Cosmetic Patient Satisfaction Research Articles

Hydroxyapatite orbital implant in children following enucleation: analysis of 531 sockets.

To evaluate the features and long-term outcomes of hydroxyapatite (HA) orbital implant following enucleation in pediatric patients. A retrospective review was performed on clinical records of patients ≤18 years of age , managed with enucleation and HA implant placement. Recorded outcomes included implant-related complications, implant and prosthesis motility, and patient cosmetic satisfaction. There were 525 children (531 sockets) with HA implant following enucleation. The mean age at HA implant placement was 3 years (median, 2 years; range, 4 days to 17 years). Indications for enucleation included retinoblastoma (n = 457, 86%), uveal melanoma (n = 17, 3%), medulloepithelioma (n = 8, 2%), and others (n = 49, 9%). The HA implant was uncoated (n = 370, 70%) or polymer coated (n = 161, 30%). For the 370 uncoated implants, wrapping was provided with scleral (n = 346, 94%) or bovine pericardium (n = 1, <1%), and 23 patients (6%) had no wrapping. The extraocular muscles were attached to the implant/polymer coat/wrap (n = 531, 100%), by suturing 4 rectus muscles (n = 349, 66%) or all 6 muscles (n = 182, 34%). Over mean follow up of 60 months, in 477 orbital implants, complications included conjunctival thinning (n = 10, 2%), implant infection (n = 6, 1%), implant exposure (n = 13, 3%), and implant migration/extrusion (n = 0, 0%). Motility for implant was judged as excellent (n = 245, 78%) and small-angle prosthesis motility was excellent (n = 196, 59%). Patient/family satisfaction with cosmetic outcome was rated as excellent in 471 implants (99%). Following enucleation in children, long-term outcomes of the HA orbital implant are excellent with favorable patient cosmetic satisfaction and rare complication.

Patient aesthetic satisfaction with timing of nasal fracture manipulation.

Introduction. To determine patient cosmetic satisfaction following nasal fracture manipulation under general anaesthetic when offered at different time intervals after injury. Materials and Methods. Prospective chart review of adult patients with nasal fractures treated by closed reduction at a busy district general hospital in Greater London over a 10-month period. Patients were asked by a standardised telephone interview about satisfaction with nasal cosmesis pre- and postoperatively using a Likert scale. Results. Seventy-six of 106 patients presented for nasal manipulation at up to 9 weeks after injury and were successfully contacted (72%) postoperatively. Forty-nine patients (64%) reported that they still would have had the surgery in retrospect. Those done within 1-2 weeks after injury resulted in the highest mean satisfaction score (4.56 ± 0.25). There was a negative correlation between patient satisfaction and timing of surgery (ρ = −0.37, P = 0.001). Of the patients satisfied or very satisfied with their procedure, 96% had it done within 4 weeks. Conclusion. The majority of patients treated with closed reduction of nasal fractures under general anaesthetic are satisfied with the cosmetic outcome and would still have undergone surgery in retrospect. Increasing time of surgery after 2 weeks resulted in lower patient satisfaction.

Abstract P5-14-10: Adjuvant intra-operative electron-beam therapy for early invasive breast carcinoma using non-dedicated linear accelerator: Toxicity, efficacy, and aesthetic satisfaction

