Long-term Patient Satisfaction Research Articles

Management of Pediatric Superficial Partial-Thickness Burns with Polyhexamethylene Biguanide: Outcomes and Influencing Factors.

Background: In burn care, achieving swift healing with minimal complications remains paramount. This investigation assesses the role of polyhexamethylene biguanide (PHMB) in managing pediatric superficial partial-thickness burns, focusing on the effects of various patient-specific factors on recovery. Methods: Through a retrospective analysis of 27 pediatric cases treated with PHMB, we evaluated the impact of age, burn size, dressing frequency, treatment delay, cold therapy application, and analgesic usage on the time until reepithelialization (TTRE). Results: The majority of patients benefited from early cold therapy, yet only 1 in 3 patients received analgesics. A mean healing time of 8.78 (SD: 2.64) days was observed, with the extent of the burn showing a strong correlation (r: 0.63) to TTRE. Most treatments were managed outpatient, evidenced by a negligible average hospital stay (0.96 days), with recorded no complications. Conclusions: Our findings endorse PHMB as a promising treatment for superficial second-degree burns in young patients, due to the observed stable and rapid wound closure without the association of increased risks. Continued exploration into the optimal application of prehospital interventions and the comprehensive benefits of PHMB in pediatric burn management is necessary. Future research should assess long-term outcomes, including functionality, scar quality, and patient satisfaction.

D4. Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Brachioplasty Following Massive Weight Loss

D4. Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Brachioplasty Following Massive Weight Loss

Super-specialty Medical Teleconsultations to Remote Areas of Ladakh, India via E-Sanjeevani under Hub-and-Spoke Model: A Pilot Study

Objectives: To assess the feasibility, spectrum, outcomes and challenges of delivering super-specialty consultations to remote areas of the Union Territory (UT) of Ladakh through telemedicine. Design: Prospective, observational (descriptive), pilot study Methodology: Super-specialty medical teleconsultations were provided to healthcare providers in UT Ladakh by specialists in the Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh from October 2021 to May 2022, employing the hub-and-spoke model of the Ayushman Bharat Digital Mission. Doctor-to-doctor teleconsultations were initiated by treating doctors at healthcare facilities in UT Ladakh on the eSanjeevani™ platform. Audio-video model was used for teleconsultation and digitally signed prescriptions were shared. Setting: India – Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (hub) and healthcare providers in UT Ladakh (spokes) Participants: Healthcare providers in UT Ladakh and specialists in the Department of Telemedicine, PGIMER, Chandigarh Interventions: Super-specialty medical consultations using telemedicine (eSanjeevani™ platform) Main Outcome Measures: Demand and spectrum of superspecialty teleconsultations, outcome of consults (whether managed successfully at teleconsultation level, or required referral for in-person visits), and technical challenges faced. Results: A total of 26 super-specialty teleconsultations were provided; 14 (54%) were for women. Patient distribution was uniform across all age groups. The super-specialty-wise distribution of consultations was - 9 from endocrinology, 9 from neurology, 3 from hepatology, 2 from cardiology, and 3 from neonatology. Reasons for seeking consultation were assistance in diagnosis (3, 12%), optimization of therapy (10, 38%), or both diagnostic evaluation and treatment optimization (13, 50%). Five cases (19%) were referred for physical visits to a higher center for advanced diagnostic testing like liver biopsy, brain biopsy, upper GI endoscopy, etc.; other cases were managed remotely. Problems with audio-visual connectivity were encountered in three patients. Conclusion: This pilot study demonstrates that complex, super-specialty medical consultations can be effectively delivered to remote areas through telemedicine. Future research should focus on assessing long-term outcomes, patient satisfaction, and cost-effectiveness to better evaluate the impact of this model.

All-On-4 Implant with Hybrid Prosthesis Opposing Implant Supported Overdenture- A Case Report

Implant-supported prosthetic solutions have revolutionized the field of dental rehabilitation, particularly for patients with extensive edentulism or failing dentition. Among these, the All-on-4 implant technique has gained popularity due to its ability to provide and aesthetic restoration with fewer implants and reduced surgical complexity. However, challenges such as insufficient bone volume or poor bone quality in the edentulous maxilla or mandible may necessitate alternative approaches to ensure long-term success and patient satisfaction. One such approach involves the integration of a hybrid prosthesis with All-on-4 implant concept opposing an implant-supported overdenture. This hybrid solution combines the stability and support of dental implants with the comfort and versatility of removable prostheses, offering a balance between fixed and removable options. Key aspects covered include the selection of appropriate candidates for this treatment modality, diagnostic imaging techniques for precise implant placement, surgical protocols for achieving optimal osseointegration and soft tissue management, prosthetic fabrication processes including material selection and occlusal considerations, postoperative care and maintenance strategies to ensure long-term success. Through a comprehensive examination of current literature, clinical case studies, and expert opinions, this case report aims to provide clinicians with valuable insights into the rationale, planning, execution, and outcomes of utilizing a hybrid prosthesis with All-on-4 implant concept opposing an implant-supported overdenture. By understanding the indications, advantages, limitations, and clinical nuances of this treatment approach, dental professionals can effectively address the diverse needs and preferences of edentulous or near-edentulous patients, ultimately improving their quality of life and oral health outcomes. Keywords: All-on-4 implants, hybrid prosthesis, implant-supported overdenture, prosthetic rehabilitation, bone quality, patient satisfaction.

