Plastic Surgery Clinic Research Articles

CURRENT PROCEDURES IN HAND REPLANTATIONS - PARTICULAR LEVEL OF TRAUMATIC UPPER LIMB AMPUTATION

Amputations in the upper extremity due to trauma are, by definition, devastating injuries that involve multiple critical structures of the fingers, hand, arm, or any combination of the three and nearly always lead to significant disabilities, both directly and through their psychosocial impact. Replantation is defined as the reattachment of a part that has been completely cut off and the reconnection of the damaged vascular structures. Chances of viability depend on the degree of vascular, bone, muscle and nerve lesions, the level of amputation, the trauma mechanism, the pacient’s age and comorbidities, the ischemia time while the functional recovery is assessed according to the following criteria: the active range of motion, the two-point discrimination sensibility ratings, the grip and pinch strength, the cold intolerance, and the return to previous employment. We report a case of a man D.V., aged 51, with a non-pathological personal history, admitted in April 2014 in the Emergency Hospital of Bucharest with the diagnostic “Severe injury by circular right upper limb. Hand amputation from radiocarpal joint, 3 hours old”. The pacient was urgently transported in the operating room, where the right hand replantation was performed. He was first hospitalized in the Intensive Care Unit, then he was transferred in the Plastic Surgery and Reconstructive Microsurgery Clinic. Post-operatively, the results were favorable, our patient achieved at 6 months evaluation S3+ and M4 on British Medical Research Council‘s scale.

Health Literacy in Women Presenting to a Urogynecology Practice

Health literacy (HL) is the degree to which an individual can obtain, process, and communicate basic health information to make appropriate health decisions. Understanding HL of patients can improve outcomes. Thus, we evaluated HL in women with pelvic floor disorders and investigated its relationship to patient demographics, reading level, and cognition. We conducted a cross-sectional study with a convenience sample of English-speaking women 18 years or older, recruited from female pelvic medicine and reconstructive surgery clinics from July 2016 to January 1, 2017. Patients with severe visual impairment or severe cognitive impairment were excluded. We used the reading comprehension passages of the short form of Test of Functional Health Literacy in Adults to assess HL, the reading subscale of the Wide Range Achievement Test 3 for reading level, and the Self-administered Gerocognitive Exam for cognition. Among 196 participants, the mean age was 61.1 ± 13.3 years, 84.7% were white, and 54.1% were college educated. Most participants (95.4%) demonstrated adequate HL. Those with adequate HL were younger (60.5 ± 13.2 vs 71.8 ± 10.7, P = 0.01), had less cognitive impairment (12.5% vs 77.8%, P < 0.001), and more frequently had post-high school reading levels (70.1% vs 33.3%, P < 0.001). Overall HL in the pelvic floor disorder population is high, but older patients with cognitive impairment and lower reading levels are at risk of inadequate HL. Lowering reading levels of educational materials and screening for cognitive impairment may be beneficial to patient understanding and health outcomes.

Ageism and Health in Patients Undergoing Cosmetic Procedures.

Ageism is a common form of prejudice that negatively affects the health of older adults. Anti-aging procedures are increasingly popular among patients seeking aesthetic surgery and minimally invasive treatments. This study aimed to identify the prevalence of age-based discrimination, and its relationship to health, among patients seeking cosmetic procedures. Patients from a university-based, single-surgeon, aesthetic plastic surgery clinic completed the Everyday Discrimination Scale, which assesses the frequency with which individuals have experienced "microaggressions" and the main reason(s) for discrimination (including age). Participants also completed: measures of perceived age discrimination across interpersonal, romantic, work, and healthcare contexts and anticipation of age-based discrimination in the future; a single-item measure of self-rated health (rated 1-5); and the Rosenberg Self-Esteem Scale. Fifty patients consented to participate in the study (94% women, 78% white, mean age 49.4 ± 13.5 years). More than 30% of participants reported age as the main reason for everyday discrimination. Participants who reported experiencing age-based discrimination, compared with those who did not, had worse self-rated health, lower self-esteem, and greater anticipated age-based discrimination. Participants most frequently endorsed experiencing age-based discrimination in an interpersonal context (36.0%) followed by work settings (20.0%). A significant portion of patients seeking cosmetic procedures may experience age-based discrimination, which could negatively affect their health and well-being. Patients might benefit from expectation management about how their procedure may or may not address their concerns about age-based discrimination. More research is needed to determine whether cosmetic procedures help to mitigate discrimination in aging patients.

