Cosmetic Sequelae Research Articles

3-dimensional stereophotogrammetry: an effective tool for detecting disease progression in lupus erythematosus panniculitis.

Lupus erythematosus panniculitis (LEP) is a rare variant of chronic cutaneous lupus erythematosus (CCLE) that commonly affects the face, upper arms, thighs, and buttocks, and is distinguished by its potential to cause irreversible scarring, lipoatrophy, and disfigurement. disease activity and prevent significant cosmetic sequelae. Even in patients with a known diagnosis of LEP, monitoring for ongoing disease activity can be challenging as overlying erythema and evolving subcutaneous nodularity and/or atrophy can be subtle. Herein, we report the first case of a patient with facial LEP monitored longitudinally with 3D stereophotogrammetry.

Reduction Cranioplasty in Cases of Hydrocephalic Macrocephaly: Pearls and Pitfalls of Computer-Assisted Surgery.

Reduction cranioplasty may be indicated to address functional or cosmetic sequelae of hydrocephalic macrocephaly. With the advent of CAD/CAM digital workflow, surgeons can design and fabricate craniotomy guides, templates, and models that allow for precise cranial reconstruction. Although there are several advantages of virtual planning, pre-determined surgical plans may limit intraoperative flexibility, requiring surgeons to troubleshoot errors in pre-operative planning or model design. The purpose of this report is to present a series of cases demonstrating our institution's technique for single-stage reduction cranioplasty using a CAD/CAM workflow. This report will highlight the benefits and challenges associated with a contemporary digital workflow for reduction cranioplasty.

Secondary Autologous Fat Grafting for the Treatment of Chin Necrosis as a Consequence of Prone Position in COVID-19 Patients.

Due to the spread of the coronavirus disease 2019 pandemic, an increasing number of ill patients have been admitted to intensive care unit requiring mechanical ventilation. Although prone positioning is considered beneficial, long periods in this position may induce important complications, including pressure ulcers in high-risk and uncommon body areas. We report five cases of pressure ulcer necrosis of the chin in coronavirus disease 2019 patients as a consequence of mechanical ventilation in prone positioning using autologous fat grafting (AFG) as a secondary technique. A series of five patients with secondarily-healed chin necrosis treated by AFG between February and June 2020 were reviewed. All patients had been treated initially with surgical debridement followed by conservative treatment. Secondary AFG was performed to reduce patient's pain, improve chin contour-projection, and minimize cosmetic sequelae and scarring. Patient satisfaction was assessed using a five-point Likert scale (0-4). Vancouver scale was used to evaluate the chin scars clinically. The average amount of fat injected into the chin area was 8.1 ± 2.0 ml. At 6-month follow-up, all patients were mostly satisfied (average Likert-scale 3.2 ± 0.4). Based on the Vancouver scale, improvement of the chin scar from 9.5 ± 0.8 to 4.7 ± 0.8 was found. We report a positive experience with secondary AFG for correction of painful and unaesthetic scarring and contour abnormality following surgical debridement and secondary-intention healing of chin pressure ulcers.

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.

Impact of Chest Wall Perforator Flaps on Rates of Total Mastectomy in Breast Cancer.