Testing Mechanical Properties of Silicone Gel-Filled Breast Implants and Their Degradation.

Breast augmentation procedures using silicone implants have become increasingly popular over the past six decades. This article addresses the concerns of patients regarding implant strength by providing clinicians with valuable information in addition to video and pictorial evidence to share, fostering reassurance. The article focuses on the structural integrity and stability of breast implants, which play a critical role in their long-term performance and patient satisfaction. Specifically, it examines the industry standards outlined by the International Organization for Standardization (ISO), with a particular emphasis on ISO14607-2018, which encompasses a range of mechanical and physio-mechanical tests, including the assessment of silicone gel-fill firmness, evaluation of shell integrity, and examination of the impact of environmental conditions on implant performance. Breast implants are not static devices and are subject to aging and fatigue-based degradation. This emphasizes the need for ongoing monitoring and evaluation to ensure the long-term safety and satisfaction of patients. By providing a comprehensive examination of breast implant structure and industry standards, this article equips clinicians with the necessary knowledge to address patient concerns and foster confidence in the safety and longevity of breast augmentation procedures using silicone implants.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-Term Satisfaction of Oral Sedation versus Standard-of-Care Intravenous Sedation for Ocular Surgery.

Long-term patient satisfaction may influence patients' perspectives of the quality of care and their relationship with their providers. This is a follow up to a comparative effectiveness study investigating oral to intravenous sedation (OIV study). The OIV study found that oral sedation was noninferior in patient satisfaction to standard intravenous (IV) sedation for anterior segment and vitreoretinal surgeries. This study aims to determine if patient satisfaction with oral sedation remained noninferior long term. Patients were re-interviewed using the same satisfaction survey given during the OIV study. Statistical analysis involved t-tests for noninferiority of the long-term mean satisfaction score of oral and IV sedation. We also compared the original mean satisfaction score and the follow-up mean satisfaction score for each type of sedation and for both groups combined. Participants were interviewed at a median of 1225.5 days (range 754-1675 days) from their surgery. The original mean satisfaction score was 5.26 ± 0.79 for the oral treatment group (n = 52) and 5.27 ± 0.64 for the intravenous treatment group (n = 46), demonstrating noninferiority with a difference in mean satisfaction score of 0.015 (p < 0.0001). The follow-up mean satisfaction score was 5.23 ± 0.90 for oral sedation and 5.60 ± 0.61 for IV sedation, with a difference in the mean satisfaction score of 0.371 (p = 0.2071). Satisfaction scores did not differ between the original mean satisfaction score and the follow-up mean satisfaction score for the oral treatment group alone (p = 0.8367), but scores in the intravenous treatment group increased longitudinally (p = 0.0004). In this study, long-term patient satisfaction with oral sedation was not noninferior to satisfaction with IV sedation, unlike our findings with short-term patient satisfaction in our original study. Patient satisfaction also remained unchanged over time for the oral treatment group, but patients in the intravenous treatment group reported higher long-term satisfaction with their anesthesia experience compared to the immediate post-operative period.

Algorithmic Midline Approach to Perineal Urethrostomy is Associated With Long-term Success and High Patient Satisfaction

PurposeTo assess surgical success and patient-reported outcomes of perineal urethrostomy via midline approach. Materials & MethodsCharts of patients undergoing primary perineal urethrostomy between May 2008 and June 2022 were reviewed. Background characteristics were assessed; success was defined as freedom from re-intervention. Patient-reported outcome measures were assessed using a cross-sectional phone survey. Several validated questionnaires were used to assess lower urinary tract symptoms, quality of life, and erectile dysfunction. ResultsAmong 1,768 urethroplasties performed over the study period, 103 patients (5.8%) underwent midline perineal urethrostomy. Surgery was successful in 95.1% of cases (98/103); 5 patients (4.9%) required re-intervention at a median of 8.7 months. Post-operative complications occurred in 5.8% of cases (6/103) and were both mild and self-limited.Forty-nine patients (47.6%) were reached via phone survey at a median of 61 months post-operatively. Some questions were not answered by all patients. Most patients (42/49, 86%) were satisfied or very satisfied with surgical results, and 82% (40/49) reported an improvement in their overall health. Most patients (31/41, 76%) were unbothered by sitting to urinate. Although 20% of patients (10/49) reported post-operative urinary symptoms that interfered “a lot” with their daily life, only 3 (6%) of these patients reported dissatisfaction with outcome. Regarding sexual function, 64% (27/42) reported indifference to or increased satisfaction with sexual encounters versus before surgery. The rate of de novo ED was 24% (12/49). ConclusionsThe midline approach to perineal urethrostomy provides excellent, durable success rates with high levels of patient satisfaction.

