Aesthetic Deformity Research Articles

Surgical management of firework-induced eyelid injuries

Fireworks injuries are frequently caused by malfunction or incorrect operation of fireworks. Injuries often affect the eyeball and the periorbit. After treatment of life-threatening bleeding, injuries of the eyeball have priority over the treatment of periorbital lacerations and burns. The aim of eyelid surgery in firework-related injuries is to prevent delayed damage, such as lagophthalmos, symblepharon, entropion with trichiasis, and keratinization of the conjunctiva of the eyelid and eyelid margin. The treatment requires aconsiderable amount of time and patience both for the elaborate surgical procedures as well as for the necessary healing and rest phases. Many patients, however, are left with serious visual impairments and stressful esthetic deformities, which result in considerable occupational and social impairments.

Oral Rehabilitation of Patients Sustaining Orofacial Injuries: The UPenn Initiative.

Tissue injuries in the oral and maxillofacial structures secondary to trauma, warfare, ablative cancer, and benign tumor surgery result in significant losses of speech, masticatory and swallowing functions, aesthetic deformities, and overall psychological stressors and compromise. Optimal oral rehabilitation remains a formidable challenge and an unmet clinical need due to the influence of multiple factors related to the physiologic limitations of tissue repair, the lack of site and function-specific donor tissues and constructs, and an integrated team of multidisciplinary professionals. The advancements in stem cell biology, biomaterial science, and tissue engineering technologies, particularly the 3-dimensional bioprinting technology, together with digital imaging and computer-aided design and manufacturing technologies, have paved the path for personalized/precision regenerative medicine. At the University of Pennsylvania, we have launched the initiative to integrate multidisciplinary health professionals and translational/clinical scientists in medicine, dentistry, stem cell biology, tissue engineering, and regenerative medicine to develop a comprehensive, patient-centered approach for precision and personalized reconstruction, as well as oral rehabilitation of patients sustaining orofacial tissue injuries and defects, especially oral cancer patients.

Association of external nose deformity in individuals with nasal septal deviation

<p class="abstract"><strong>Background:</strong> Deviated nasal septum presents a challenge as often functional problems as well as aesthetic deformities must be addressed. Deviated nasal septum can be a result of varying pathologies and etiologies. Classifying the nasal deviation enables the surgeon to choose the appropriate operative intervention. This study is intended to know the association of external nose deformity in patients with deviated nasal septum.</p><p class="abstract"><strong>Methods:</strong> 100 patients were attending to the Department of ENT, Vijayanagara Institute of Medical Sciences, Ballari with deviated nasal septum, septal dislocation, septal spur and external nose deformity. Deviated nasal septum was classified as per the classification proposed by Mladina. External nose deformity was classified into 5 types proposed by Yong Jo Jang’s classification depending on the orientation of 2 horizontal units (bony pyramid and cartilaginous subunits) with respect to facial midline. </p><p class="abstract"><strong>Results:</strong> Out of 100 patients with deviated nasal septum, external nose deformity was present in 61% of the patients. Significant association was present between the deviated nasal septum and external nose deformity (p=0.01).</p><p><strong>Conclusions:</strong> Type II (33%) deviated nasal septum was most common followed by Type VII (31%). Among the external nose deformity, Type I was most common followed by Type V. Type II deviated nasal septum was associated most commonly with Type V external nose deformity, Type VII deviated nasal septum with Type I external nose deformity and Type IV deviated nasal septum with Type I/II external nose deformity in equal frequency.</p>