Facial Plastic Surgery Clinics of North America: Controversies in Facial Plastic Surgery

Facial Plastic Surgery Clinics of North America: Controversies in Facial Plastic Surgery

Possibilities for more accurate prediction of thermal injury severity and determination of its impact on the body using the Abbreviated Burn Severity Index

INTRODUCTION: During the last decades, the chances of survival in burn patients have been progressively increasing, but the issue of prognosis of death after such injuries is still of great ethical, social, medical, and forensic interest. AIM: The purpose of our study was to examine and confirm the accuracy of the ABSI (Abbreviated Burn Severity Index) system in predicting the risk of death in thermal trauma by comparing its values with the actual risk reported. MATERIALS AND METHODS: In order to achieve this purpose, the medical records of burn patients admitted to the Clinic of Thermal Trauma, Plastic, Reconstructive and Aesthetic Surgery at the Naval Hospital of Varna for a five-year period (2011-2015) were studied and the death cases were analyzed. The mortality rate predicted by ABSI was compared to the actual death rate reported in the medical records. RESULTS: There was a significant difference in the mean values of ABSI in survivors and deceased: 4.65 and 11, respectively. All with an ABSI value less than 3 survived. For ABSI values up to 10, a slightly lower mortality was reported than the predicted. For the values ≥11 they matched. Despite these discrepancies, we believe that ABSI is suitable for calculating the risk of death in thermal trauma, especially in more severe burns, where the threat to life is higher. CONCLUSION: Three groups were differentiated with a sharp increase in the percentage of actually reported mortality. Their respective ABSI values can be taken as a reference for forensic medical practitioners in the classification of bodily injuries due to burns.

The characteristics of private plastic surgery practice in developing country: An epidemiological study.

Background:With the rise in working-age population, there has been notable economic growth in Indonesia. Along with it, there is an increase in expenditure for non-food items such as health-care service, without exception to plastic surgery practice. Aesthetic plastic surgery practice has gained its popularity in several other developing countries such as Brazil, Russia, India and China. Epidemiology report of private plastic surgery practice in Jakarta, the capital of Indonesia, will provide the evidence of increasing need for aesthetic plastic surgery practices as the basis for further improvement.Methods:This is a single-centre descriptive cross-sectional study with a total sampling method which included all patients registered at a private plastic surgery clinic between January 2008 and December 2016.Results:There were 1457 medical procedures. The majority (93.4%) of patients were female. More than 80% were surgical procedures, the most common ones were breast implant and blepharoplasty with the latter being similarly popular in both gender. The majority of the patients fell into 20–45-year-old group. Patients <20-year-old had undergone a more minor surgical procedure such as skin tumour and nevus excision or scar treatment while patients >45-year-old had more procedures with rejuvenation purpose.Conclusion:The epidemiology of private plastic surgery practice in an urban area of developing country resembles those in either developed or developing countries with a similar socio-demographic profile. This data can be further utilised for a more focused private plastic surgery practice improvement. The limitation however is that, the study is based on a single centre data.

Cross-sectional investigation and analysis of anxiety and depression in preoperative patients in the outpatient department of aesthetic plastic surgery in a general hospital in China