Breast-conserving surgery (BCS) outcomes are comparable to mastectomy in breast cancer treatment. However, patients with large tumours were offered mastectomy due to the resulting poor cosmetic sequelae after standard BCS. With the introduction of chest wall perforator flaps (CWPF), BCS is an option in patients with large tumour:breast ratio. The objective of our study was to evaluate the surgical outcomes of CWPFs and their impact on mastectomy rates. In order to assess the impact of CWPF on mastectomy rates, patients who underwent breast cancer surgery from January 2016 to December 2019 were included in a cohort named group A. In group A, the type of surgery performed was collected for each year from January 2016 to December 2019. Patients who underwent BCS and CWPF from July 2016 to June 2021 were included in another cohort named group B. In group B, patient-related and disease-specific details including post-operative complications were collected and analysed. In group A, following the introduction of CWPF, the mastectomy rates dropped by 10.69% and the mastectomy with reconstruction rates dropped by 23.29%. In group B, a total of 152 patients underwent CWPF reconstructions. The median tumour size was 20mm (range = 0-80). A majority of patients were discharged within 24-h hospital stay (98.2%). Seventeen patients (11.11%) had a re-operation for margin positivity. Sixteen patients (10.46%) developed early complications and 19 patients (12.42%) developed delayed complications. CWPFs expand indications for BCS thus reducing mastectomy rates. It also has less morbidity when compared to reported mastectomy and reconstruction rates, thus making it a safe option for suitable patients.

Giant cell tumor of the tenosynovial type in the prevertebral space with a cervical approach

<p class="abstract">The complex anatomy of the neck makes surgical interventions of cervical neoplasms a very complex process. The aforementioned challenges the surgeon to find a surgical approach with the least morbidity and cosmetic sequelae. This is particularly true in tumoral occupation of the prevertebral space (PVS), most frequently due to the extension of neoplasms from naso and oropharynx; whereas primary tumors of the PVS are extremely rare. There are a number of surgical approaches to access the skull base and the anterior region of the upper cervical spine, such as the transcervical-transtemporal approach, retraction and dissection of the soft palate, mandibular osteotomy, medial glossotomy, among others. The following article presents a case report in which a less invasive combined transcervical-transoral approach was performed on a tenosynovial giant cell tumor of the PVS. As an alternative in the treatment of these type of lesions, it is in our opinion equally effective and less morbid.</p>

Mohs Defect Repair with Dehydrated Human Amnion/Chorion Membrane.

Importance: Reconstructing cosmetically sensitive defects in an aging population undergoing multiple Mohs micrographic surgeries (MMS) may be addressed with alternatives to surgery.Objective: Patients undergoing MMS with defect reconstruction in visually prominent areas receiving placental allograft were compared with traditional autologous tissue-based procedures—flaps and full-thickness skin grafts (FTSG).Design, Setting, and Participants: This retrospective case–control study evaluated patients who underwent MMS for removal of a basal or squamous cell carcinoma with same-day repair.Main Outcomes and Measures: The primary endpoint was the incidence and comparison of postoperative morbidity. Risk for developing medical or cosmetic sequelae was determined through multivariate logistic regression.Results: The study population consisted of 143 propensity score-matched pairs (n = 286) with moderate- to high-risk defects on the face, head, and neck. Compared with autologous tissue, placental allograft cases were associated with significantly lower risk for infection (p = 0.004), poor scar cosmesis (p < 0.0001), scar revision (p < 0.0001), or reoperation (p = 0.0007).Conclusions and Relevance: Postoperative complication rates for placental reconstructions did not exceed those demonstrated by autologous tissue counterparts, indicating this is a safe alternative to flap and FTSG in cosmetically sensitive repairs.

Blaschko-linear lichen planus of the face: A retrospective study of 6 cases and a literature review

Introduction and methodsDifferent clinical and histological variants of lichen planus (LP) exist, such as lichen planopilaris, pigmentosus, linear, or atrophic LP. Recently, some cases came to our attention of hyperpigmented and atrophic linear lesions of the face with lichenoid histology, suggesting a combination of these different variants. We carried out a single-center, retrospective descriptive study of 6 similar cases selected from our database and compared them with a literature review. ResultsThere were 4 males and 2 females of mean age 42 years. Each had linear lesions located on one side of the face. All lesions were initially itchy; they appeared hyperpigmented in all patients and atrophic in 5 cases. Biopsies indicated lichen planopilaris in 5 patients, with deep peri-eccrine involvement in 4 of them. Only 2 of the 6 patients had extra-facial lesions. Discussion and literature reviewWe found 24 cases in the literature having similar clinical and histological aspects. Men aged around 37 years seemed particularly affected. An atrophic course was noticed in 10 patients. Such a clinicopathological picture may suggest differential diagnoses like lichen striatus, lupus erythematosus, lichen sclerosus atrophicus, or Moulin's linear atrophoderma. Early histopathological examination could be of precious assistance in allowing the initiation of effective treatment immediately as of the initial inflammatory phase, thereby limiting the risk of cosmetic sequelae such as atrophy or residual pigmentation. ConclusionWe describe a form of facial lichen planus that is highly particular in terms of its follicular tropism, its blaschkoid distribution, its pigmented character, and its atrophic progression.