ABDOMINOPLASTY IN THE SURGICAL TREATMENT OF PATIENTS WITH COMPLEX ABDOMINAL WALL DEFECTS

Patients with complex abdominal wall defects usually have deformations of the abdomen, which may remain after the operation, and require the solution of a whole ramge of problems. Quite often, abdominal wall defects are combined with a variety of aesthetic deformities that are associated with abnormal postoperative scars, trophic ulcers, and fistulas. Though the restoration or improvement of abdominal wall functionality is the main goal of alloplasty for complex abdominal wall defects, the cosmetic aspects of the operation, sometimes far more important for patients, deserve special attention. The choice of optimal operative access largely depends on lateral surgery, but most surgeons do not pay special attention to it and mainly use framing incisions above the defect or protrusion. By this time, such values ​​as the type, size of the incision, depth, and borders of flaps flaking are reported empirically and often lead to additional deformation of the operative area and the development of complications. Abdominoplasty is one of the most controversial operations in aesthetic and plastic surgery, where complications reach 27.5-30.8%. The concept of "abdominoplasty" provides techniques for the operational correction of abdominal wall deformities presented by excess skin and subcutaneous fat, pathological postoperative scars, as well as defects of the muscular aponeurotic layer in abdominal area. There are several abdominoplasty techniques. The purpose of this work is to determine the efficacy of the modified abdominoplasty in the surgical treatment of complex abdominal wall defects. Materials and methods. The study involved 360 patients with complex abdominal wall defects operated on at the surgical department of the Poltava Municipal Hospital №1 in for the last 10 years. Various deformities of the abdominal wall were detected in 289 patients (80,3%). Localization of the defects can be described as following: M – 306 (85%), L – 31 (8,6%), ML – 23 (6,4%). The size of the defects: W1 – 103 (28,6%), W2 – 188 (52,2%), W3 – 69 (19,2%). Additional diastase rectus muscles were detected in 179 patients (49,7%). The combined surgical diseases were found in 332 patients (92,2%); 18,1% of them were diagnosed to have intra-abdominal pathology. Results and discussion. The following types of dermatolipectomy were used: longitudinal - 77 cases (28,1%), by Babcock - 114 cases (41,6%), by Kelly - 6 cases (2,2%), by Fernandes - 63 cases (22,9%), modified Fernandez - 7 cases (2,5%), by Berson - 3 cases (1,1%), by Torek - 2 cases (0,8%), by Hrazer – 2 cases (0,8%). Simultaneous operations were performed on in 65 patients (18,1%). Types of alloplasty used: «onlay» - 3 cases (0,8%), «sublay» - 289 cases (80,3%), «sublay-inlay» - 38 cases (10,6%), «inlay» - 3 cases (0,8%), Ramirez – 4 cases (1,1%), intra-abdominal - 2 cases (0,6%), combine – 21 (5,8%). Conclusions. The term abdominoplasty has a broader definition than it was considered previously. Differentiated surgical tactics for patients with complex abdominal wall defects improves the abdominoplasty outcomes.

Frontal sinus obliteration using autogenous abdominal fat versus autogenous bone: Randomized control clinical trial

Aim: The aim of this study was to compare postoperative complications and donor site morbidity following frontal sinus obliteration with autogenous abdominal fat compared to autogenous bone harvested from anterior iliac crest. Research question: Will frontal sinus obliteration with autogenous abdominal fat result in less sinus and donor site complications compared to sinus obliteration with autogenous bone harvested from anterior iliac crest? Materials and Methods: This was a randomized controlled trial conducted on 10 patients with frontal sinus anterior wall fracture indicating frontal sinus obliteration. In group I, the sinuses were obliterated with autogenous abdominal fat. While in group II, the sinuses were obliterated with autogenous bone harvested from anterior iliac crest. Sinus postoperative assessment was performed clinically and radiologically to evaluate postoperative complications (local sinus pathology including sinusitis, mucocele, pyomucocele, wound infection, wound dehiscence, esthetic deformity). Donor site morbidity was assessed for the presence of any complication, postoperative pain intensity and duration. Results: Both groups showed no postoperative sinus complications. Group II showed donor site higher pain intensity and longer pain duration with statistically significant difference when compared to group I.. Conclusions: Abdominal autogenous fat seemed to be a better frontal sinus obliteration material compared to autogenous bone harvested from iliac crest, thanks to its lower donor site morbidity. However, we recommend further investigations with longer follow up periods to elucidate more about this topic.

Alar Rim Reconstruction With Autologous Graft Cartilage: External Approach.