(011) Implementing Virtual Intracavernosal/ Penile Injection Therapy (ICI) Training in a Prostate Cancer (PC) Supportive Care Program

Abstract Introduction The Sexual Health Clinic (SHC) offered by our prostate cancer (PC) supportive care program delivers sexual health care for PC patients and their partners. Over a two-year period, patients receive seven appointments in which different options for sexual satisfaction are explored, including intracavernosal/penile injection therapy (ICI). Since April 2020, sexual health clinicians have provided virtual and in-person ICI training appointments. Before each appointment, patients are instructed to review educational material, including an educational video, an ICI instruction booklet, and ICI dosing handout. Objective To evaluate the effectiveness of ICI training presented virtually compared to in-person by comparing clinical and patient-reported outcomes (PROs) in each group. Methods All patients who received ICI training between January 2019 and April 2023 were included in this retrospective chart review. PROs from the SHC were obtained prospectively during service as part of usual clinical care. Results Over 4.3 years, 74 patients received ICI training, 54 virtually and 24 in-person. All patients were in heterosexual relationships and rated their pre-treatment erectile function as a median of 9 on a scale of 0-10, with 10 being the highest level of erectile function. In contrast, the median erectile function for all patients was 0 after PC treatment. At the time of attending the SHC, most patients expressed ‘resume intercourse’ as their goal of treatment. Table 1 shows that the demographics of each group are similar with respect to age, education level, ethnicity, and partner information. The use of erectile aids after PC therapy is shown in Table 2. Most patients had not attempted ICI before enrollment in the SHC and were not satisfied with other options offered by the SHC. Details of ICI treatments and response to therapy are shown in Table 3. Overall outcomes and satisfaction rates were similar between groups. Conclusions Overall, clinical outcomes with ICI training in the virtual format do not appear to differ from that done in person. Patient satisfaction with ICI is better than other erectile aid options in each group but is still low. In the future, we will prospectively assess ICI usage and outcomes at 3, 6, and 12 months after ICI training to determine treatment adherence, complications, and long-term patient satisfaction with ICI training across the different delivery methods. Disclosure No.

(118) Clinical Predictors of Long-Term Satisfaction with Treatment of Collagenase Clostridium Histolyticum for Patients with Peyronie’s Disease

Abstract Introduction Collagenase clostridium histolyticum (CCH) is the only FDA-approved medication for Peyronie’s Disease (PD) in the United States. Roughly half of patients who received CCH experience improvements in curvature by more than 20% in the IMPRESS I/II trials. Current literature reports varying satisfaction rates of 67-81% within one year of treatment completion. However, little is known of long-term patient satisfaction following CCH treatment and its clinical predictors. Objective The aim of this study was to identify clinical predictors of long-term satisfaction with CCH for PD. Methods An Institutional Review Board approved retrospective chart review and standardized questionnaire was conducted for all patients with PD who received CCH from 2009-2022. Patients who received CCH before presenting to our institution were excluded. The questionnaire utilized the Treatment Satisfaction Questionnaire for Medication (TSQM), which is validated across the subdomains of satisfaction with effectiveness, side effects (SE), convenience, and global satisfaction (GS), and summed to generate the TSQM total score. Statistical analyses were performed in R using Wilcoxon rank sum test and independent T-test to compare continuous variables with TSQM scores, and Spearman’s rank correlation to compare categorical variables with TSQM scores. Results Of the 243 eligible patients, 80 (32.9%) responded (Table 1). Of these, 34 (42.5%) reported satisfaction with CCH treatment. On average, surveys were completed 4.7 (SD 2.3) years after last CCH injection. Age at presentation, at last CCH injection, and at survey completion were significantly correlated with satisfaction with side effects (Spearman's ρ= 0.32, 0.32, 0.33, respectively; p&amp;lt;0.004 for all) (Table 2). Curvature degree, plaque diameter, and plaque volume measured before CCH treatment and the amount of change in these parameters were not significantly associated with TSQM scores. However, having any improvement in curvature significantly increased the GS subdomain score without affecting the TSQM total score (GS means 37.6 change v 20.7 no change; p=0.03). Greater final curvature degree and plaque volume after CCH completion were significantly correlated with lower TSQM total scores (Spearman's ρ= -0.36, -0.32, respectively; p&amp;lt;0.04 for both). 10 (12.5%) patients reported depression, which significantly decreased scores of the effectiveness subdomain, GS subdomain, and TSQM total (p&amp;lt;0.04 for all). 10 (12.5%) patients proceeded to surgical intervention after CCH treatment and reported significantly decreased scores in the effectiveness subdomain and TSQM total (p= 0.008, 0.001, respectively). Conclusions Our data suggests that older patients exhibit greater long-term satisfaction and tolerability of side effects from CCH. Additionally, final curvature and plaque volume after CCH completion were the most important objective predictors of long-term satisfaction rather than the degree of change in these parameters. Patients with depression also reported lower long-term satisfaction rates with CCH treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: M.K. acts as a consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast. M.K. is an investor of Sprout. L.L. acts as a consultant for AbbVie, Aytu BioScience, Contraline, Lipocine. L.L. acts as an advisor for Inherent Bioscences. L.L. acts as consultant/speaker for Endo Pharmaceuticals. L.L. acts as a speaker for American Medical Systems/Boston Scientific.