Abstract INTRODUCTION: In May 2004 we started a prospective trial on adjuvant intraoperative electron-beam therapy (IORT) in early invasive breast cancer, but instead of a dedicated machine, we used a non-dedicated linear accelerator (NDLA). OBJECTIVES: To analyze early and late complications, cosmetic satisfaction of patients, and recurrence rates. METHODS: Patients with the following characteristics were included: invasive breast ductal carcinoma, local staging with mammogram, ultrasound and magnetic resonance imaging showing uni-central and uni-focal tumor, age≥40 years, T1N0. The procedure is done according to the following steps on table 1: PROTOCOL STEPS1Surgery performed in an operative room close to linear accelerator suite2Wide local excision with frozen sections of surgical margins and sentinel lymph node biopsy3If positive margins, they are expanded until negativity. If sentinel node positive, or multicentric/multifocal tumor, IORT is aborted4With both margins and sentinel lymph node free, the parenchyma round the surgical cavity is detached from skin and pectoralis major muscle. A shield (lead/aluminum/silicone disc) is placed underneath the breast parenchyma to avoid foward radiation5The breast parenchyma is sutured above the shield surface6The parenchyma thickness is measured for selection of the suitable electron energy7A collimator (cilindrical radiation applicator) is chosen for entire coverage of parenchyma8The patient is transferred from operative room to linear accelerator room and the collimator is attached to the machine9A portal-film (6MV photon-beam) is taken to check the alignment between the shield and applicator10If portal-film shows unfavorable positioning, the shield is realigned and a new portal-film is taken. Upon satisfactory condition, a single dose of 21Gy is delivered at 90% isodosis11After IORT completion the surgical procedure is ended RESULTS: Initially 194 patients were included, but due to intraoperative exclusion criteria (positive sentinel lymph nodes or margins), 159 were analyzed. The median age was 57.9 (40 to 85.4) years and the median follow-up was 56.6 (1 to 103.2) months. Seven patients recurred (4 local and 3 regional). The average estimates for overall and event-free survival were respectively 95.4 (CI 95% 93.1-97.6) months and 90.1 (CI 95% 85.8-94.5) months. The crude incidences for acute (up to one month after surgery) and late (after one month) toxicities were respectively 8.2% and 26.2%. Excellent, good, fair and bad cosmetic outcomes (Harvard/NSABP/RT OG scale) were observed in 70.9%, 14.2%, 3.7% and 3.0%, respectively. Collimator sizes were 4cm in 18.7%, 5cm in 80.6%, and 7cm in 0.7% of cases. The electron energy chosen for treatment was 6MeV in 7.4%, 9MeV in 52.2%, 12MeV in 35.8%, 15MeV in 3.7% and 18MeV in 0.7%. The alignment between the shield and the collimator was appropriate in 72.4% (27.6% of patients required repositioning). No infection cases were related to peri-hospitalar time. CONCLUSIONS: IORT using NDLA has shown low toxicity profile, high favorable aesthetics outcomes, and good oncologic efficacy. The use of NDLA may be usefull in settings without dedicated equipment for breast IORT. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-10.

Round Block Technique Without Cerclage in Breast-Conserving Surgery

Round block technique is a unique breast resection through periareolar doughnut incision. However, it is more technically challenging and time consuming. We simplified the procedure by exclusion of round block cerclage. The purpose of this study was to introduce our round block technique without cerclage and to evaluate the results of oncological and cosmetic outcomes. A total of 92 patients with centrally located breast cancer were treated with breast-conserving surgery using round block technique at Samsung Medical Center from July 2009 to May 2012. All patients had a small breast defect with excised breast volume less than 20 % compared to the total breast volume. We minimized the extent of skin removal and used simple interrupted inverted intradermal sutures without cerclage in doughnut closure. Patient's cosmetic satisfaction was assessed by subjective questionnaires at least 6 months after the operation. The median size of tumors was 1.7 cm (range 0.5-5.0 cm). The average distance of the tumors from the nipple was 2.0 cm (range 0.0-4.0 cm) on sonogram and most of the tumors were located upper breast (82.6 %). The median operative time was 101.5 min (range 55-180), including axillary surgeries. Median follow-up was 12.0 months (range 2-36), and none of patients have developed local recurrence. Up to the longest 3 years of follow-up, favorable cosmetic results have been found in patients treated with round block technique. Round block without cerclage is technically easy and feasible for centrally located breast tumors with favorable cosmetic results.

Natural orifice translumenal endoscopic surgery: Current status and future technical development

The technology behind NOTES, an evolutionary endoscopic surgery conducted through the natural orifices of the patient to completely eliminate external post-operative scars, has been substantially improved in the last decade. The scarless nature of NOTES is believed to decrease the chance of wound infections and incision hernias, improve recovery times and increase the cosmetic satisfaction of patients. Although various animal and human studies have extended our understanding of physiology and the requirements of NOTES procedures, current NOTES technology is still too rudimentary to be applied to various clinical settings due to the technical and instrumental limitations. Recently, numerous efforts have been made in the development of proper surgical instruments for NOTES procedures. A secure closure method for luminal perforation is one of the most actively investigated areas, and several promising devices have already been introduced. A virtual navigation system for flexible endoscopic instruments would be beneficial for surgical reliability and safety issues by assisting the narrow endoscopic visual field. Various retraction devices are also necessary to enable complex endoscopic surgical maneuvers. Unfortunately, engineers have only taken supportive roles in the history of NOTES development, though engineering experience and knowledge are crucial for the development of complicated and miniaturized endoscopic devices. The active involvement of engineers in NOTES technology is required for the realization of NOTES in routine clinical practice.