Alar deformities are frequently sequels of the incorrect primary rhinoplasties. Malpositions and irregular cartilage as consequence of either inadequated or exaggerated resection are the skeletal representation not only of aesthetic deformities but also collapse or depression, airway obstruction, valve narrowing by scarring, etc. Replace of alar cartilage is mandatory and many techniques have been described using autogenous cartilage graft since either ear or costal areas. Basically, a pocket must be made inside the thickness of ala permitting the placement of the graft. In our experience the placement of the graft was made by an incision in the fold in the base of the ala and a wide and net alar undermining, carving a pocket was carried out until the tip by means of sharp dissection with the scalpel, permitting the placement of the graft "like a sandwich." The reason for this publication is to describe a surgical technique that permits an exact and correct placement of the graft obtaining the recuperation of normal shape, form projection, and functionality of the ala. The external alar incision is conspicuous and it remains hiding inside natural fold in the alar base.

Single Port Endoscope-Assisted Excision of Forehead Lesions: An Innovative Way of Improving the Optical Cavity.

Exophytic lesions involving the face present with an undesirable esthetic deformity and usually necessitate surgical excision. Conventional open excision techniques may lead to scar formation or pigmentation issues postoperatively. Minimally invasive endoscope-assisted surgery will be able to overcome these problems. However, this technique is not widely used because of the limited optical cavity working space, which hinders good visualization. We describe a technique to improve the optical cavity workspace to enable adequate endoscope-assisted surgical excision of forehead lesions in 2 cases. Foley's catheter and ribbon gauze were used in both cases to gain optical cavity workspace. The surgical technique is described in detail. One case had a frontal osteoma, whereas other was a nodular fasciitis of the forehead, confirmed by histology. Postoperative follow-up showed good outcomes at 1 year with no recurrences. Both patients were satisfied with the surgical and cosmetic outcomes. Endoscopic excision of a forehead lesion using the described technique is both safe and reliable. It is an excellent method for excising benign growths over the forehead while being cosmetically acceptable.

The dilemma of extensive unilocular radiolucent lesions of the jaws - value of immunohistochemistry as a diagnostic marker and prognostic Indicator

IntroductionLarge Unilocular radiolucent lesions of the jaws often present a dilemma to both, the Oral Pathologist and the Maxillofacial surgeon with regards to their accurate diagnosis as well as their most appropriate treatment modality. A precise identification as to whether the lesion is a cyst or a tumor is imperative before any treatment is instituted. Once the correct diagnosis and likely prognosis are established, a management protocol can be planned which will completely eliminate the lesion, while at the same time, ensure least possible morbidity for the patient, such as pathological jaw fractures, persisting neurological deficits, esthetic deformity, functional debility, recurrence/persistence of the lesion, etc. Aim & objectivesTo establish the value of Immunohistochemistry (IH) as a Diagnostic marker and Prognostic indicator for extensive Unilocular radiolucent lesions of the jaws. To assess its role as an adjunct to Histopathological Examination (HPE) in distinguishing Odontogenic tumours from the cysts, by identifying the former using IH Tumor Markers; and in aiding in selection of the most appropriate and effective treatment option for each of such ambiguous lesions, based on their prognosis as indicated by the expression of lH Cell Proliferation Markers. Materials and methodThirty cases of large Unilocular Radiolucent lesions of the jaws (Maxilla/Mandible) were managed over a period of three years. Histopathological examination (HPE) and Immunohistochemical (IH) analysis were carried out of the biopsy specimens in all the cases. Calretinin, an Immunohistochemical Tumor marker, was used to distinguish between Odontogenic cysts and tumours. Ki-67 and Proliferating Cell Nuclear Antigen (PCNA), Immunohistochemical Cell Proliferation markers, provided information on the aggressive potential of the lesions.On the basis of the above information, an appropriate management protocol was established for each of these different lesions. Nerve sparing enucleation and curettage was employed for the established cases of Odontogenic Cysts; Enucleation and curettage, peripheral ostectomy, followed by chemical cauterization was employed for the Unicystic Ameloblastomas and other Odontogenic tumours with a low Ki-67 and PCNA Proliferation Index (PI)/Labelling index (LI ≤ 3); Marginal resection was carried out for the tumours with a higher Labelling Index (LI >3 ≤5), and Segmental resection (including partial/complete Maxillectomy, Hemimandibulectomy with/without disarticulation) for the aggressive pathologies with high Labelling Index (LI > 5). ResultsOf the thirty cases of large Unilocular radiolucent lesions of the Maxilla and Mandible, thirteen were diagnosed as Dentigerous cysts, one as Dentigerous cyst showing Ameloblastomatous transformation; two as Unicystic Ameloblastomas, one as the Mural variant of Unicystic Ameloblastoma; four as Follicular Ameloblastomas, two as Plexiform Ameloblastomas; four as Acanthomatous Ameloblastomas; one as Ameloblastic Fibroma and two as Adenomatoid Odontogenic Tumours. The predictive and prognostic indication of the Immunohistochemical markers correlated well with the post treatment findings. ConclusionIn cases of extensive Unilocular lesions of the jaws, where ambiguity often exists in both diagnosis and appropriate treatment plan to be employed, Immunohistochemistry can serve as an invaluable tool in establishing the precise diagnosis, guiding the treatment plan, as well as indicating the likely prognosis of these lesions.

