Aesthetic Results In Patients Research Articles

Satisfacción con los resultados estéticos de la reconstrucción mamaria posmastectomía, en el Instituto Nacional de Oncología y Radiobiología (INOR) de Cuba, mediante el cuestionario BREAST-Q

IntroductionThe surgical treatment of breast cancer leaves deforming sequelae; therefore, breast reconstruction is considered an integral part of the treatment. Evaluating patient satisfaction with the aesthetic results of reconstruction is one way to assess the effectiveness of the surgical techniques used. ObjectivesTo evaluate satisfaction with aesthetic results in patients reconstructed after mastectomy and to compare these results with frontal breast symmetry after surgery. MethodsA case series study was conducted in 40 reconstructed post-mastectomy patients from 2013-2018 at INOR. Satisfaction with aesthetic results was evaluated using the modified Breast Q survey. Differences in satisfaction levels between groups of covariates were determined by the non-parametric Kruskal-Wallis test. The results were correlated with measurement of post-surgical global frontal symmetry using Spearman's correlation. ResultsHigh satisfaction levels were obtained in reconstructed patients in the evaluated scales, with medians above 95 points. Scores were significantly higher in patients aged between 35 and 54 years (p<0.05). Satisfaction with breast appearance correlated positively and significantly with post-surgical frontal symmetry. ConclusionsThe high satisfaction levels achieved suggest a high effectiveness of the reconstructive surgical techniques used, especially with latissimus dorsi plus implant technique; this statement is verified by the positive correlation between satisfaction with the appearance of the breasts and the overall post-surgical symmetry.

Umbilical closure using 2-octyl cyanoacrylate in transumbilical laparoscopic adrenalectomy: A randomized controlled trial.

To evaluate postoperative pain and esthetic outcomes in patients undergoing transumbilical laparoscopic adrenalectomy with wound closure using 2-octyl cyanoacrylate. A total of 26 patients who underwent laparoscopic adrenalectomy with the transumbilical approach and agreed to participate in this study were included. Patients were randomly divided into two groups: the 2-octyl cyanoacrylate group (Glue group) or the non-use group (non-Glue group). A single surgeon (AM) carried out all procedures between 2014 and 2017. There were no significant differences in the clinical background of the Glue and non-Glue groups. The number of patients with moderate or high levels of pain in the resting/moving period on postoperative days1, 2 and 3 was 6/10 (46%/77%), 6/9 (46%/69%) and 3/5 (23%/38%) in the non-Glue group, and 5/7 (38%/54%), 2/7 (15%/54%) and 1/3 (8%/23%) in the Glue group. These differences were not significant. In the subgroup analysis of patients aged <50years, the numbers were 4/6 (57%/86%), 5/7 (71%/100%) and 3/5 (43%/71%) in the non-Glue group, and 3/4 (33%/44%), 1/4 (11%/44%) and 0/1 (0%/11%) in the Glue group in the resting/moving period. On postoperative days2 and 3, these differences were significant (P=0.035 and 0.037 in the resting period, and P=0.017 and 0.013 in the moving period). 2-octyl cyanoacrylate can be used safely for laparoscopic adrenalectomy with the transumbilical approach, and might be useful for reducing postoperative pain in patients aged <50years.

Keystone flap: a safe coverage option in the handling of salvage for myelomeningocele

Myelomeningocele (MMC) is the most common and severe pathology of open spina bifida compatible with life. Its early closure is an urgent therapeutic objective to reduce the morbidity and mortality of neonates, being a surgical challenge with two major objectives: (1) achieve closure of the dural cerebrum-spinal fluid fistula and (2) ensure a stable and durable soft tissue coverage. The use of fasciocutaneous flaps in keystone design is shown as a safe and stable surgical option with excellent aesthetic results in patients with MMC and who presented failed primary closures. Two clinical cases of fasciocutaneous flaps in keystone design were described as a coverage option in patients with lumbosacral MMC, in whom the primary closure was unsuccessful and required a safe coverage as a priority. Successful coverage of the lumbosacral defect was performed using keystone flaps in neonatal patients with MMC and previous manipulation of the soft tissues when attempting primary closure, but they have had dehiscence of the wound, with a large area of lumbosacral defect and sizeable defect/back ratio. The use of keystone flaps is a useful, accessible, and versatile technique as a management option for lumbosacral coverage defects in MMC, achieving a stable and safe covering of the meninges, without cerebrum-spinal fluid fistulas, which also allows the primary closure of the soft tissues in the donor area. The safety of this type of flap when used as salvage in lumbosacral defects with previously handled and raised tissues could infer that it is reliable enough to be considered as a first surgical option in the initial management of MMC.