(398) The Correlates of Satisfaction with Long-term Outcomes Following Collagenase Clostridium Histolyticum Treatment for Peyronie’s Disease

Abstract Introduction Collagenase Clostridium histolyticum (CCH) is the only FDA-approved medication for Peyronie’s Disease (PD) in the United States. Roughly half of patients who received CCH experienced improvements in curvature by more than 20% in the IMPRESS I/II trials. Despite objective improvements in PD severity, some patients still report dissatisfaction with CCH treatment. The effects of subjective reasons of greatest satisfaction and dissatisfaction on long-term overall treatment satisfaction is even less clear. Objective The aim of this study was to assess how subjective patient responses regarding reasons for satisfaction and dissatisfaction correlate to long-term satisfaction with CCH treatment. Methods An Institutional Review Board approved retrospective chart review and standardized questionnaire was conducted for all patients with PD who received CCH from 2009-2022. Patients who received CCH before presenting to our institution were excluded. The questionnaire utilized the Treatment Satisfaction Questionnaire for Medication (TSQM), which is validated across the subdomains of satisfaction with effectiveness, side effects (SE), convenience, and global satisfaction (GS), and summed to generate the TSQM total score. The questionnaire also included multiple-choice questions on CCH insurance coverage, reasons for greatest satisfaction and dissatisfaction with a free-response “other” answer choice, and likelihood of recommending CCH to other patients with PD on a scale from 0-6. Statistical analyses were performed in R using Wilcoxon rank sum test and independent T-test to compare continuous variables with TSQM scores, Spearman’s rank correlation to compare categorical variables with TSQM scores, and Fisher's exact test to compare categorical variables with one other. Results Of the 243 eligible patients, 80 (32.9%) responded (Table 1). Of these, 34 (42.5%) reported satisfaction with CCH treatment. On average, surveys were completed 4.7 (SD 2.3) years after last CCH injection. When queried on what factors patients were the most satisfied with, improvements in curvature and sexual function were significantly correlated with increased scores in the effectiveness subdomain, GS subdomain, and TSQM total (p&amp;lt;0.01 for all) (Table 2). 30 (37.5%) patients self-reported no satisfaction because of no perceived improvement in the same question, which significantly correlated with decreased scores in the effectiveness subdomain, GS subdomain, and TSQM total (p&amp;lt;0.0001 for all). Of this cohort, 26 (86.7%) patients would not recommend CCH to other patients with PD (OR 10.27, 95% CI 2.94-46.85, p=0.00002). When queried on what factors patients were the most dissatisfied with, pain with injection, duration of CCH series, and no improvements in curvature were all significantly associated with lower scores in effectiveness subdomain, GS subdomain, and TSQM total (p&amp;lt;0.003 for all). Patients with insurance coverage had lower odds of reporting cost of CCH as their greatest dissatisfaction (OR 0.05, 95% CI 0.004-0.62, p=0.03). Conclusions Our data suggests that the most important factors for long-term patient satisfaction with CCH treatment are improvements in curvature and sexual function while the most important factors for patient dissatisfaction are pain with injection, duration of CCH series, and no improvements. While pain with injection is temporally brief, it continues to negatively affect patient satisfaction even years after completion of CCH. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: M.K. acts as a consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast. M.K. is an investor of Sprout. L.L. acts as a consultant for AbbVie, Aytu BioScience, Contraline, Lipocine. L.L. acts as an advisor for Inherent Bioscences. L.L. acts as consultant/speaker for Endo Pharmaceuticals. L.L. acts as a speaker for American Medical Systems/Boston Scientific.

Autologous Fascial Slings for Stress Urinary Incontinence: a 17-year Follow-up of a Randomised Controlled Study.