This study was designed to evaluate anxiety and depression disorders and investigate the prevalence and risk factors in preoperative patients who visited a cosmetic plastic surgery clinic. The estimate of anxiety and depression in preoperative patients, who were admitted to the outpatient department of plastic surgery in a general hospital from July 2016 to July 2017, was determined by a field survey method using the Hospital Anxiety and Depression Scale. The demographic information of all patients was collected. All data were analyzed by SPSS statistical package. A total of 315 patients were enrolled, which included 15 males and 300 females, with an average age of 30 ± 8.4 years. The mean HADS score was 8.2 ± 5.13, HADS-A was 4.7 ± 3.04, and HADS-D was 3.5 ± 2.72. The HADS-A score was significantly higher than the HADS-D score (p = 0.000). There were 34 cases (10.8%) with anxiety, 15 cases (4.8%) with depression, and 6 cases (1.9%) with both anxiety and depression. We found that the education level of these patients (p = 0.001) and the development level of their residence places (p = 0.040) have a negative correlation with the score of anxiety. There was a negative correlation between education level (p = 0.000) and depression score. Education level was associated with the diagnosis of anxiety (p = 0.034). Education level (p = 0.001) and occupation (p = 0.015) were associated with the diagnosis of depression. In patients seeking cosmetic plastic surgery, the preoperative anxiety is more obvious than depression. There is a negative correlation between education level and anxiety and depressive symptoms.

Development of a New Patient-reported Outcome Measure for Ear Conditions: The EAR-Q.

Background:Patient-reported outcome measures are widely used to improve health services and patient outcomes. The aim of our study was to describe the development of 2 ear-specific scales designed to measure outcomes important to children and young adults with ear conditions, such as microtia and prominent ears.Methods:We used an interpretive description qualitative approach. Semi-structured qualitative and cognitive interviews were performed with participants with any type of ear condition recruited from plastic surgery clinics in Canada, Australia, United States, and United Kingdom. Participants were interviewed to elicit new concepts. Interviews were audio-recorded, transcribed, and coded using the constant comparison approach. Experts in ear reconstruction were invited to provide input via an online Research Electronic Data Capture survey.Results:Participants included 25 patients aged 8–21 years with prominent ears (n = 9), microtia (n = 14), or another condition that affected ear appearance (n = 2). Analysis of participant qualitative data, followed by cognitive interviews and expert input, led to the development and refinement of an 18-item ear appearance scale (eg, size, shape, look up close, look in photographs) and a 12-item adverse effects scale (eg, itchy, painful, numb).Conclusions:The EAR-Q in currently being field-tested internationally. Once finalized, we anticipate the EAR-Q will be used in clinical practice and research to understand the patient’s perspective of outcomes following ear surgery.

Pubic Hair Restorative Surgery Using Grafts Harvested by the Nonshaven Follicular Unit Extraction Technique.

Pubic atrichosis or hypotrichosis is quite common among Korean women. Although Korean people are increasingly opening up to Western culture, pubic hair transplantation is still pursued for cultural reasons. However, many hesitate to undergo restorative surgery because follicular unit strip surgery would leave a linear donor scar, preventing patients from hiding their surgical history. Thus, follicle harvesting using nonshaven follicular unit extraction (NS-FUE), aside from many other strengths, is very useful when performing pubic restorative surgery. There has been no previous report concerning the effectiveness of NS-FUE for treating pubic atrichosis or hypotrichosis. To investigate the effectiveness of NS-FUE when performing pubic restorative surgery. The 50 patients who were included in the study underwent pubic hair restoration using NS-FUE between March 2014 and June 2016 at Dana Plastic Surgery Clinic (Seoul, Korea), and were followed for at least 10 months afterward. Patients and the surgeon completed a survey about donor and recipient site surgical results using a 5-point Likert scale. The average satisfaction scores of patients and surgeon were 4.5 and 4.6, respectively. Nonshaven follicular unit extraction is one of the most effective harvesting methods when performing restorative surgery for patients with pubic atrichosis or hypotrichosis.

Description of Mandibular Improvements in a Series of Infants With Congenital Muscular Torticollis and Deformational Plagiocephaly Treated With Physical Therapy.