Traitement par chimiothérapie orale (sonidegib) de carcinomes basocellulaires étendus, à propos de 4 cas

Basal cell carcinoma (BCC) is the most frequent cutaneous carcinoma. Its incidence is constantly increasing, primarily due to sun exposure during the two first decades of life. The lower lid and medial canthus are the most common locations. In the majority of cases, surgery with sufficient margins is the first-line treatment. In the case of inoperable tumors (extensive lesions, poor general health, high surgical morbidity, unacceptable cosmetic sequelae), oral chemotherapy can be suggested. We report the follow-up of 4 patients with advanced non-metastatic basal cell carcinoma (BCC) treated with oral chemotherapy (sonigegib). All patients were female with a mean age of 80years. The first patient had an infiltrative BCC of the right lower lid with orbital invasion, the second a nodular BCC of the right inferior lid with massive cutaneous and orbital invasion extending to the controlateral medial canthal angle, the third an advanced infiltrative BCC invading both orbits and nasal cavities, and the fourth, an infiltrative BCC with extension to the ipsilateral skin of the face. The diagnosis of BCC was confirmed by multiple biopsies in our four patients prior to starting chemotherapy. Because of the locally advanced lesions, surgery was contraindicated in all cases, chemotherapy was undertaken (sonidegib 200mg daily), and ophthalmological and dermatological examinations were performed every 3months. In all 4 patients, the outcome was very favorable, with one clear regression in tumor size and infiltration and 3 partial regressions. Many side effects were noted, including nausea, muscle cramping, dysgeusia resulting in significant weight loss, and malnutrition in the elderly patients. The treatment had to be discontinued after 11months in the patient with total macroscopic regression because of major side effects. The treatment is still underway for the other patients and will be continued as long as a clinical benefit is observed. The treatment will be discontinued if intolerable side effects develop. Oral chemotherapy (sonidegib) is an effective alternative treatment when surgery cannot be realized, especially in the case of extensive infiltrative non-metastatic BCC.

28336 Outcomes of cosmetic procedures for treatment of morphea: A retrospective cohort study

Reconstructive surgery is recommended for cosmetic sequelae of morphea. We examined a retrospective cohort of 15 morphea patients who underwent a total of 41 procedures followed for 1-60 months postprocedure. The majority of patients were white (60%), female (60%), with facial linear morphea (93%). The most common procedure was fat grafting for facial morphea (75%, n = 30). Other procedures included gingival grafting (10%) and filler injections (7.5%). Recurrent disease activity was noted 8-36 months postprocedure in 4 patients, 3 after fat transfer and 1 after osteoplasty.

Nipple sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct-to implant reconstruction