Safety concerns with the use of mesh in vaginal surgery have been ongoing. Autologous fascial slings (AFS) avoid foreign body complications. We compared the long-term (17-year) outcomes of two AFS repair methods-the standard sling and short sling (sling-on-string), and assessed durability and patient satisfaction of these for the treatment of stress urinary incontinence (SUI). A total of 107 patients from three urogynaecology units who had participated in a randomised controlled trial assessing standard (n = 52) and short (n = 55) slings were followed up for a median period of 17 years. Primary outcomes were Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores to assess the impact on the quality of life and symptom distress. Logistic quantile regression was employed to compare the two methods. Secondary outcomes included long-term complications and patient satisfaction. Mean scores showed no statistically significant difference between the standard and short slings at the 17-year follow-up relating to IIQ and UDI scores, leakage or urgency (p > 0.05). Improved bladder function was observed at 17 years compared with baseline (standard sling-IIQ scores mean difference [MD] 1.22 [CI: 0.69, 1.74], UDI scores MD 0.83 [CI: 0.70, 0.97]; short sling-IIQ score MD 1.14 [CI: 0.73, 1.54], UDI scores MD 0.54 [CI: 0.40, 0.67]) with age-related deterioration over time. Re-operation rates were low and patient satisfaction rates were high (67.2%) at follow-up. Autologous fascial slings are an effective and durable option for management of SUI and the short sling procedure can be recommended owing to plausible surgical advantages.

Long-Term outcomes of pediatric dacryocystorhinostomy in a single medical center- a retrospective study.

To examine the long-term success rate of pediatric endoscopic DCR surgery via telephone questionnaires, as determined by patients and their parents. This is a retrospective cohort study of all patients who underwent DCR surgery at the Schneider Children's Medical Center of Israel between 2010 and 2020. We performed long-term follow-ups to assess the quality of life, surgical complications, and satisfaction with surgical outcomes. Our study includes seventy-nine patients with a total of 108 eyes. The mean age at the time of DCR was 7.05 years (Std = 4, min = 0.3, max = 17.7) Mean follow-up time was 5.7 years (Std =2.5, min = 1.4, max = 11.1). Tubes were inserted for a mean of 129 days (Std = 101). Fifty-seven patients (72%) declared they had no complications after surgery, three patients (4%) reported pain after surgery, and 14 patients (17.7%) reported tube extrusion, which occurred 7-21 days after surgery. Forty-four patients (56%) reported no recurrence of symptoms, 29 (37%) complained of mild epiphora, and 18 (23%) reported some ocular discharge. Sixty-eight patients (86%) stated that they did not undergo additional surgery, while the remaining 11 (14%) reported undergoing a revision operation for symptom control. Satisfaction rate (1-7) mean score reported was 6.15 (Std = 1.6). Sixty-two (78%) reported improved quality of life, while 17 (22%) reported no improvement. Our questionnaire results have been compared with the TEARS scores with similar findings. Regardless of its etiology, endoscopic DCR surgery in the pediatric population is safe and efficient, with a high long-term patient satisfaction rate, as reported via a telephone questionnaire.

Long-term Outcomes and Patient Satisfaction Following Salvage Robot-assisted Radical Prostatectomy: A Modern Perspective

Background and objectiveApproximately two-thirds of men who undergo primary treatment for prostate cancer (PC) will experience biochemical recurrence (BCR). Salvage robot-assisted radical prostatectomy (sRARP) offers curative treatment in this disease setting and men who choose this option may avoid palliative androgen deprivation therapy (ADT). The purpose of this study was to describe long-term outcomes and patient feedback following sRARP. MethodsWe reviewed data for consecutive men with biopsy-proven localized BCR who underwent sRARP and pelvic lymph node dissection at a single tertiary referral center between 2004 and 2021. Perioperative data, Clavien-Dindo complications, and functional outcomes were recorded. The Kaplan-Meier method was used to estimate prostate-specific antigen–free (≥0.2 ng/ml) survival (PSAFS) and metastasis-free survival (MFS). Three Likert-type items (score 1-5) from the validated Surgical Satisfaction Questionnaire-8 were distributed to patients postoperatively. Key findings and limitationsWe included 78 men, of whom 72 (92%) had undergone primary radiotherapy and six (8%) had received primary prostate ablation. Median follow-up was 10.1 yr (interquartile range 5.8–12.4). Final pathology identified ≥pT3N0M0 in 35 patients (45%) and positive margins in 23 (29%). The overall complication rate was 50%. Of the 26 (33%) major (grade ≥III) complications, anastomotic stricture (32%) was most common. The estimated 3-, 5-, and 10-yr survival rates were 85.6% and 80.2%, 83.5% for PSAFS (n = 11), and 74.1%, 83.5%, and 70.5% for MFS (n = 23), respectively. At last follow-up, postoperative ADT had been administered to 17 patients (22%), and 39 men (50%) remained alive a decade after sRARP. Continence and potency were maintained in 33/62 (53%) and 1/16 (6%) patients, respectively. Thirty-five respondents (45%) reported median questionnaire scores (≥4) in favor of sRARP. Limitations include the small single-center series and a single query point for patient feedback. Conclusions and clinical implicationsLong-term outcomes of sRARP suggest that the technical challenges and morbidity of the procedure are qualified by patient feedback and the opportunity to evade the morbidity and mortality of biochemically recurrent PC. Patient summaryWe reviewed the cancer outcomes and side effects of robot-assisted surgical removal of the prostate after treatment failure with radiation or ablation for prostate cancer. We found that this type of treatment has substantial risks and long-term side effects, but the surgery provides an opportunity to cure prostate cancer and/or avoid the consequences of indefinite hormonal treatment. Overall, most men who underwent this surgery were not disappointed with their decision despite the higher risks and consequences.