Many infants with congenital muscular torticollis (CMT) have deformational plagiocephaly (DP), and a small cohort also demonstrate mandibular asymmetry (MA). The aim of this retrospective study was to evaluate mandibular changes in these infants with previous computed tomography (CT) scans who underwent physical therapy (PT) to treat CMT. A retrospective study included patients presenting to a pediatric plastic surgery clinic from December 2010 to June 2012 with CMT, DP, and MA. A small subset of these patients initially received a 3D CT scan due to concern for craniosynostosis. An even smaller subset of these patients subsequently received a second 3D CT scan to evaluate for late-onset craniosynostosis. Patients were treated with PT for at least 4 months for CMT. Initial CT scans were retrospectively compared to subsequent CT scans to determine ramal height asymmetry changes. Clinical documentation was reviewed for evidence of MA changes, CMT improvement, and duration of PT. Ten patients met inclusion criteria. Ramal height ratio (affected/unaffected) on initial CT was 0.87, which significantly improved on subsequent CT to 0.93 ( P < .05). None of the patients were diagnosed with craniosynostosis on initial CT. One patient was diagnosed with late-onset coronal craniosynostosis on subsequent CT. We identified a small cohort of infants with MA, CMT, and DP. These patients uniformly demonstrated decreased ramal height ipsilateral to the affected sternocleidomastoid muscle. Ramal asymmetry measured by ramal height ratios improved in all infants undergoing PT.

The Impact of Cosmetic Surgery on Women's Marital Satisfaction and Self-Concept.

BACKGROUNDToday, cosmetic surgery is one of the most common procedures worldwide, and its use is increasing. This study aimed to identify the impact of cosmetic surgery on married women’s marital satisfaction and self-concept. METHODSFrom January 1st, 2015 to June 6th, 2015, 44 married women operated in a plastic surgery clinic or seeking for a cosmetic surgery and 55 non-applicants as general population were enrolled. ENRICH marital satisfaction questionnaire and Rogers’ Self-concept Inventory were used to compare groups. RESULTSOperated applicants revealed a significant higher level of satisfaction in comparison with other groups regarding personality, conflict and leisure. Compared to control group, the surgical group had significantly higher satisfaction in marital and familial relationship, friendship, and financial management.CONCLUSIONIt can be drawn that expectation for postoperative positive outcome probably is an important factor affecting high level of marital satisfaction in cosmetic surgery applicants. Furthermore, the self-concept is significant predictor of applying for cosmetic surgery.

Gluteal Augmentation With Fat: Retrospective Safety Study and Literature Review

Use of gluteal augmentation with fat increased by 3267% from 2002 to 2015, and the rate of death is highest compared with other aesthetic procedures: 1 in 3448 patients dies, compared with 1 in 55,000. To retrospectively investigate patients who underwent this procedure at Oslo Plastic Surgery Clinic, to review international data to determine factors causing mortality, and to provide guidelines for safety. Patient data were searched for reason for the procedure, assessment of patients, techniques performed, and safety measures used. In 60 cases, a vibration machine was used for fat harvesting. Review of the international literature, with special emphasis on fatal complications, was performed on Medline, Google Scholar, and PubMed. Mean patient age was 32 years. Mean amount of grafted fat was 422 mL (range, 210-850 mL). Sedation, local and tumescent anesthesia were used in all patients, with mobilization directly after surgery. Mean operation time was 89 minutes. Eighteen patients required a second surgery. Minor complications occurred in 8 patients. Average follow-up was 8 months. Ninety percent of patients were satisfied. Review of international literature showed that the main reason for death in 2015 was fat lung embolism related to muscular and submuscular grafting. Gluteal augmentation with fat is one of the most popular procedures, with an internationally high mortality rate. Patient safety is a priority, and preventive measures should improve safety because appropriate patient selection, avoiding muscular and submuscular grafting, avoiding infragluteal incision, moderate grafted volume, and direct postoperative mobilization are essential.

Primary Repair of Cleft Lip and Nose in the Neonatal Period

Abstract Facial cleft malformations belong to the most common problems of the congenital facial anomalies. At the Clinic of Plastic, Aestetic and Reconstructive Surgery at the Faculty Hospital in Banská Bystrica we have been performing primary cleft lip repairs during the first week of life of a newborn since 1995. During this life period the fetal healing still persists. Modern anesthetic techniques have considerably reduced respiratory complications after the lip closure. The adequate postoperative sedation together with monitoring of the pacient remarkably reduces the occurrence of wound dehiscence. The advantages of the neonatal cleft lip repair are the scarless healing, no negative effect on the growth of the middle thirt of the face, as well as the pschychosocial effect on the family and the fact that the ortodontic aparat has not been needed.