Fire Safety in Mohs Micrographic Surgery.

Surgical fire is a rare event, but one with potentially devastating patient outcomes. This study was conducted to investigate the incidence, risk factors, and outcome of surgical fires experienced by members of the American College of Mohs Surgeons (ACMS). An internet survey was developed and sent to ACMS members. Data collected included total years of experience, total number of cases, typical management of supplemental oxygen, and surgical fires experienced. Eighty participants contributed data on 886,200 cases of MMS. Nine surgeons (11%) reported at least 1 surgical fire, yielding an estimated incidence of 1 fire per 88,620 cases (0.001%). The most common site of involvement was the scalp (67%). Common ignition sources included monopolar electrosurgical devices (78%) and battery-powered thermal cautery (22%). Fuel sources included towels or drapes, gauze, isopropyl alcohol, aluminum chloride, hairspray, and diethyl ether. Supplemental oxygen was not involved in any of the cases. Five patients suffered singed hair while 4 patients did not suffer any injuries. None suffered any permanent functional or aesthetic deformities. The overall risk of surgical fire in MMS is minimal. However, safety measures and greater awareness of fire risks are necessary to prevent patient harm.

PREVALENCE OF POPEYE DEFORMITY AFTER LONG HEAD BICEPS TENOTOMY AND TENODESIS.

ABSTRACTObjective:To evaluate whether body mass index (BMI) 30 can be used as a cut-off point in decisions about whether or not to perform long head biceps (LHB) tenodesis, leading to a low rate of esthetic complaints, and to compare two tenodesis techniques.Methods:Ninety-six patients underwent shoulder arthroscopy where tenotomy was performed separately in patients with a BMI ≥30 and was followed by tenodesis when BMI <30. The patients were assessed on the basis of their personal perception of the deformity and by 3 independent observers.Results:The patient's perception of esthetic deformity in the arm was 15.6%. In the tenotomy group (12.5%) and in the tenodesis group (17.9%) - (p = 0.476). Patients with rocambole-like tenodesis perceived the deformity in 13.2% of cases, while patients with anchor tenodesis noticed the deformity 27.8% (p = 0.263) of the time. There was no statistical difference in the perception of deformity among the independent examiners.Conclusion:BMI 30 can be used as a cut-off point in decisions about whether or not to perform LHB tenodesis, leading to low rates of esthetic complaint by patients (12.5%). The rocambole-like tenodesis technique appears to be more able to avoid esthetic deformity of the arm after the LHB tenotomy according to the patients' observations. Level of evidence II, Prospective comparative study.

Appropriate Pathways and Surgical Approaches in the Fractures of the Frontal Sinus

Fractures of the frontal sinus are part of the fractures of the border between the facial and the cranial regions. They cause both aesthetic and vital problems, but also functional, requiring rapid and global care in a multidisciplinary setting. The document provides a descriptive and cross sectional study with prospective data collection, conducted in the department of Maxillofacial and Aesthetic Surgery of the Mohammed 6 Teaching Hospital of Marrakech, describe describe 18case operated for frontal sinus fractures over a 2-year period. The ideal time of repair was beyond the 72nd hour, at best between the 8th and 15th days after the reduction of cerebral and facial edema and the exclusion of any lesions that require emergency intervention. Our indications were mainly influenced by aesthetic deformities, impaction and embarrure fracture of ethmoidal and orbital roofs with clinical expression, obliteration of the naso-frontal duct, posterior wall displacement predicting dura mater laceration, and by the time to management. The coronal approach was the most indicated with 83, 33% of the cases. We realized sinus exclusion in 72.22%, cranialization in 22.77%, and repair of dura mater injuries in 27.77%. The sequelae found in 27.77%, were essentially functional and aesthetic.