Nipple-Sparing Mastectomy Long-Term Outcomes: Early and Late Complications.

Background and Objectives: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being destructive to being more respectful of the anatomical and physiological integrity of the gland. The aim of the breast surgery should be finalized to obtain the best aesthetic and functional results, respecting the principles of oncologic radicality. The present study is a retrospective analysis aimed to evaluate the long-term outcomes of a conservative technique like the nipple-sparing mastectomy. Materials and Methods: We observed 894 patients with a median age of 47.5 years old, underwent nipple-sparing mastectomy between 2002–2017. The data acquired include population and tumor characteristics, patient reconstructive outcomes, including locoregional, regional, and distant metastases; other variables, among nipple–areola complex necrosis and infection were collected. Results: The complications detected were considered as “early” within 1 month later the nipple-sparing mastectomy or “late” after this time. The overall complications rate (early and late) and the overall survival and the relapses detected by this study were comparable with those reported in the literature. In order to identify factors that correlate with complications, either early or later, it has been processed an evaluation of the univariate analysis showing adjuvant chemotherapy as the only predictive factor for late complications, while we encountered no predictors for early complications. Conclusions: The present study adds to the data already present in literature, demonstrating that the nipple-sparing mastectomy is a safe procedure, providing good oncological and aesthetic results in patients carefully selected.

Management of Large Facial Defects.

There is considerable variation in the surgical management of patients with large facial defects after excision of skin malignancy. The surrounding facial subunits as well as local, regional, and distant soft-tissue flaps can be considered in more complicated facial defects. We place an emphasis on the versatility of adjacent tissue advancement and transposition flaps in the treatment of these defects. We also focus on the secondary reconstructive efforts necessary to achieve the best functional and aesthetic outcomes for patients.

Classification of the concha-type microtia and their new suitable treatment strategies without autogenous costal cartilage grafting

ObjectiveNumerous corrective methods have been successfully applied in concha-type microtia reconstruction over the past several decades, and autogenous rib cartilage grafting has become a routine technique in a two or three-stage operation. However, it still remains a challenge due to the effective use of the large volume of the remnant cartilage and skin involved. The objective of this study was to clarify how this remnant cartilage and skin could be manipulated for new suitable treatment strategies without autogenous costal cartilage grafting. MethodsA total of 424 patients with concha-type microtia operated at our Center from January of 2012 to June of 2019 have been reviewed and analyzed cases. At the same time, a classification system for grading the severity of concha-type microtia was created on the basis of anatomical findings and ear size. ResultsA total of 436 ear cases (involving 424 patients), showing concha-type microtia, were included in our study and reviewed through medical records, photographs, analysis of surgical methods, and postoperative outcomes. The concha-type microtia were classified into four graded types: Grade I (n = 151), Grade II (n = 101), Grade III (n = 93), and Grade IV (n = 79). A total of 352 ears in 345 patients with Grade I to III concha-type microtia were followed up for 1 month to 7 years (average, 14.7 months). 329 patients (95.4%) were satisfied with the aesthetic outcomes of the corrected ear. ConclusionsIndividual corrective methods and aesthetic outcomes for patients with Grade I to III of deformity were described in this study. The authors present new suitable approaches according to a progressive classification system which provide conservative and individualized methods of treatment in early stages of life.

Cross-cultural adaptation and psychometric validation of the Patient Scar Assessment Questionnaire to the Spanish language in head and neck surgery.