Free Dermal Fat Grafting: A Novel Technique for the Correction of Nasolabial Folds During Facelift Surgery.

Traditional facelift surgery does not behave well in the correction of nasolabial folds, which is a common clinical problem and needed to be improved. To investigate the effect of free dermal fat grafting during facelift surgery for the treatment of nasolabial folds. This prospective cohort study involved 80 patients with moderate to severe nasolabial folds and facial skin dermatolysis. Fifty of them underwent facelift surgery combined with free dermal fat grafting, and 30 of them underwent traditional facelift surgery. These patients were followed up 2 months, 6 months, and 1 year after the surgery to evaluate the effect. The difference in Wrinkle Severity Rating Scale (WSRS) scores, assessed at each follow-up, between the patients who underwent and did not undergo free dermal fat grafting during facelift surgery, was statistically significant. For patients who underwent free dermal fat grafting during facelift surgery, the WSRS scores assessed at 2 months, 6 months, and 1 year after the surgery were significantly different from those before the surgery. The analytic results of FACE-Q indicated a high level of overall satisfaction rate. No major complications were recorded. Free dermal fat as a filler for nasolabial folds can achieve excellent therapeutic effect. The combination of facelift surgery with free dermal fat grafting for the treatment of nasolabial folds can provide very good long-term results and a high patient satisfaction rate for patients with symptoms of facial aging such as facial dermatolysis, obvious wrinkles, and deep nasolabial folds.

Long-term patient-centred outcomes of periacetabular osteotomy in a large consecutive series.

We assessed the long-term outcomes of a large cohort of patients who have undergone a periacetabular osteotomy (PAO), and sought to validate a patient satisfaction questionnaire for use in a PAO cohort. All patients who had undergone a PAO from July 1998 to February 2013 were surveyed, with several patient-reported outcome measures (PROMs) and radiological measurements of preoperative acetabular dysplasia and postoperative correction also recorded. Patients were asked to rate their level of satisfaction with their operation in achieving pain relief, restoration of activities of daily living, ability to perform recreational activity, and their overall level of satisfaction with the procedure. A total of 143 PAOs were performed between 1998 and 2013. Of those, 90 postoperative surveys were returned. Only 65 patients (73 hips) had both pre- and postoperative radiographs available for measurement. The mean time to follow-up was 15 years (6.5 to 20). Most patients were female (91%), with a mean age of 26.4 years (14.9 to 48.3) at the time of their surgery. A statistically significant improvement in radiological correction was detected in all hips (p < 0.001). A total of 67 patients (92.3%) remained either very satisfied or satisfied with their PAO. The internal consistency of the patient satisfaction questionnaire, measured using Cronbach's α, ranged from 0.89 to 0.94 indicating 'good' to 'excellent' reliability. Outcomes of importance to patients undergoing a PAO include several key domains: pain relief, improve activities of daily living, and improve recreational ability. Our study demonstrates high rates of long-term patient satisfaction in all domains, and found the patient satisfaction questionnaire to be a valid and reliable instrument for use in this cohort.

DRUJ Capsular Release for Forearm Rotational Limitation: Surgical Technique and Case Series.

