Excellent Aesthetic Results Research Articles

Photodynamic therapy in the treatment of non-melanoma skin cancer: A literature review

Objective: The following study aims to analyze the mechanism of action, efficacy, safety and recent trends in the use of photodynamic therapy (PDT) as a therapeutic approach in the treatment of non-melanoma skin cancer. In addition, it seeks to provide a comprehensive overview of the current state of knowledge on the subject, highlighting its use and availability in the Brazilian scenario. Methods: The research was carried out using a literature review based on data published in Periódicos CAPES, Biblioteca Virtual de Saúde (BVS) and UpToDate. Results: PDT is a technique that has already been consolidated globally and has several advantages in the treatment of non-melanoma skin cancer, as well as actinic keratoses, even in comprehensive cases. PDT is considered a non-invasive, fast, safe method, with few side effects, providing rapid recovery and being well tolerated by patients. It has a significant cure rate and excellent aesthetic results, differing from other treatments often cited for their disadvantages, such as undesirable scars. Conclusion: It is crucial to further explore the benefits of PDT, considering its application in different subtypes of non-melanoma skin cancer and optimizing protocols to expand its clinical application. As a promising innovation, the technology has the prospect of contributing to improving the quality of life of patients affected by this specific type of skin cancer.

RIGHT AXILLARY MINI–THORACOTOMY FOR MINIMALLY INVASIVE MITRAL SURGERY: A 5–YEAR SINGLE–CENTER EXPERIENCE

Abstract Objectives To report early– and long–term outcomes of patients undergoing minimally invasive mitral surgery (MIMS) through right axillary mini–thoracotomy (RAMT) over a 5–year period. Methods From July 2016 to December 2021, a total of 172 patients underwent MIMS through RAMT at “Vito Fazzi” Hospital. Results Mitral valve diseases were degenerative (62.8%), rheumatic (13.9%), functional (13.4%), Barlow (5.2%), and endocarditis (4.7%) mitral disease. Mitral valve repair was performed in 142 patients (82.5%) and 30 (17.5%) had mitral replacement. Repair techniques included neochordae implantation (53.5%), isolated annuloplasty (28.9%), leaflet resection (11.3%), sliding plasty (4.9%) and Alfieri procedure (0.7%). Furthermore, in 29 patients (16,8%) concomitant procedures were associated. All cardiac procedures were performed under direct vision and without using thoracoscopes. Mean length of skin incision under the armpit (fig 1) was 5.7 ± 1.3 cm. Of note, conversion to median sternotomy occurred only in 2 (1.2%) cases. Stroke incidence was 0.9% and in–hospital mortality 0.5%. Overall survival and freedom from reoperation at 5 years were 91.5% and 99.1%, respectively (fig 2). Conclusions RAMT access for MIMS is a safe and reproducible approach associated with low mortality and morbidity, the possibility to perform complex mitral surgery under direct vision, high rate of mitral valve repair, and excellent late results. Importantly, limited skin incision under the armpit provided excellent aesthetic results.

Myomucosal composite graft: A simple technique for full-thickness vermilion defects of the lower lip.

Reconstruction of vermillion defects of the lower lip requires careful consideration of functional and aesthetic aspects. Traditionally, various local flap methods involving tissue advancement from the corner of the mouth, lateral chin, and medial cheek have been commonly employed to fill lower lip defects. However, these approaches have inherent limitations, which include technical complexity, disruption of the orbicularis oris muscle, lip tightening, microstomia, and visible scarring. To overcome these limitations, we employed a free myomucosal composite graft from the lower lip to reconstruct small to medium vermilion defects. Our technique is based on a simple and reproducible surgical approach that facilitates natural volume rearrangement of tissues. Moreover, this method enables precise inset and tension-free repair, prevents lip tightening, and offers excellent aesthetic outcomes with no vertical scarring and appropriate color matching with surrounding tissues.

A Rare Case of Osia Extrusion. Our Management Proposal.

The Cochlear™ Osia® System is a hearing system indicated for patients with conductive and mixed hearing loss or unilateral deafness. Given its recent introduction, this is one of the first cases in the literature of implant dehiscence with treatment using local flaps with excellent aesthetic and functional outcomes.