External appearance is the main aesthetic outcome in patients who undergo surgical procedures. Scars located in exposed areas, such as the neck and face, are important for patients. There are at least eight instruments that are used to evaluate postoperative scars, but few fulfil standard methodological conditions. The Patient Scar Assessment Questionnaire (PSAQ) was designed and validated using psychometric methodology. However, this scale has not been translated or validated in the Spanish language. The aim of this study was to undergo a cross-cultural adaptation and psychometric validation of the PSAQ scale to the Spanish language in patients who underwent head and neck surgery. We followed The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for the translation and validation of health-related scales. Forward and back translations were made by independent translators. We included adult patients who underwent thyroidectomy, parathyroidectomy, parotidectomy, and neck dissection. For the psychometric validation, we used a principal axis exploratory factor analysis with oblimin rotation. A reliability test involving Cronbachs alpha and the item-total correlation was performed and for the convergent/concurrent validity, we selected the Spanish version of the Vancouver Scar Scale. A total of 180 patients were recruited. Factor analysis showed a five-factor solution. Cronbachs alpha for the subscales was >0.7. The comparison between the PSAQ appearance subscale and the VSS demonstrated a high correlation (rho = - 0.89). In a sample of 62 patients, the test-retest evaluation showed high correlation (0.74-0.99). Our study supports the Spanish version of the PSAQ as a valid, reliable, and reproducible tool to assess the perception and impact of neck scars in Spanish-speaking patients who undergo head and neck surgery.

Role of enamel microabrasion associated with external bleaching in the management of patients with dental fluorosis

La fluorose dentaire est une anomalie de développement qui affecte l'aspect esthétique des dents. L'association de la micro-abrasion à l'éclaircissement externe a montré des résultats satisfaisants pour l'amélioration de l'esthétique des dents atteintes de fluorose légère. L'objectif de ce travail est de mettre le point sur l'intérêt de cette association ainsi que sur ses différents effets sur la surface amélaire.

Predictors affecting complications and aesthetic outcomes in autologous breast reconstruction with free muscle-sparing transverse rectus abdominis myocutaneous flaps.

Identification and understanding of predictors for complications and aesthetic outcomes in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap are essential for successful breast reconstruction. The purpose of this study was to investigate predictors for complications and aesthetic outcomes in patients who underwent autologous breast reconstruction with free MS-TRAM flaps. Between March 2003 and September 2017, a total of 214 patients who underwent breast reconstruction with MS-TRAM flaps were included in this study. Mean age of the patients was 43.2 years (range, 28-61 years). Four outcome data, including operation time, hospital stay, aesthetic scores, and complications; and 12 patient data, including recipient vessel type, age, body mass index [BMI] > 25, smoking status, neoadjuvant chemotherapy, radiotherapy, nipple-sparing mastectomy, contralateral breast surgery, history of hypertension, diabetes mellitus, cardiac disease, and endocrine disease were collected. Five and 52 patients experienced major complications, including partial flap loss, and minor complications, respectively. In stepwise multiple logistic analysis, risk factors for complications were BMI > 25 (P < 0.001), smoking status (P = 0.012), and neoadjuvant radiotherapy (P = 0.002). BMI > 25 (P < 0.001), smoking status (P < 0.001), contralateral breast surgery (P < 0.001), and history of cardiac (P = 0.001) and endocrine disease (P = 0.003) were predictors for aesthetic outcome. Predictors for complications and aesthetic outcomes determined in this study may facilitate microsurgeons engaged in the assessment of patients needing free MS-TRAM flaps.

Balcony genioplasty: a novel technique for better esthetic results in patients with deep mentolabial fold

BackgroundTo introduce a novel technique for advancement genioplasty helping surgeons to avoid soft tissue difficulties especially in short-faced patients with deep mentolabial fold and everted lower lip.Case presentationIn a trapezius-shaped, osteotomy was performed in the chin region. The mobilized segment was advanced, and the existing gap was grafted using interpositional allograft materials. Each side had been fixated by three-hole plates and two screws. The outcomes revealed no change in lower anterior teeth vitality. The patients did not report any changes of sensation in lower lip and chin either. The measurements indicated no increase in depth of mentolabial fold in patients undergoing this surgical technique. The postoperative evaluation showed a successful esthetic outcome for the patient and the surgeon concurrently.ConclusionBased on our experience, the authors concluded that the Balcony technique is a simple and reliable procedure for patients with a deep mentolabial fold.