Forearm stiffness can be caused by distal radioulnar joint (DRUJ) capsular contractures, which can occur after trauma such as a distal radius fracture. In this setting, a DRUJ capsular release may help improve forearm rotation, but the long-term functional outcomes remain unknown. The purpose of this case series is to investigate the short-term improvement in total pronosupination arc range of motion and long-term patient-reported outcomes (PROs) after DRUJ capsular release. We performed a retrospective review of consecutive patients who underwent DRUJ capsular release. Range of motion prior to surgery and at final short-term follow-up was collected and analyzed with a Wilcoxon signed-rank test. Patient-reported outcomes including QuickDASH and Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) scores were obtained as medians with interquartile range (IQR), while patient satisfaction was measured on a 4-point Likert scale. Five patients met the inclusion criteria with a median short-term follow-up of 5.5 (IQR: 4.3-10.3) months. The median preoperative supination was 25° (IQR: 0°-35°), and the median postoperative supination was 50° (IQR: 40°-60°; P = .03). The median preoperative pronation was 45° (IQR: 10°-60°), and the median postoperative pronation was 70° (IQR: 60°-80°; P = .04). After the long-term median follow-up of 10.9 (IQR 9.7-11.2) years, all the patients were satisfied or very satisfied with the results of the surgery. The median QuickDASH score was 13.6 (IQR: 9.1-20.5), and the median PROMIS UE score was 46.5 (IQR: 43.8-47.7). Distal radioulnar joint capsular release can improve pronation and supination in patients with posttraumatic forearm stiffness and is associated with high long-term patient satisfaction.

Advancements in Joint Replacement Surgery: Improving Long-Term Outcomes and Patient Satisfaction

Orthopaedic procedures have changed dramatically in the last several years due to the spectacular developments in joint replacement surgery. The purpose of this review article is to clarify the various developments in joint replacement surgery with an emphasis on improving patient satisfaction and long-term results. The study looks at five important topics: patient selection, prosthetic materials, surgical techniques, technological advancements, and long-term outcomes.&#x0D; Precision and implant longevity have been transformed by technological advancements such as 3D printing, robotic-assisted surgery, and computer-assisted navigation. Modern surgical methods have a strong emphasis on tissue preservation, less invasive procedures, and improved recovery protocols, which greatly lower postoperative problems and speed up recovery. Prosthetic material advancements including highly cross-linked polyethylene and customised designs have enhanced patient-specific results and implant longevity. In order to maximise surgical success and satisfaction, patient selection criteria, customised care regimens, and psychological support have become essential. When long-term results are assessed, functional abilities, implant durability, and patient satisfaction all show notable improvements; nonetheless, problems with complications and revision operations still exist.

Endolesional ablation of xanthelasma using microfiber optic laser delivery

Xanthelasma palpebrarum is the most common type of cutaneous xanthoma and is often a cause of psychological distress and aesthetic dissatisfaction. The extent, depth, or background skin type, intolerance to downtime, or cost, may restrict the treatment options, or contribute to a recurrence rate of up to 60%. 1470 nm microfiber laser is a recent clinical innovation that allows highly targeted delivery of Laser to deeper tissues through fibers as small as 150 μm in diameter, targeting fat and/or water chromophores. We report a retrospective data series on five patients (10 eyelids) treated with intralesional microfiber laser, where other treatment methods were inappropriate, contraindicated, or declined. Single-use tip firing microfibers (150-300 μm), were introduced into lesions under tactile and visible indicator light guidance (1-2 W; 250-500 Hz, LEED 1-2 Jcm–2, 1470 nm ). Results were followed up with before/after photography. The pain was measured using a prevalidated 1-10 Likert scale. Patients were followed up by remote consultation up to one year post-treatment. Xanthelasma size was (7 mm ± 4 mm, mean ±SD). The average time to complete resolution was 12±2.4 weeks ( All patients were normolipidemic pre-treatment. Sessions needed were 1.2±0.4 (mean ±SD). Maximum discomfort on a 1-10 Likert scale was 3±1/10 (mean ±SD), at eight weeks’ follow-up. No recurrences were reported up to 1 year’s follow-up. No patients had visible scarring. Most importantly, all patients reported minimal downtime and could continue normally with activities of daily life. 1470 nm microfiber laser is a promising method for the management of palpebral xanthelasma: within this case series was safe and effective in experienced hands. Further, larger studies are in hand to assess follow-up long-term outcomes and patient satisfaction.

An Open Label, Multi-center, Controlled, Retrospective Study of a Biodegradable Synthetic Graft for Soft Tissue Reconstruction in Patients Suffering from Chronic Lateral Ankle Instability