IntroductionSpira technique is a type of nipple-sparing mastectomy that allows immediate reconstruction (IBR), ideal for ptotic breasts. Although, controversy persists regarding oncological results in breast cancer. The aim is to analyze complications, cosmetic outcomes, causes of reoperation and oncological results. MethodsRetrospective observational analysis of patients undergone surgery during 2003–2018 in our center. Study population is based on patients with breast carcinoma or undergoing prophylactic mastectomy due to high-risk, in which a skin-sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct to implant reconstruction was performed. Short and long-term complications, sequelae, tumor recurrence and survival rates are analyzed. ResultsA total of 247 mastectomies with immediate reconstruction in 139 patients, 216 bilateral (87.4%) and 31 unilateral (12.5%) were performed. 121 therapeutic (49%) and 126 prophylactic (51%). Median follow-up 81 months. Complications were observed in 16.2%; skin necrosis 5.3% and 5 cases of NAC necrosis (2%). Reoperation rate due to cosmetic sequelae was 17.4% (capsular contracture was the most frequent,11.3%) and a 39.3% of these patients have received RT. Recurrence of 14% (0.8% skin, 3.3% locoregional and 9.9% metastatic), 8 patients died (6.6%). Rates of FSD and OS were 92.6% and 93.3% respectively. ConclusionSpira mastectomy is a safe option and provides good cosmetic and oncologic results as breast cancer treatment and prophylaxis in moderate-large ptotic breasts.

Case of Angular Blepharitis Caused by Demodex folliculorum

Angular blepharitis is inflammation of the eyelid skin at the lateral canthus, most commonly caused by Staphylococcus and Moraxella species. The Demodex mite is an external parasite that often infests the human eyelid margin and has been implicated in both anterior and posterior blepharitis. The authors describe the case of a 43-year-old female who presented for evaluation of a 3-month history of bilateral canthal eyelid irritation, consistent with angular blepharitis. This is a case report and review of relevant literature. Skin biopsy showed evidence of Demodex folliculorum infestation. Multiple D. folliculorum organisms were visualized within the hair follicles and on the surface, along with pockets of acute and chronic nongranulomatous inflammation surrounding hair follicles. The patient was treated with tea tree oil applied to her eyelids and eyelashes twice daily with complete resolution of symptoms. To our knowledge, this is the first report of angular blepharitis with histopathologic confirmation of Demodex infestation. In this discussion, we cover manifestations of the Demodex mite, angular blepharitis, and treatment options. Due to the lack of literature regarding this entity, we feel that it may be an underrecognized periocular and dermatologic condition that can lead to misdiagnosis, visits to multiple practitioners, and significant functional and cosmetic sequelae to the patient. Demodex infestation should be considered on the differential diagnosis for cases of refractory angular blepharitis, particularly when unresponsive to topical steroids. Based on results from treating Demodex anterior and posterior blepharitis and this case, treatment with tea tree oil should be considered.

Cosmetic sequelae after oncoplastic breast surgery: long‐term results of a prospective study

To analyze risk factors for the cosmetic sequelae of patients treated with oncoplastic procedures and their impact on patient-reported satisfaction. Prospective nonrandomized study between 2003 and 2020. Complications and cosmetic sequelae were reported by the surgeon. We employed the Clough classification for oncoplastic procedures (Level 1 and Level 2) and to define the cosmetic sequelae (Type I, Type II and Type III). The assessment of satisfaction and quality of life was performed with the BreastQ™ questionnaire. 429 level 1 and 326 level 2 oncoplastic operations were included. We recorded 89 cosmetic sequelae: 55 deformities (type II), 29 asymmetries (type I), and 5 type III defects. The incidence of cosmetic sequelae at 10years for levels 1 and 2 oncoplastic procedures was 11.5% and 20.0%, respectively. The level 2 techniques and the postoperative complications increased the risk of cosmetic sequelae. Patients with cosmetic sequelae did not achieve significant improvements in breast satisfaction. Cosmetic sequelae affect up to 17% of oncoplastic procedures. Most of them appear during the first 5years. Cosmetic sequelae and their predisposing factors should be part of the shared decision-making process with patients, as well as part of the training programs for breast surgeons.