Improving Tip Aesthetics Using Mastoid Fascia Tissue Graft in Rhinoplasty: A Reliable Alternative to Soft Cartilage Grafts

Abstract Goals/Purpose Traditional rhinoplasty tip grafts often lead to visibility issues, prompting patients to seek revision surgery. The mastoid fascia tissue graft (MFTG) provides a natural-looking alternative with fewer complications. MFTG remains less visible through the skin, enhancing long-term aesthetic results. This eight-year study on 193 patients examines MFTG's effectiveness in nasal tip refinement, evaluating revision and infection rates. Methods/Technique A retrospective analysis of MFTG use for nasal tip refinement during open rhinoplasty in the senior author's practice was conducted from July 2014 to June 2022. Inclusion criteria encompassed open rhinoplasty cases using mastoid tissue for tip refinement with at least 12 months of follow-up. Among 2003 cases, 193 met these criteria and were evaluated for subsequent revision and infection rates. Results/Complications The average patient age was 34.2 years (175 females, 18 males). Primary rhinoplasties were done on 114 patients, with 79 receiving revision surgeries. Average follow-up was 14.8 months. 6 patients (3.1%) needed extended antibiotics. Overall, 6 (3.1%) patients required revision rhinoplasty, comprising of 2 (1.8%) primary and 4 (5.1%) secondary rhinoplasty patients. These revisions were unrelated to the use of MFTG for nasal tip refinement. Conclusion MFTG use for nasal tip refinement is associated with low revision rates for both primary and secondary rhinoplasty compared to rates in current literature, without increase in complications or prolonged operative durations. MFTG for nasal tip refinement is a safe and convenient technique delivering excellent aesthetic outcomes with minimal morbidity.

Relocation of polyotia tissue to reconstruct the tragus and fill the preauricular depression

ObjectivesThe present article introduces a lingual composite tissue flap based on the tragus-like structure for correcting polyotia deformity, with the aim of providing a surgical technique that involves relocating polyotia tissue to reconstruct the tragus and fill the preauricular depression. MethodsThe study included a total of 21 patients with polyotia who underwent lingual composite tissue flap reconstruction between January 2020 to December 2022. Patients were retrospectively assessed through a comprehensive review of their medical records and photographic data. Tragus morphology was evaluated based on the measurements of tragus length and width. The Aesthetic Outcomes Scale (AOS), modified Vancouver Scar Scale (mVSS), and Visual Analogue Scale (VAS) were employed for the assessment of surgical outcomes. ResultsThe follow-up period for all patients ranged from 6 to 15 months. The length and width of the normal tragus were not significantly different from those of the reconstructed tragus. The mean preoperative AOS score was 2.73 ± 0.51, while the mean postoperative AOS score increased to 7.61 ± 0.65. The mVSS yielded an average score of 1.80 ± 1.43, indicating inconspicuous scarring post polyotia surgery. The preoperative VAS satisfaction score was recorded as 1.57 ± 0.67, while the postoperative VAS score significantly increased to 8.33 ± 0.91. The flaps all successfully survived post-operation without any occurrences of flap hematoma, necrosis, infection, or wound dehiscence. ConclusionThe reconstruction of the tragus should be given careful consideration when addressing polyotia. The utilization of a lingual composite tissue flap for correction can achieve excellent aesthetic results for the tragus, with high patient satisfaction and minimal complications.

The Tree Flap: A Novel Modification of the Hatchet Flap for Lower One-third Nasal Reconstruction.

Nasal reconstruction after skin cancer excision has routinely been challenging without any aesthetic sequelae, and any defects on the nose are readily noticeable. To circumvent this problem, surgeons have developed different flap techniques to mobilize adjacent tissue to repair aesthetically sensitive defects. We describe our experience, outcomes, and valuable tips for using the "tree flap," a novel modification of the hatchet flap that extends the back cut to significantly increase mobility, leaving only a small skin paddle to maintain perfusion to the flap. The combination of undermining, a rotatory component, and minimal skin attachment allows radical mobility without compromising blood supply. Thus, the tree flap allows for reconstruction of defects of the dorsum of the nose and defects near the nasal tip with ease, given both advancement and rotational movements. Compared with other local flaps such as the shark pedicle flap or bilobed flap, the tree flap has a similar learning curve, minimal donor site morbidity, and equivalent aesthetic outcome. It may be used to repair larger defects that may not be amenable to the bilobed flap as an alternative to a full-thickness skin graft. In our experience, the tree flap also has the advantage of a lower rate of pin cushioning when compared with other options such as the bilobed flap. The tree flap has great mobility and is a reliable option for reconstruction of the lower one-third of the nose with excellent aesthetic results and minimal complications.