Transposition of Duplicated Thumb for Reconstruction of Asymmetric Radial Polydactyly

In this study, we present the long-term functional and aesthetic outcomes in patients with complicated asymmetric radial polydactyly treated with this surgical technique involving the transposition of a duplicated thumb. We evaluated 6 thumbs in 6 patients who underwent radial polydactyly reconstruction using the transposition of duplicated thumb procedure between 2001 and 2017. The procedure was used when one of the thumbs was not obviously dominant over the other, with one having a better proximal portion and the other having a better distal portion. The average age at the time of surgery was 35 months, and at the final follow-up, average age was 86.5 months. Objective outcome values were obtained, and the Japanese Society for Surgery of the Hand evaluation form was adopted to assess functional and cosmetic outcomes. Neither soft tissue loss nor nonunion of the osteotomy was noted. No patients reported pain or difficulties in their activities. Mean flexion-extension arc for the metacarpophalangeal joint was 72.9° (range, 8.8° extension to 64.1° flexion), and that for the interphalangeal joint was 44.0° (range, 5.7° extension to 38.3° flexion). Mean key pinch, tip pinch, and grip strength of unaffected thumb were 75.1%, 68.7%, and 81.9%, respectively. Total scores using the Japanese Society for Surgery of the Hand scoring system averaged 18.2 points, and the results were excellent in 1 case and good in 5. Transposition of duplicated thumb can provide durable functional and cosmetic results for Rotterdam types IV and VI with asymmetric radial polydactyly in which neither thumb has adequate distal and proximal components.

Periumbilical Perforator-Sparing Abdominoplasty in Patients With Abdominal Scars.

Abdominoplasty is one of the most common cosmetic surgical procedures. Patients who undergo abdominoplasties with abdominal scars are at an increased risk for skin necrosis and wound breakdown. To prevent further disruption of vascularity, the dissection and mobilization is often limited resulting in a suboptimal esthetic result. The periumbilical perforator-sparing technique allows for vascular preservation and adequate mobilization to produce excellent esthetic results in patients with abdominal scars.

Abstract 16.05 VASCULARIZED COMPOSITE ALLOTRANSPLATATION AS THERAPEUTIC STRATEGY FOR BURNED PATIENTS

Traditional reconstructive methods can fail in achieving a good functional and aesthetic outcome in patients with extensive defects, involving multiple layers of functional tissue, often necessitating numerous, and staged, surgical interventions with unsatisfactory results. Transplantation of vascularized composite allografts(VCA) opened a new, promising era in reconstructive surgery, offering a unique restorative opportunity for those complex situations. In order to extend VCA indications, further studies are needed to develop less toxic immunosuppressive regimens and possibly achieve donor-specific tolerance, the ideal situation in transplantation. Extensively burned patients, especially of the face and cervical region, having severe mutilations and also unilateral or bilateral hand amputations, like after high voltage electric injuries, present functional and aesthetic deficits, with devastating impact on their quality of life and, constituting potential candidates for receiving a vascularized composite allotransplantation, as the only reconstructive solution. With this paper, we discuss the indications and limits, from clinical and immunological perspectives, of the consideration of VCA as surgical option for burn patients with complex tissue defects, impossible to approach by conventional techniques.

Modified lower eyelid blepharoplasty improves aesthetic outcomes in patients with hypoplastic malar prominences

Modified lower eyelid blepharoplasty improves aesthetic outcomes in patients with hypoplastic malar prominences

Is the transposition of the nipple-areolar complex necessary in Simon grade 2b gynecomastia operations using suction-assisted liposuction?