Anteroinferior 2.7-mm Versus 3.5-mm Plating for AO/OTA Type B Clavicle Fractures

To compare the Disability of the Arm, Shoulder, and Hand (DASH) and Constant scores, time to union, rate of union, patient cosmetic satisfaction rate, and the need for secondary procedures between 2.7- and 3.5-mm anteroinferior plating for Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type B clavicle fractures. Retrospective, comparative cohort clinical outcomes study. Level I university trauma center. PATIENTS/PARTICIPATION: Thirty-seven patients with an AO/OTA type B clavicle fracture who underwent open reduction internal fixation with either a 2.7- or 3.5-mm reconstruction plate placed in the anterior-inferior position. The main outcome comparisons included DASH score, Constant score, time to union, rate of union, rate of hardware failure, cosmetic satisfaction, and secondary procedure. DASH score, constant score, time to union, rate of union, cosmetic satisfaction, secondary procedure. At 1-year follow-up, analysis yielded no significant differences in DASH scores (P = 0.26) and Constant Shoulder scores (P = 0.79) between the 2 cohorts. There were no statistically significant differences in the time to union (P = 0.86) and the rate of union (P = 0.49). Although the 2.7-mm cohort had a lower reoperation rate, it was not statistically significant (P = 0.11). However, the 2.7-mm cohort did demonstrate a significantly higher rate of cosmetically acceptable reconstruction (P = 0.003). Compared with 3.5-mm anterior-inferior plating, 2.7-mm anteroinferior plating for AO/OTA type B clavicle fractures leads to significantly higher rates of cosmetic acceptability while reducing the need for a secondary procedure and achieving excellent clinical outcomes as measured by the DASH and Constant scores. There were no differences between the 2.7 and 3.5 cohorts in time to union or in union rate. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Endoscopic Surgery and Open Surgery for Gluteal Muscle Contracture

To compare the clinical effects of endoscopic surgeries with traditional open surgeries in the treatment of gluteal muscle contracture and discuss their indications and value. In this retrospective study, 50 patients received traditional open surgeries and 52 received endoscopic surgeries. The 2 groups were compared in terms of surgery duration, incision lengths, postsurgical pain, complications, off-bed activity times, hospitalization duration, clinical outcome, and 1-year recurrence rates. The endoscopic surgery group was significantly superior to the open surgery group in regard to incision length, postsurgical pain, off-bed activity time, hospitalization duration, and patient cosmetic satisfaction. Differences were not statistically significant for the surgery duration, complications, clinical outcome, or the 1-year recurrence rate. All the endoscopic surgery group patients stated that they would choose endoscopic surgery again. The endoscopic release of gluteal muscle contracture is safe and reliable, with the advantages of less trauma and pain, shorter operative time, earlier rehabilitation, and return of functional activities. Its application, though, should be carefully controlled based on the indications. It is applicable to degree I and II patients, but may be used only very cautiously in degree III patients. Level III.

Single access cholecystectomy using standard laparoscopic instruments

The aim of this study was to verify feasibility and safety of single incision laparoscopic cholecystectomy using conventional surgical instruments. Twenty patients underwent single incision laparoscopic cholecystectomy. Indications for cholecystectomy were symptomatic cholelithiasis. Operative time, postoperative length of stay, intraoperative and postoperative complications, postoperative pain (by visual analogue scale), and patient cosmetic satisfaction were considered. All 20 procedures were successfully concluded without additional skin incisions. The mean operative time was 69±16min with a trend toward a reduction in operating time with increasing surgical experience. Intraoperative bile leakages for gallbladder rupture were observed in only three cases. No postoperative complications were recorded. The median pain scale value was 3 and the median value of cosmetic satisfaction was 3. The mean postoperative length of stay was 1.3±0.9days. Single incision laparoscopic cholecystectomy with conventional surgical instruments is a feasible and safe procedure, but additional studies in larger series are needed to confirm our results.

Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part III—Reconstruction following Breast Conservative Treatment

Of the relatively few studies that exist regarding the cosmetic satisfaction of patients following breast conservation therapy, several indicate significant dissatisfaction in many patients. Breast conservation often results in some of the most challenging and complex reconstructive problems. Indeed, even defining the problem or analyzing the defect can be difficult for the junior surgeon. For the more seasoned reconstructive surgeon, analyzing the problem and applying solutions may be less difficult, but clearly communicating the defects typically seen after an aggressive lumpectomy and radiotherapy can be difficult, especially with trainees or junior surgeons. The goal of this article, the third in a four-part series, is to provide a template for the analysis and surgical reconstruction of defects resulting from breast conservation therapy utilizing a systematic three-step method. Part I of this series described the three main anatomical features of the breast--the footprint, the conus of the breast, and the skin envelope--and how they interact. By systematically analyzing the breast with this three-step method, a "problem list" based in specific anatomic traits of the breast can be generated, allowing the surgeon to then generate an appropriate surgical plan for reconstruction. Surgical approaches based on the percentage of breast parenchyma resected are suggested, with a focus on glandular rearrangement, breast reduction techniques, and locoregional flaps. The three-step method of breast analysis, evaluating the anatomical deformation of the breast footprint, conus, and skin envelope, remains the fundamental "fall-back" principle of this approach.