Cranioplasty in Oman: Retrospective review of cases from the National Craniofacial Center 2012-2022.

Cranioplasty is a complex craniofacial and neurosurgical procedure that aims to reinstate the architecture of the cranial vault and elevate both its aesthetic and neurological function. Several reconstructive materials have been thoroughly explored in the search for the optimal solution for cranioplasty. This study aimed to evaluate different material used for cranial reconstruction in Oman. This retrospective study included all patients who had had cranioplasty procedures performed at Khoula Hospital, Muscat, Oman, from 2012 to 2022. Demographic information, the characteristics of the cranial defect and any complications that occurred post-operatively were analysed. A total of 47 patients were included in this study. The most common cause of cranial defects was craniectomy following traumatic head injury (70.2%) along with excision of fibrous dysplasia (10.6%). The most frequently utilised material for cranial repair was autologous bone grafts (n = 28), followed by polyetheretherketone (PEEK; n = 14). Interestingly, the replacement of bone grafts from previous craniectomy showed a notably high resorption rate (71.4%), in contrast to split calvarial grafts (0%) and other types of bone grafts (14.3%). Additionally, delayed graft infection was observed in 3.6% of the bone graft group and 7.1% of the PEEK group. Patient-specific alloplastic implants such as PEEK have gained popularity for large and complex cranioplasty, as they provide excellent aesthetic outcomes and leave no donor site morbidity. In contrast, bone grafts remain the gold standard for small to medium-sized cranial defects.

The Long-Term Esthetic and Radiographic Outcome of Implants Placed in the Anterior Maxilla after Ridge Preservation, Combining Bovine Xenograft with Collagen Matrix.

The objective of the study was to evaluate the long-term esthetic and radiographic results of implants placed in the anterior maxilla after ridge preservation, combining bovine xenograft with collagen matrix. Fifteen patients who required a single tooth extraction because of fracture, root resorption, or extended caries were included in the study. After extraction, all sites were grafted using Deproteinized Bovine Bone Mineral (DBBM) with collagen and covered by a resorbable collagen matrix (CM). Five months after socket grafting, implants were successfully installed. The implant diameter range was between 3.8 and 4.2 mm. All patients were monitored for over 7 years, both clinically and radiographically. Three independent observers evaluated the long-term esthetic outcome, employing the Pink Esthetic Score (PES) technique. Over a period exceeding seven years, a 100% survival rate was observed for all 15 implants, with minimal marginal bone loss. The mean PES was 11.40 (±1.44) at the first assessment and 11.38 (±1.63) at the second assessment. The difference was not statistically significant (p = 0.978), and the scores of PES measurements indicated excellent esthetic results even after seven years. Based on these preliminary results, it seems that placing collagen bovine bone in a fresh extraction socket, covered with a collagen matrix, can preserve the alveolar ridge and provide long-term stable esthetic results.

Outcomes of Deep Inferior Epigastric Artery Perforator (DIEP) Flap in Indian Population-A Prospective Single-Institute Study.

Introduction Breast reconstruction has become integral part of breast cancer treatment. Deep inferior epigastric perforator (DIEP)-based flap is considered the gold standard in autologous breast reconstruction. Aims and Objectives The aim of this study was to evaluate the patient satisfaction and the incidence of complications in DIEP flaps in an Indian setup for breast reconstruction. Materials and Methods This is a prospective, nonrandomized study at a single institute-Manipal Hospitals, Old Airport Road, Bangalore. Eligible patients were women aged between 28 and 60 years with primary breast cancer requiring mastectomy and radiotherapy, who consented for DIEP flap reconstruction. Results The study includes subjects who had autologous breast reconstruction after mastectomy with DIEP flap between January 2019 and August 2021 that included 31 patients with a minimum follow-up of 2 years. Four flaps were turbocharged and 17 flaps were superdrained primarily. The average operative time for the whole procedure by adopting a two-team approach is 353.8 ± 43.793 minutes. About 94.1% patients had excellent aesthetic score results. Six patients developed mastectomy flap necrosis, one had fat necrosis that was managed conservatively, whereas one patient had donor site re-exploration for hematoma. We had no DIEP flap necrosis, seroma, flap site hematoma, or flap failure. Physical well-being module of Breast-Q indicated an average of 83 points, psychosocial well-being module indicated 80 points, whereas sexual scores reverted an average of 77 points. Among satisfaction module, aesthetic outcomes for breast showed an average of 94 points, whereas the donor site had 96 points. Satisfaction with information, surgeon, medical staff each gained more than 87 points. Conclusion Breast reconstruction with DIEP flap yields good aesthetic outcomes and quality of life in Indian population. The incidence of fat necrosis, flap and donor site complications is less over time and will enhance the patient satisfaction score further.