Objective: The aim of this study was to assess the efficacy of suction-assisted liposuction (SAL) in Simon grade 2b gynecomastia and its effect on sternal notch to nipple areola (SNN) distance.Methods: A retrospective analysis was performed on 21 patients with grade 2b gynecomastia who underwent SAL. Preoperative and postoperative SNN distances of the patients were measured, the results were analysed using a Mann–Whitney U test and a p-value <.05 was accepted as statistically significant. Aesthetic results were evaluated by the surgical team considering five criteria: breast size, breast shape, nipple-areolar complex positioning, scarring, and skin tightness of the breast envelope. A 10-point Likert scale was used to assess patient satisfaction with SAL surgery.Results: All of the patients were followed up for an average period of 17.8 months (range = 12–28 months). The mean amount of lipoaspirate was 232 mL per breast (range = 190–310 mL). The mean preoperative SNN distance was 22.3 cm (range = 20–23.5 cm), whereas postoperative was 21.3 cm (range = 19.2–22.8 cm); the difference was statistically significant (p < .05). There was one case of nipple areola necrosis, three hypoesthesia, five persistent pains, and four slight buttonhole deformities. The aesthetic result was evaluated as very good by the surgical team, and the overall patient satisfaction rate in terms of breast shape and volume was 92%.Conclusions: It was concluded that SAL provides a good aesthetic outcome in patients with Simon grade 2b gynecomastia and shortens the SNN distance by 1 cm, but further clinical studies are required to support this conclusion.

The potential role of three-dimensional surface imaging as a tool to evaluate aesthetic outcome after Breast Conserving Therapy (BCT)

PurposeTo establish whether objective measurements of symmetry of volume and shape using three-dimensional surface imaging (3D-SI) can be used as surrogate markers of aesthetic outcome in patients who have undergone breast conserving therapy (BCT).MethodsWomen who had undergone unilateral BCT in the preceding 1–6 years were invited to participate. Participants completed a satisfaction questionnaire (BREAST-Q) and underwent 3D-SI. Volume and surface symmetry were measured on the images. Assessment of aesthetic outcome was undertaken by a panel of clinicians. The Kruskal–Wallis test was used to assess the relationship between volume and shape symmetry measurements with the panel score. Spearman’s rho correlations were used to assess the relationship between the measurements and patient satisfaction.Results200 women participated. Median volume symmetry was 87% (IQR 78–93) and shape symmetry was 5.9 mm (IQR 4.2–8.0). The participants were grouped according to panel assessment of aesthetic outcome (poor, fair, good, excellent) and the median volume and shape symmetry was calculated for each group. Volume symmetry significantly differed between the groups. Post hoc pairwise comparisons demonstrated that these differences existed between panel scores of fair versus good and good versus excellent. Median shape symmetry also differed according to patient panel groups with four significant pairwise comparisons between poor versus good, poor versus excellent, fair versus good and fair versus excellent. There was a significant but weak correlation of both volume symmetry and surface asymmetry with BREAST-Q scores (correlation coefficients 0.187 and −0.229, respectively).ConclusionBreast volume and shape symmetry are both associated with panel assessment scores and patient satisfaction. The objective volume and shape symmetry measures were strongly associated with panel assessment scores, such that a 3D-SI tool could replace panel assessment as a faster and more objective method of evaluating aesthetic outcomes.

Evaluation of the decision-making process in the conservative approach to small testicular masses.