Mastectomía preservadora de piel con colgajo dermograso desepitelizado (técnica de Spira modificada) y reconstrucción mediante implante directo

Spira technique is a type of nipple-sparing mastectomy that allows immediate reconstruction (IBR), ideal for ptosic breasts. Although, controversy persists regarding oncological results in breast cancer. The aim is to analyze complications, cosmetic outcomes, causes of reoperation and oncological results. Retrospective observational analysis of patients undergone surgery during 2003-2018 in our center. Study population is based on patients with breast carcinoma or undergoing prophylactic mastectomy due to high-risk, in which a skin-sparing mastectomy with a de-epithelialized derma-fat flap (modified Spira technique) and direct to implant reconstruction was performed. Short and long-term complications, sequelae, tumor recurrence and survival rates are analyzed. A total of 247 mastectomies with immediate reconstruction in 139 patients, 216 bilateral (87.4%) and 31 unilateral (12.5%) were performed. 121 therapeutic (49%) and 126 prophylactic (51%). Median follow-up 81 months. Complications were observed in 16.2%; skin necrosis 5.3% and 5 cases of NAC necrosis (2%). Reoperation rate due to cosmetic sequelae was 17.4% (capsular contracture was the most frequent,11.3%) and a 39.3% of these patients have received RT. Recurrence of 14% (0.8% skin, 3.3% locoregional and 9.9% metastatic), 8 patients died (6.6%). Rates of FSD and OS were 92.6% and 93.3% respectively. Spira mastectomy is a safe option and provides good cosmetic and oncologic results as breast cancer treatment and prophylaxis in moderate-large ptosic breasts.

Closed reduction of zygomatic arch fractures by using Tubbs-Logan mitral valve dilator

Objective: To present technical details and experiences regarding the use of a Tubbs-Logan mitral valve dilator for the closed reduction of zygomatic arch fractures.Method: Over a period of about three years, closed reduction was indicated and performed in 22 patients with a zygomatic arch fracture. In all patients, depressed fracture segments were reduced using a Tubbs-Logan mitral valve dilator via the Gillies’ temporal approach.Results: The majority of the injuries were due to motor vehicle collisions (n=8, 36.4%). The zygomatic arch fracture was isolated in 12 patients (54.5%). However, it was a component of a zygomatic complex fracture in 10 patients (45.5%). Of those, rigid internal fixation of the zygomatic body was performed in 8 and the zygomatic body was only closely reduced by a bone hook in 2 patients. Repair of a concomitant orbital floor fracture was performed in 2, a mandibular angle fracture in 1 and a frontal sinus fracture in 1 patient. The reduction status of the zygomatic arch was excellent in 12 (54.5%), good in 8 (36.4%) and fair in 2 patients (9.1%). During the follow-ups, no functional or cosmetic sequelae regarding repaired fractures of the zygomatic arch, zygomatic body or other facial bones were recorded.Conclusion: We suggest that the Tubbs-Logan mitral valve dilator is a safe and effective alternative in terms of closed reduction of zygomatic arch fractures, whether they are isolated or not. We think that further ergonomic modifications would be beneficial to improve the positioning of the instrument in restricted areas observed due to severe depression of the zygomatic arch.

Submandibular gland excision: From external surgery to robotic intraoral and extraoral approaches.

Submandibular gland excision is generally performed through a transcervical approach, a safe procedure that, however, carries few neurological, functional and aesthetic drawbacks. Intraoral approach to the submandibular gland has been described many years ago but it has been newly proposed in recent years thanks to endoscope-assisted and robot-assisted surgical procedures. The main purpose of intraoral approaches is to avoid cosmetic sequelae and to reduce the risk of marginal nerve injury although the recent introduction of retroauricular, postauricular, facelift and transhairline neck incisions has overcome the need for an alternative to traditional transcervical approach. Different surgical approaches (transoral versus transcervical) to the submandibular gland as well as different type of cutaneous incisions will be illustrated and discussed in the light of advancement of endoscope-assisted and robot-assisted procedures.