Category: Ankle; Sports Introduction/Purpose: Ankle sprains represent one of the most common injuries among both athletes and the general public (1). While most sprains resolve with conservative therapy, failure resulting in ligament laxity may necessitate surgical intervention due to pain and instability from injury to the anterior talofibular ligament (ATFL), the weakest ligament in the lateral ligamentous complex (2). Surgical repair of ATFL has relatively high success rates, however post-procedure chronic instability and pain remain a clinical challenge, with re-operation rates reported as high as 14% (3). The Artelon® FlexBand® matrix is a biocompatible, synthetic matrix designed to reinforce soft tissue repair during tendon/ligament reconstructive procedures. The goal of this study is to compare the outcomes of ATFL reconstructive surgery with and without this synthetic graft augmentation. Methods: This multi-center, IRB approved study used a combination of retrospective medical chart review and prospective procedure satisfaction phone surveys in patients that had undergone ATFL repair (isolated and non-isolated) with or without synthetic graft augmentation. These results represent an interim data analysis of an ongoing clinical study. A total of 234 patients, (82 Control and 152 FlexBand augmented) diagnosed with chronic lateral ankle instability that had failed conservative therapy, and required surgical intervention to repair the lateral ligament complex were enrolled across four different research centers. Patient demographics, physician assessment of healing progression, safety, complications necessitating a return to OR, and post-op rehabilitation schedule were analyzed. Two study sites used Visual Analog Scale (VAS) to assess pain pre-surgically and at 2, 6, and 12 week follow-up visits. Phone survey questionnaires were given to patients that reached at least 1yr post-op to assess long-term patient satisfaction and function. Results: Average patient age was 42yrs in both groups and average follow-up time was 19.2mo (FlexBand) and 28.4mo (Control). There was no statistical difference in baseline VAS pain scores between groups. Augmented patients demonstrated significantly lower VAS scores at 2-,6-, and 12-week follow-up visits (p &lt; 0.001, p&lt; 0.0001and p&lt; 0.0001, respectively) compared to controls (Fig 1). In addition, a significant acceleration in return to FWB status in augmented group compared to control patients was observed (9.04 ± 0.38wks, N=101 vs. 11.82 ± 1.67wks, N=45; p = 0.027). Both groups demonstrated equivalent AE safety profiles and complications were similar across groups with 3.7% (3/82) of control and 3.9% (6/152) augmented patients requiring a return to OR, however, no AEs or complication events were related to the Flexband Device. Conclusion: Our data shows a significant reduction in VAS pain scores in patients who underwent the modified Brostrom procedure with augmentation at all follow up time points. In addition, synthetic graft augmentation may lead to earlier return to function due to the significantly lower time to achieve FWB status. Further investigation on the potential clinical benefits of ATFL augmentation with Artelon Flexband is ongoing through a prospective, randomized, controlled study. Overall, long-term (&gt;1yr) patient satisfaction was equivalent across groups and a trend toward potential earlier recovery times were better for the augmented group than the control group.

A Population-Based Assessment of Long-Term Sexual Well-Being and Patient Satisfaction after Breast Reconstruction and Post-Mastectomy Radiation

In 2016, more than 40% of women who underwent mastectomy for breast cancer went on to have breast reconstruction, but there is little data regarding long-term cosmetic outcomes past 5 years after post-mastectomy radiation (PMRT) and reconstruction. This study aims to evaluate the difference in patient breast satisfaction and sexual well-being over time by receipt of reconstruction and PMRT. The iCanCare study is a population-based, longitudinal study of women diagnosed with breast cancer in 2014-15 identified in the Los Angeles and Georgia SEER registries. Women were surveyed during initial treatment and again approximately 6 years later in survivorship (2021-2022). Participants were asked about their "Sexual well-being after mastectomy" and "Satisfaction with breasts" using the Breast-Q, which was dichotomized into "high" and "low" scores (using the median), with a high score indicating increased satisfaction. We then evaluated whether satisfaction differed by treatment characteristics, using unadjusted odds ratios (OR) for categorical variables, calculated using the Chi-square test, or the Kruskal-Wallis test for continuous variables. Adjusted odds ratios were found using multivariable logistic regression models adjusting for treatment characteristics, diagnosis, age, BMI, education, and breast cancer stage. In this preliminary sample of 1191 respondents, 445 underwent mastectomy, of which 272 (61.12%) had reconstruction, and 65 (14.61%) had PMRT. Having breast reconstruction was associated with higher long-term sexual well-being (median score 36.30 vs. 22.20, OR 1.69, 95% confidence interval [CI] 1.09 - 2.64) and breast satisfaction scores (OR 1.53, 95% CI 1.01 - 2.33) compared to not having reconstruction. However, this improvement in sexual well-being was attenuated in women who additionally had PMRT (OR 0.83, CI 0.271 - 2.51). In women who did not have reconstruction after mastectomy, there was no statistically significant difference in sexual well-being scores regardless of the use of PMRT (OR 0.68, CI 0.39 - 1.22). Among respondents in adjusted models who did not receive PMRT, those with reconstruction had higher sexual well-being scores than those with without reconstruction (aOR 2.47, CI 1.34 - 4.56), though there was no statistically significant difference in breast satisfaction scores (p = 0.16) among the groups. Sexual well-being and breast satisfaction are improved with reconstruction 6 years after mastectomy for breast cancer. However, these improvements were attenuated for women who received PMRT. To our knowledge, this is the first study to look at long term outcomes of sexual well-being and treatment satisfaction after breast reconstruction for patients who underwent mastectomy for breast cancer. These data suggest that continued work should be done to optimize patient outcomes when combining PMRT and breast reconstruction.