We evaluate the clinical outcome of patients treated with conservative approach for small testicular masses (STMs). We analyzed the steps who brought to the selection of the therapeutic approach: starting from clinical presentation, through imaging and lab studies. We considered 18 patients who underwent an organ-sparing approach for STMs from 2005 until 2014. The selection criteria were dimension of the mass and absence of clinical, laboratory and/or radiological malignancy suspicion. Preoperative scrotal ultrasound (US) was carried out in all the patients by the same radiologist. The postoperative fertility profile was evaluated in patients younger than 40 years. We performed 13 enucleations, one partial orchiectomy (PO) and four active surveillances. During surgery, a frozen section examination (FSE) was always requested and no discrepancies were noted between its results and the definitive histology. Only one seminomatous tumor was identified, while the remaining masses were four necrosis, four epidermoid cysts, three Leydig tumors, one Sertoli tumor and one chronic orchitis. After a mean follow-up of 41.6 ± 24.7 months, all the patients resulted free of disease and hypogonadism and five of them reached the fatherhood after surgery. The clinical and instrumental evaluation consented an accurate selection of patients eligible for the organ-preserving approach. We believe that testis-sparing surgery leads good functional and aesthetic results in patients with benign lesions; it is a safe option for STMs with a reliable pathologist performing FSE and is an important goal in young patients with fatherhood desire.

Lipostructure Plus Platelet Rich Plasma Injections for Enophthalmos Treatment in Patients Carrying Prosthetic Eye- Safety and Efficacy

Purpose: To describe one-year functional and aesthetic outcomes in patients with post-enucleation enophthalmos who underwent lipostructure plus platelet-rich plasma injections. Materials and Methods: 26 patients treated with orbital lipostructure and three platelet rich plasma injections at 1, 2 and 6 months after surgery were retrospectively assessed. Photographs of all patients were taken preoperatively and at 1 and 12 months after surgery. The area of each eye lid esthetic unit/subunit was calculated, both in frontal and profile images. Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, Illinois, USA). Paired t-test was used to compare the unit/subunit areas before and after surgery. Differences were considered significant when P &lt;0.05. Results: Comparing baseline to 1-month images, an improvement of the enophthalmos appearance was observed in all patients. Analysis of each single esthetic units was performed, with an overall unit area reduction of 19.8%. Comparing the two postoperative images, the overall amount of resorption was 12.75%. The surgical procedure appeared to be well tolerated in all cases. Minor complications regarding the lower eyelid were recorded in 6 cases. Conclusions: lipostructure plus platelet rich plasma injections proved to be a valid and effective option for the treatment of post enucleation socket syndrome.

No evidence that bone thickness will affect soft-tissue and esthetic outcomes in patients with thin buccal bone undergoing immediate implant placement in the anterior maxillary zone

Arora H, Ivanovski S. Correlation between pre-operative buccal bone thickness and soft tissue changes around immediately placed and restored implants in the maxillary anterior region: a 2-year prospective study [published online ahead of print July 29, 2016]. Clin Oral Implants Res. http://dx.doi.org/10.1111/clr.12939.

Treatment options and outcome after bony avulsion of the flexor digitorum profundus tendon: a review of 29 cases

The objective of this retrospective review was to evaluate the functional and esthetic outcomes in patients with non- or minimally (<2mm), and severely (>2mm) displaced bony avulsions of the flexor digitorum profundus (FDP) tendon. Between 1996 and 2010, 29 patients with a bony avulsion of the FDP tendon were treated. The displacement magnitude of the avulsed fragment determined, whether conservative or surgical treatment was performed. Persisting functional deficit, radiological findings, remaining disabilities using the Disability of the Arm, Shoulder, and Hand (DASH) score, as well as treatment-related deformities and complications were evaluated retrospectively and at a mean follow-up of 7 years. In 16 patients, conservative therapy by initial static splinting due to a fragment displacement of <2mm was conducted. These patients reported no functional impairment at follow-up. In 13 cases, major displacement (>2mm) of the bony fragment led to an open reconstruction of the avulsion injury either by screw fixation or a Lengemann pull-out wire. In a majority, an extension deficit in the DIP joint and a decrease of tip pinch strength by 25% was present at follow-up. In five patients, peri- or short-term postoperative complications occurred and in five, a nail deformity remained. DASH score revealed satisfying results after both therapeutic approaches. Conservative treatment in non- or minimally displaced avulsions leads to satisfying functional results. Patients receiving surgery after major fragment displacement need to be aware of a possible impaired ROM at the DIP joint. The use of the Lengemann pull-out wire may place patients at an increased complication risk and frequently induces nail deformities. Therapeutic, level IV.