Magnetic seed localisation for non-palpable lesions in patients undergoing breast conservative surgery

Purpose: Breast-conservative surgery is the standard procedure for breast cancer when tumour resection does not lead to significant cosmetic sequelae. The usual technique to locate non-palpable lesions is the wire-guided localization (WGL). However, the WGL may migrate and cause interference with the electro cautery. The placement of the WGL has to be performed on the day before or the day of the surgery, causing organizational problems. To optimize care pathway and increase ambulatory activity, the authors studied the feasibility and efficacy of a 5-mm iron seed MAGSEED. Materials and Methods: During four months, 20 seeds were placed in 19 patients undergoing a lumpectomy for non-palpable breast lesions. The evaluation questionnaire was filled by radiologists, surgeons, and patients. Results: All clips were detected. The radiological and surgical team found the MAGSEED simple and intuitive. Placement was done by ultrasound and stereotaxic guidance up to 15 days before surgery. Time of lumpectomy was reduced to an average of 11 minutes. Patients’ pain level was low (2/10). Conclusion: The use of MAGSEED for the detection of non-palpable breast lesions is simple, safe, and feasible. A comparative randomized prospective study should be performed between MAGSEED and WGL to study the medico-economic outcomes and the surgical and radiological benefits of the magnetic seed.

The Use of Spreader Grafts or Spreader Flaps—or Not—in Hump Reduction Rhinoplasty

Hump reduction is one of the most common reasons patients seek cosmetic rhinoplasty. Spreader grafts or spreader flaps have become a key maneuver in supporting and reconstructing the nasal midvault after reductive profileplasty to prevent long-term functional and cosmetic sequelae. This article reviews the pertinent anatomy, describes indications for spreader graft or spreader flap placement, discusses surgical techniques and approaches for spreader graft placement, and describes complications of spreader graft use after hump reduction.

Extravasation of calcium solution in the child: Value of negative-pressure wound therapy

The extravasation of a calcium solution into soft tissue constitutes a medical emergency, and a lack of adequate management can lead to significant functional and cosmetic sequelae. Here, we report on the management of and long-term outcome in two children who experienced calcium infusion leakage. We also describe the emergency procedures used in cases of extravasation and discuss the role of negative pressure wound therapy as an appropriate adjunct to conventional techniques for dealing with serious extravasation-related injuries.

Perichondritis of the auricle: bacterial findings and clinical evaluation of different antibiotic regimens.

Pseudomonas aeruginosa is commonly found in suppurative perichondritis, but the significant pathogens in non-abscess perichondritis are unclarified. We aimed to explore the bacterial findings and evaluate the effectiveness of different antibiotic regimes in the treatment of patients with perichondritis. All patients treated for perichondritis at the two Ear-Nose-Throat Departments in Central Denmark Region (covering 20% of the Danish population) from January 1990 to October 2018 were included. In total, 112 patients with (n = 12) or without (n = 100) abscess were included in the study. Potential pathogens were found in 40 of 55 cultures. P. aeruginosa was recovered in 58% of abscess cases, while Staphylococcus aureus was predominant in non-abscess infections (49%). Eighty-two percent of S. aureus recovered were isolated as heavy or moderate growth. In non-abscess cases, no significant differences in clinical progress (p = 0.65), alteration in antibiotic therapy (p = 0.31), duration of hospitalization (p = 0.65), or frequency of relapse of infection (p = 1.00) or sequelae (p = 0.38) were found between patients treated with antibiotics covering S. aureus vs. P. aeruginosa. Our findings suggest that intravenous antibiotic therapy covering S. aureus is sufficient and appropriate empirical treatment in the majority of patients with non-abscess perichondritis. Antibiotic coverage should be expanded to include P. aeruginosa if the clinical response is disappointing or cultures grow P. aeruginosa. The risks and downsides to this approach seems limited as only a minority of patients suffered (minor) cosmetic sequelae and relapse of infection in our cohort of non-abscess perichondritis patients initially treated with antibiotics not covering P. aeruginosa.