Prograde transposition for anteriorly low-set earlobe in lobule-type microtia reconstruction

BackgroundLobule transposition, a common procedure in auricle reconstruction, has been successfully performed over the past few decades. However, the transposition methods for unilateral microtia with evident asymmetry of bilateral earlobe positions still remain a challenge. The objective of this study was to investigate the application of prograde transposition for anteriorly low-set earlobes. MethodA total of 25 patients with lobule-type microtia with anteriorly low-set residual earlobe underwent prograde transposition during auricle reconstruction between 2020 and 2022. The post-operative earlobe aesthetic assessment and patient satisfaction were evaluated, and the data on any complications that occurred when followed-up were collected. This study provides a comprehensive analysis and summary of the techniques used in earlobe transposition for auricular reconstruction. ResultsThe patients with evident asymmetry between the residual and healthy earlobes were usually concomitant with hemifacial microsomia and the residual ear was located in the anterior and lower region. No instances of flap necrosis, hematoma, or wound dehiscence were observed following auricular reconstruction. The mean aesthetic score of the auricle was 3.52, with 23 patients attaining good or excellent aesthetic outcomes. The mean Visual Analog Scale satisfaction score was 3.68, with 24 patients reporting relative satisfaction or satisfaction. ConclusionThe prograde transposition of anteriorly low-set earlobe in lobule-type microtia reconstruction can effectively ensure adequate blood supply, enhance aesthetic appearance, and significantly improve patient satisfaction.

(041) What Penis Size and Glans-Shape do Cis and Trans Men and Women Prefer?

Abstract Introduction The ideal length, circumference, and appearance of the penis are important to the self-confidence and body image of most men. To date, only 2 works have assessed preferred erect (but not flaccid) penis length, and only among cis-gender women. No study has evaluated preferred aesthetics--ideal erect and flaccid penile length, or, glans-shape and size preferences among cis-gender and transgender and non-binary individuals. These preference domains are especially important with genital gender-affirming surgery (gGAS) because length and glans-shape are entirely elective and technique-based, and help define neophallus appearance. Lastly, outlining the planned glans shape on a neophallus can be technically challenging, and, to date no publications have reported offering trans men input/choices. Objective 1) To query ideal for flaccid and erect penis length across all individuals, across cis- and transgender identities; 2) Determine specific likes/dislikes among all subjects for 7 different glans-shape examples; and 3) Among men undergoing phalloplasty, creation of glans-shape stencils for use in the OR, as a means to offer patients choice, and, to ensure that the final product aligns with patient’s choice. Methods An anonymous, online survey (QualtricsTM) evaluated glans preferences among 7 realistic prosthetic penis models shown. Participants were queried about their age, sex, gender, sexual orientation, and their ideal flaccid and erect penis length. Stencils were created based on 6 penis models. Subsequently, 7 transmen-subjects were able to choose the most-preferred glans shape and the stencil was applied before glansplasty surgery (Figure 1). Glansplasty results were assessed 12-weeks post-operatively (Figure 1c;E-F). Results 74 participants took the survey, (mean age of 35.3, Range: 23–59). 43/74 (58%) self-identified as men, and 28/74 (38%) identified as men, including 7 trans men (Table 1a). Men reported a mean ideal flaccid and erect length of 4.5 and 6.3-inches, respectively, while women reported a length of 5.2 inches and 6.16-inches, respectively. Women had a wider range of responses for both ideal flaccid and erect penile length (p>0.05) (Table 1b). For glans-shape preference, across all groups (independent of sex or sexuality), the “most-liked” options were A and E, and “most-disliked” were B and D (Figure 2). Among the 7 transmen undergoing glansplasty, 5/7 (71%) chose glans-shape C, and 1/7 (14%) each chose glans-shapes A and E, for their own phallus. Conclusions This is the first study to survey both men and women regarding ideal erect penile length, and the first regarding ideal flaccid penile length and glans-shape preferences. Our data suggests that the ideal erect and flaccid length are longer (within 2SD) than the mean values for cis-men of 5.16-inches and 3.61-inches respectively, (Miles et al., BJUI, 2014) but there is greater variability among women’s responses. Regarding glans-shape, most preferred a more tapered, bullet-like tip for the distal glans and a less prominent glans ridge. Finally, our glansplasty stencils are easy to use, yield excellent aesthetic results, and the option to choose their own glans shape is highly appreciated by patients. Disclosure No.

Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures.

Reconstructive options that can be used following conservative mastectomy, skin-, nipple-sparing and skin-reducing mastectomies, allow a remarkable variety of safe methods to restore the natural shape and aesthetics of the breast mound. In case of two-stage breast reconstruction, tissue expanders (TEs) are usually placed in a subpectoral position. The purpose of this retrospective cohort study is to evaluate the feasibility and safety of two-step reconstruction with TE in pre-pectoral position covered by acellular dermal matrix (ADM). Between March 2021 and May 2023, at the Azienda Ospedaliero Universitaria Careggi, University of Florence, 55 patients with BRCA 1/2 mutations or early breast cancer underwent conservative mastectomy with immediate pre-pectoral reconstruction using TE covered with ADM, followed by a second surgery with replacement of the expander with definitive prosthesis. Demographic, oncological, and histological data along with surgical complications were recorded. A total of 64 conservative mastectomies were performed. In 2 patients (3.1%) complications were found that required reintervention and, in both cases, the TE had to be removed. Two patients developed hematoma and one patient developed seroma. Two patients showed wound dehiscence, both healed after conservative treatment and without implant exposure. No case of necrosis of the skin or nipple-areola complex has been observed, neither of capsular contracture. Capsule formed around TE was populated with cells and blood vessels and showed a thin area of synovial metaplasia. In selected cases it may be more cautious to perform a two-stage breast reconstruction after radical breast surgery by means of TEs. The placement of TEs in pre-pectoral position combines the excellent aesthetic and functional results of the pre-pectoral philosophy with a quite safer and more prudent two-step approach. Our experience reports optimistic results: the ADM covering the TE is seen successfully integrating during tissue expansion and becoming a vascularised new self-tissue. Complications rates are low and such ADM-assisted two-stage pre-pectoral reconstructive technique is a safe, practical, and reproducible method.

Bilayer Technique for Alveolar Ridge Augmentation in Pre-Prosthetic Implant Surgery: Indications and Problems

Abstract Background: Prosthetic rehabilitation of missing teeth with dental implant-supported restorations has recently become a predictable treatment option in contemporary dentistry with a highly successful rate. Due to different factors, vertical and horizontal bone loss could present, and the available alveolar bone may not be sufficient for optimum implant position. Ridge augmentation procedures could be applied to increase the volume of the deficient sites for accurate prosthetic implant placement, which assures functional and esthetic stability of tissues around the implants, essential for long-term success. Our study aims to evaluate the efficiency of the bilayer technique of guided bone regeneration for alveolar ridge augmentation procedure in cases of bone deficiency for optimum implant placement and long-term success. Materials and methods: We present several cases of alveolar bone deficiency treated with the bilayer technique – the combination of allo- and xenograft, covered by collagen membrane, with long-term follow-up. The defects were filled with allograft, and a layer of xenograft and barrier membrane was placed above it. This technique combines the benefits of all xenografts and barrier membranes. Results: The bilayer technique with allo- and xenograft and collagen membranes is predictable, with a high success rate and lower morbidity. We have a 100% survival rate of the implants placed in a grafted area with long-term follow-up with excellent aesthetic and functional results. Conclusions: The bilayer technique uses the benefits of two bone graft materials, is associated with less morbidity for the patients, and has excellent long-term results if performed accurately according to indications and technique.

Reconstruction of Full-Thickness Eyelid Defects Following Tumor Resection: The Bucket Handle Modification.

