studies are needed to confirm these findings.

OPAR: A Multicenter Phase II Randomized Trial of Fractionation Schedules for Once-a-Day Accelerated Partial Breast Irradiation (APBI)

<h3>Purpose/Objective(s)</h3> APBI is the delivery of radiotherapy (RT) to the tumor bed after breast conserving surgery (BCS) often given over a week or less. An attractive approach to deliver APBI is by external beam 3DCRT or IMRT. Previous studies have suggested that external beam APBI delivered twice-a-day can lead to increased late effects and poor breast cosmesis. The objective of our trial was to determine if two doses for APBI given once-a-day over 1-week result in acceptable long-term morbidity. <h3>Materials/Methods</h3> Eligible patients were > 50 years with DCIS or invasive breast cancer < 3 cm treated by BCS with negative margins and negative axillary nodes. Consenting patients were planned to receive APBI with 3-5 non-coplanar fields using a 3DCRT or IMRT and randomized to 27.5Gy or 30Gy each given in 5 fractions once-a-day over 5-8 days. Cosmetic evaluation with the EORTC Cosmetic Rating System was performed at baseline and 2 years by: a study nurse directly assessing the breast, and a group of oncologists unaware of RT regimen assessing photographs. Patient assessment of cosmesis was also performed at 3 years. Patients were followed for toxicity using the NCI CTCAE and recurrence. The primary outcome was adverse cosmesis (fair or poor global score) by photographic assessment at 2 years. The rate of adverse cosmesis with standard whole breast irradiation was 17% in our previous trial. Based on this consideration and one-sided α of 5% for each group, the upper bound of a one-sided 95% (two-sided 90%) confidence interval (CI) had to be < 23% for the treatment to be acceptable; 140 patients were required for each group. The proportion of patients with adverse cosmesis at 2 years and cosmetic deterioration from baseline to 2 years (excellent/good to fair/poor) with corresponding two-sided 90% CIs were estimated using the Wilson score method. The proportion of patients with any late breast toxicity (edema, induration, and telangiectasia) grades 2-3 at 2 years and local recurrence (LR) were also determined. <h3>Results</h3> Of the 281 patients: 139 were randomized to 27.5Gy and 142 to 30.0Gy. Median follow-up was 3 years. The mean age was 65 years; mean tumor size was 1.2cm. With respect to photographic assessment both schedules met our criteria for acceptability (Table 1). Adverse cosmesis assessed by nurse or patient and toxicity appeared to be less for 27.5Gy compared to 30Gy. No LRs were observed for 27.5Gy and one LR was observed for 30Gy. <h3>Conclusion</h3> According to the study design 27.5Gy and 30Gy resulted in acceptable cosmetic outcomes. In light of recent studies, the lower dose may be preferable in terms of late adverse effects but requires further evaluation.