Bilateral unexpanded supraclavicular flaps for single-stage resurfacing of anterior neck contractures

Context: Anterior neck scar contracture causes functional and esthetic deformity which is difficult to conceal. Supraclavicular flap is an accepted modality for neck scar reconstruction but has limitations of reach and skin deformation if used as a pedicled flap. Island flap and propeller modification can allow primary closure of donor site. Aims: The aim of the study is to assess the efficacy of bilateral supraclavicular unexpanded flaps in single-stage release and resurfacing of anterior neck contractures. Subjects: Seven cases of anterior neck contracture were operated with release and flap cover. Grades of contracture treated were Onah 2b, 2c, 3b and 3c. Methods: All cases underwent single stage release and resurfacing with bilateral propeller island supraclavicular flaps. Patients were followed up fo an average 30+/- 10 months using extension angle to check for recurrence. Results: All cases achieved satisfactory cosmesis at 1year followup. The average increase in neck extension angle achieved at 1 year was 22.9° ± 10°. No recurrence of contracture was noted. One flap had partial necrosis requiring skin graft. Two cases had axilla scarring requiring graft closure for donor site. Average flap length was 14.4 ± 1.7 cm. Average flap width was 7.1 ± 1 cm. Conclusions: Bilateral supraclavicular flaps can be used to resurface anterior neck contractures in a single stage with acceptable donor-site morbidity.

Cosmetic Reconstruction of Frontotemporal Depression Using Polyethylene Implant after Pterional Craniotomy.

Purpose Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. The present study was performed to determine the postoperative outcomes of patients following frontotemporal depression reconstruction using a high-density porous polyethylene (HDPE) implant (Medpor®; Stryker, Kalamazoo, MI) after pterional craniotomy. Materials and Methods The patients had undergone reconstruction of frontotemporal depression using Medpor® implants after pterional craniotomy at our medical institution during the period from February 2010 to March 2014. We evaluated the thickness and volume of both the temporalis muscle and Medpor® implant through a retrospective review of the medical records and computed tomography (CT) scans of 92 patients. Results The mean temporalis muscle thickness ratio (muscle thickness of the affected side/nonaffected side) was 0.61 ± 0.16. The mean reconstructed temporalis muscle thickness ratio (muscle and Medpor® implant thickness of affected side/muscle thickness of nonaffected side) was 1.15 ± 0.02. The mean temporalis muscle volume ratio (muscle volume of affected side/nonaffected side) was 0.67 ± 0.02. The mean reconstructed temporalis muscle volume ratio (muscle and Medpor® implant volume of affected side/muscle volume of nonaffected side) was 1.18 ± 0.02. Conclusions Temporalis muscle thickness and volume were significantly decreased on the affected side after pterional craniotomy. Reconstruction of frontotemporal lesions using Medpor® implants after the pterional approach improved temporal hollowing without additional complications.

Reconstruction of frontal defects with calvarial grafts.

There are many options for the reconstruction of frontal sinus wall defect resulting from injury, neoplastic lesions and aesthetic deformities. These mainly include autogenous grafts, allogenous grafts, and alloplastic materials. The aim of the present study is to report the advantages of using autogenous calvarial bone grafts over other reconstruction techniques, in the reconstruction of frontal defects. We describe 16 consecutive cases of anterior frontal sinus defects between 2004 and 2015, in which calvarial bone grafts were used. Medical records were retrospectively analysed to evaluate graft survival. Bone defects were caused by injury (3), aesthetic deformities (2), external frontal sinus surgeries (2), tumours (6: three osteomas, two fibrous dysplasias, one squamous cell carcinoma), and osteomyelitis (3). There were no significant complications during harvesting, and morbidity was minimal. Furthermore, at one and five-year follow-up, no graft resorption or rejection was noted, and cosmetic results were satisfactory. Our results indicate that calvarial bone graft is an appropriate material to use in anterior frontal sinus reconstruction.