To describe a modified approach for full-thickness lower eyelid defect reconstruction. This is a retrospective review of 5 patients with large full-thickness lower eyelid defects after tumor resection requiring reconstruction. For these lower eyelid defects, a lateral-based or superior-based tarsoconjunctival pedicle flap from the upper eyelid was used to rebuild the posterior lamella. In all cases, the anterior lamella was supplied from an adjacent myocutaneous flap in a bucket handle configuration. Data collection included tumor type and location, size of eyelid defect, presence of canalicular involvement, postoperative eyelid position, patient satisfaction, and complication rates. Five eyelids of 5 patients underwent Mohs micrographic excision of basal cell carcinoma followed by reconstruction with a bucket handle flap. Age range was 68 to 96 years old (mean of 81y). Five patients presented with lower eyelid involvement. The defect size ranged from 80% to 100% of the eyelid. Three patients had canalicular involvement and required bicanalicular nasolacrimal stent placement. After reconstruction, all patients showed good eyelid apposition to the globe with excellent esthetic outcome. No revision procedures were done. Average follow-up time was 13 months (range of 8 to 21mo). The bucket handle flap for full-thickness eyelid reconstruction is a simple technique that allows for preservation of all anatomical layers of the anterior lamella. This technique shows promising functional and esthetic outcomes.

(139) What Penis Size and Glans-shape do Cis and Trans Men and Women Prefer?

Abstract Introduction The ideal length, circumference, and appearance of the penis are important to the self-confidence and body image of most men. To date, only 2 works have assessed preferred erect (but not flaccid) penis length, and only among cis-gender women. No study has evaluated preferred aesthetics--ideal erect and flaccid penile length, or, glans-shape and size preferences among cis-gender and transgender and non-binary individuals. These preference domains are especially important with genital gender-affirming surgery (gGAS) because length and glans-shape are entirely elective and technique-based, and help define neophallus appearance. Lastly, outlining the planned glans shape on a neophallus can be technically challenging, and, to date no publications have reported offering trans men input/choices. Objective 1) To query ideal for flaccid and erect penis length across all individuals, across cis- and transgender identities; 2) Determine specific likes/dislikes among all subjects for 7 different glans-shape examples; and 3) Among men undergoing phalloplasty, creation of glans-shape stencils for use in the OR, as a means to offer patients choice, and, to ensure that the final product aligns with patient’s choice. Methods An anonymous, online survey (QualtricsTM) evaluated glans preferences among 7 realistic prosthetic penis models shown. Participants were queried about their age, sex, gender, sexual orientation, and their ideal flaccid and erect penis length. Stencils were created based on 6 penis models. Subsequently, 7 transmen-subjects were able to choose the most-preferred glans shape and the stencil was applied before glansplasty surgery (Figure 1). Glansplasty results were assessed 12-weeks post-operatively (Figure 1c; E-F). Results 74 participants took the survey, (mean age of 35.3, Range: 23–59). 43/74 (58%) self-identified as men, and 28/74 (38%) identified as men, including 7 trans men (Table 1a). Men reported a mean ideal flaccid and erect length of 4.5 and 6.3-inches, respectively, while women reported a length of 5.2 inches and 6.16-inches, respectively. Women had a wider range of responses for both ideal flaccid and erect penile length (p>0.05) (Table 1b). For glans-shape preference, across all groups (independent of sex or sexuality), the “most-liked” options were A and E, and “most-disliked” were B and D (Figure 2). Among the 7 transmen undergoing glansplasty, 5/7 (71%) chose glans-shape C, and 1/7 (14%) each chose glans-shapes A and E, for their own phallus. Conclusions This is the first study to survey both men and women regarding ideal erect penile length, and the first regarding ideal flaccid penile length and glans-shape preferences. Our data suggests that the ideal erect and flaccid length are longer (within 2SD) than the mean values for cis-men of 5.16-inches and 3.61-inches respectively, (Miles et al., BJUI, 2014) but there is greater variability among women’s responses. Regarding glans-shape, most preferred a more tapered, bullet-like tip for the distal glans and a less prominent glans ridge. Finally, our glansplasty stencils are easy to use, yield excellent aesthetic results, and the option to choose their own glans shape is highly appreciated by patients. Disclosure No.