Reconstrucción nasal con cartílago costal de banco de hueso

Presentamos una serie de reporte de casos de 10 pacientes con deformidad rinoseptal de distinta etiología; traumáticas, infecciosas y quirúrgicas. Estos pacientes presentaban obstrucción nasal como principal síntoma además de la deformidad estética. Los pacientes fueron tomados de la consulta externa del servicio de Otorrinolaringología del Hospital de San José. A los pacientes se les realizó reconstrucción nasal con cartílago costal de banco de hueso, se les practicó un abordaje por técnica abierta y se utilizó el injerto de banco de hueso. Los pacientes fueron seguidos por 7 meses como mínimo y máximo 16 meses. Los pacientes se evaluaron con registro fotográfico pre y posquirúrgicamente. Dentro del periodo de seguimiento no hubo infección del sitio operatorio o extrusión del injerto. La mejoría funcional y estética fueron evaluadas con grado de satisfacción del paciente y del cirujano como buenas-excelentes. La aplicabilidad de la técnica mostró buenos resultados y aplicación en diferentes grupos etarios y etiológicos.

Surgical Management of Madelung Deformity: A Systematic Review.

Background: Madelung deformity is a congenital wrist condition characterized by volar subluxation of the wrist caused by premature growth arrest of the distal radius. Progressive symptoms can necessitate surgical intervention, yet optimal treatment strategy remains unknown. The aim of this study is to determine treatment options, surgical indications, and operative outcomes for Madelung deformity. Methods: This study adhered to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive systematic review was performed to identify all studies describing surgical interventions for Madelung deformity. All studies were evaluated by level of evidence and a self-developed quality assessment tool. Results: Twenty-five studies met inclusion criteria; all case series with type IV level of evidence. Studies assessed pain, range of motion, aesthetic deformity, and grip strength. The primary indication for surgery was the presence of wrist pain. Various surgical procedures exist and could be categorized as radial lengthening, ulnar shortening, or a combination of both. All studies report postoperative pain reduction and most studies report an improved range of motion. Conclusions: A variety of surgical procedures reportedly have satisfactory outcomes. However, outcomes are reported in an inconsistent manner, prohibiting pooling of studies and comparisons of surgical procedures and their outcomes. We propose several methodological changes for implementation in future studies, increasing the quality of evidence to compensate for small patient numbers.

Frontal Sinus Obliteration Utilizing Autogenous Abdominal Fat Graft.

BACKGROUND:Frontal sinus fractures have always been unique because of the controversy surrounding their ideal treatment protocol and the fatal complications that could follow if the wrong treatment opts.AIM:The purpose of this study was to assess clinically and radiographically frontal sinus obliteration technique utilising autogenous abdominal fat graft.PATIENTS AND METHODS:This study was carried out on 20 patients having anterior table fracture of their frontal sinuses indicated for sinus obliteration. All sinuses were obliterated using autogenous abdominal fat graft. Post-operatively, patients were clinically evaluated for any signs or symptoms of intracranial infections, wound dehiscence, sinus affections, or aesthetic deformity. Computerized tomography (CT) radiographic evaluations were carried out immediately and 12 months postoperatively to evaluate any uneventful healing of the graft.RESULTS:Clinical follow-up showed no cerebrospinal fluid leak, no postoperative infection or wound dehiscence in 18 cases. There were two cases however that showed infection. Radiographic follow-up revealed uneventful healing of the abdominal fat grafts with no abnormality detected in the sinus cavity throughout the whole postoperative period.CONCLUSION:Autogenous abdominal fat graft appears to be a successful obliteration material in the frontal sinus cavity and is beneficial in fractures of the anterior table.

Patient satisfaction after hook plate treatment of bony avulsion fracture of the distal phalanges

BackgroundBony avulsion fractures of the distal phalanges can result in mallet finger deformity if not treated appropriately. Therefore, only minimally displaced fractures can be treated conservatively with a good outcome, as dislocation occurs very often. Several surgical treatment options have been developed during the past decades. Data concerning the recently developed hook plate are promising. So far, no data concerning the subjective satisfaction with this method have been published. Therefore, we have analyzed the outcome after hook plate implantation using a self-assessment score, which focuses also on subjective parameters and satisfaction.MethodsStandardized questionnaires (self-assessment scores and SF-36 questionnaire) were sent to each patient treated with a hook plate due to fracture of the distal phalanx, type Doyle IVb and IVc. Clinical data were evaluated according to the medical record. Scores given per question range from 0 to 10, 10 is the worst and 0 the best outcome.ResultsFrom 69 patients treated, 38 (58%) were enrolled. The whole collective (n = 38) reached a score of 39.7 ± 28.7 points, while men had slightly better results. Men (n = 24) achieved 37.3 ± 27.9 points, women (n = 14) 43.9 ± 30.7 points. Women had significantly better results when analyzed later than 12 months after surgery (52.1 ± 27.9 vs. 29.1 ± 32.8), whereas no changes could be detected in the male group (37.1 ± 29.9 vs. 37.4 ± 27.6). Overall, men were slightly more satisfied than women. Most satisfaction was found regarding pain and fine motor skills (0–0.46 points). Esthetic aspect and nail deformities (3.65 points average) led to the highest dissatisfaction. No differences in the SF 36 score could be detected.ConclusionsThe hook plate is not only a convenient method but it also results in high patient satisfaction. Nail deformities are challenging; however, with increasing experience of the surgeon they decrease. SF 36 score is not an appropriate testing tool for this problem.

THE PSYCHOLOGICAL IMPACT IN WOMEN AFTER MASTECTOMY WITH AND WITHOUT IMMEDIATE MAMMARY RECONSTRUCTION

Breast cancer is a very common pathology in the female environment, being the second largest cause of neoplasia in Brazil. Surgical treatment with mastectomy is seen as resolving in most cases, but breast reconstruction is crucial for improving the psychological aspects of the patient, since the removal of the breast without the oncoplastic can trigger emotional, stress and sadness problems. Breast reconstruction may be immediate, when performed in the postoperative period of the mastectomy, or late, when performed at any time postoperatively. The mastectomy, in isolation, can leave the patient with visible scars, aesthetic deformities in the breasts, causing greater psychological problems such as anxiety, depression, panic syndrome, distortion of body self-image, as well as sexual dysfunctions. Thus, there are still gaps in knowledge in the analysis of the psychological impact and, of course, new researches that analyze the psychological factor in mastectomized women with and without immediate breast reconstruction are crucial to better work the moment of vulnerability that these patients are going through. Keywords: Mastectomy; Breast cancer; Oncoplastic; Breast reconstruction; Psychological problems.

Long non-coding RNA CACNA1G-AS1 promotes calcium channel protein expression and positively affects human keloid fibroblast migration.

Keloids are a type of benign hyperplasia that cause dermatologic dysfunction and esthetic deformity by invading adjacent normal tissues. Little is known about their etiology, therefore, they are a challenge to treat using plastic surgery. In a previous study, it was demonstrated that the expression of the long non-coding RNA CACNA1G-AS1 (CAS1) is high in keloid tissue, suggesting that CAS1 is involved in keloid formation. In the present study, the aim was to identify potential keloid target proteins by exploring CAS1 biological function during cell proliferation and migration, cytokine secretion, collagen secretion and the control of calcium channel protein expression in human keloid fibroblasts. Three biopsy samples were collected from each patient with keloids at The Peking Union Medical College Hospital, which were then used to investigate the role of CAS1 in cell proliferation and migration. CAS1 silencing was also carried out using small interfering RNA; cell factors, collagen and calcium channel protein levels were compared with control cells. The interference of CAS1 expression reached 50% compared with the control group. CACNA1G and type I collagen expression was significantly downregulated by CAS1 knockdown, while the expression of transforming growth factor-β and type III collagen was not affected. Wound healing time was longer in the CAS1-knockdown group, but there was no visible change in cell proliferation. In conclusion, CAS1 appeared to promote calcium channel protein and type I collagen expression, and to have a positive effect on cell migration in human keloid fibroblasts. Therefore it has potential as a novel therapeutic target for keloids.