A case series of prophylactic negative pressure wound therapy use with purse-string closure in stoma closure wounds in infants

BackgroundThe study introduces the application of negative pressure wound therapy (NPWT) in pediatric stoma closure, emphasizing the importance of enhancing aesthetics and minimizing surgical site infections (SSI).Case presentationThe case series involves four infants undergoing non-umbilical stoma closure with a combination of purse-string closure (PSC) and NPWT, focusing on aesthetic outcomes and infection prevention. NPWT was initiated immediately after surgery, and patients were monitored every 3–4 days. Notably, none of the four infants experienced SSI or other complications. The patients adequately tolerated NPWT, with no significant adverse events. Furthermore, Manchester Scar Scale (MSS) was 9 [7–10], and Patient and Observer Scar Assessment Scale (POSAS) (observer) was 12.5 [12–19], POSAS (patient) was 12.5 [11–16] (all median values [minimum–maximum]), indicating that excellent aesthetic outcomes were achieved.DiscussionWe emphasizes the significance of aesthetics in pediatric patients; in addition, our findings demonstrate that four infants who received NPWT combined with PSC achieved superior outcomes that did the most recent four infants who underwent PSC only at our institution. It also addresses the risk of SSI in stoma closure and discusses the pros and potential cons of using NPWT in pediatric cases, underlining the need for further research and the accumulation of additional reports.ConclusionsThis is the inaugural report of prophylactic NPWT for pediatric stoma closure, emphasizing the effectiveness of combining PSC and NPWT for SSI prevention and improved aesthetics. The study calls for additional research and reports on NPWT in pediatric cases to further solidify its benefits in this patient population.

Replacement of metal-ceramic crown with fully ceramic: Case report

Dental treatments with aesthetic involvement drive the market towards an increase in the quality and diversity of materials, aiming to provide the highest satisfaction for both the patient and the dentist. Faced with limitations in metal-ceramic treatments, fully ceramic systems have evolved, enabling excellent aesthetic and functional results when appropriately indicated. The purpose of this case report is to describe a clinical case of oral rehabilitation in an aesthetic area through the replacement of a metal-ceramic crown with pure lithium disilicate ceramic (E-Max) for tooth 22. For the clinical success of the treatment, it was necessary to perform teeth whitening and dental recontouring with composite resin of the adjacent teeth prior to the fabrication of the definitive crown. Considering the techniques and materials used, the treatment performed was able to provide a result of clinical excellence, especially in this region that demands higher aesthetic requirements, offering satisfaction and restoring the patient's self-esteem.

Esthetic reconstruction of a localized severely resorbed anterior maxilla associated with peri-implantitis: A clinical report

This clinical report described the esthetic reconstruction of a localized severely resorbed right anterior maxilla associated with peri-implantitis. For vertical bone augmentation, guided bone regeneration surgery was performed by raising a flap with the remote incision technique, followed by soft tissue grafting and vestibuloplasty. The biologically oriented preparation technique was used to improve the health and stability of the peri-implant tissues. The surgical treatment and a novel method of prosthetic rehabilitation provided excellent esthetic and functional outcomes.

The Central Facial Defect Reconstruction Using a Radial Forearm Free Flap after Malignant Cutaneous Tumor Ablation.

Acquired defects of the central face pose significant challenges in achieving acceptable cosmetic and functional outcomes. The site, size, and depth of tissue loss often render local tissues inadequate for the repair of major nasal defects. In this article, we aim to demonstrate the efficacy of radial forearm-free flaps as an ideal choice for various central facial unit reconstructions. This study encompassed patients treated between 2020 and 2022 who underwent facial reconstruction using radial forearm flaps. These flaps were employed in eleven patients with defects involving the lower lid, nose, upper lip, and lower lip. Additionally, we used osteocutaneous flaps in one patient to reconstruct a right nasal bone defect. In three patients requiring medial and lateral canthal tendon reconstruction in one case and oral sphincter reconstruction in two cases, the palmaris longus tendon was included with the flap. In the majority of cases, we achieved good to excellent aesthetic and functional results. Notably, there were no instances of flap failure or partial necrosis in this series. All patients experienced uneventful healing at the donor site. The radial forearm-free flap stands as an ideal and reliable method for reconstructing various facial defects. It offers efficient and thin-conforming skin coverage.