The Retrospective Analysis and the Demographics of Upper Extremity Injury Patients and Their Problems in the First 24 Hours After Operation.

Objectives:In this study, we analyzed patients with upper extremity injuries concerning patient demographics, injury type and etiological factors, and the most common problems encountered during the first 24 hours that were noted in the retrospective analysis.Methods:In this study, a total of 82 patients who presented to the emergency plastic surgery clinic in Şişli Hamidiye Etfal Research and Training Hospital, postoperatively these patients were checked after surgery for first 24 hours concerning pain, nausea and vomiting, edema, agitation, arm immobilization arm and vascular patency.Results:Among etiological factors, 54 patients were sharp-object trauma, 10 patients punched a hard object, 15 patients had work hazard, two patients had traffic accident, one patient from the fight. When these patients were postoperatively analyzed, in 45% patients pain, in 7% nausea and in 14 % bleeding were observed. Plaster was placed in 100% of the patients in order and their arms were elevated to reduce edema. During the first four hours, in 2% of the patients, edema was seen, 16% agitation, 8%vascular problems.Conclusion:When the type of injury is subcategorized to injuries of several compartments (nerve, tendon, muscle, artery, vein), the early postoperative challanges are more easily and correctly handled.

Alternative Approach to Traumatic Stensen’s Duct Injuries Accompanied by Glandular Involvement: Botulinum Toxin Injection to the Gland in Conjunction with Microsurgical Repair of the Duct in an Acute Setting

There is high tendency to ignore the diagnosis as the incidence of the injury of parotid gland and its duct is relatively rare. In order to prevent the long-term complications such as facial deformities, sialoceles, cutaneous fistulae, salivary gland cysts and gustatory sweating (Frey’s syndrome) and to restore the parotid gland functions, it is important for the duct injuries to be diagnosed and treated immediately. 3 patients consulted to Plastic Surgery Clinic from the Emergency Room of Hacettepe University following maxillofacial trauma was reviewed in this study. Exploration of the facial nerve and Stenon duct was planned for all patients within the first 72 hours following the injury. Following intraoral catheterization of the Stenon duct through the papilla with an epidural catheter, microsurgical end-to-end anastomosis was performed. Concurrently, 100 Units of botulinum toxin A was injected at standardized 8 points on the parotid gland. Postoperative MR sialography revealed patency in all patients at the end of postoperative first year. The mean postoperative parotid volume of the injured and non-injured sides were 19,82±10,55 and 17,79±10,98 respectively and the results were found to be comparable. Fibrillation potentials in the postoperative electromyography recordings and clinical examination demonstrated the nerve regeneration. In conclusion, botulinum toxin A is appears to be effective in both treatment of the injuries of the duct accompanied by glandular involvement in the acute setting, as well as prevention of the long term complications.

Plastic Surgery Management of Victims of Terrorist Violence in Ankara, Turkey.

Terror attacks have been progressively increasing worldwide through the present era. The management of the consequences of terrorism events is under debate in almost every scientific area. The organization and advancement of health services constitute important components of the crisis management. Similar to other specialty areas in medicine, the medical management of terrorist attacks is becoming important in terms of plastic and reconstructive surgery.Ankara, the capital of Turkey, has been subject to 2 terrorist events in public places within a year. The total number of patients involved in both cases was 434. Ankara Numune Training and Research Hospital is a tertiary health care institution and one of the most important trauma centers in the region. A total of 178 Patients exposed to these events referred to our hospital. Of the total, 34 patients were completely or partially treated in the plastic and reconstructive surgery clinic. In this study, we tried to discuss the difficulties encountered in the classification of patients and plastic surgery during the treatment period of patients who experienced these attacks.Data were obtained from The National News Agency, hospital, and our own clinic registries. Patient classification was based on the injured parts of the body. Statistical analysis was performed for all data. In conclusion, the role and the importance of plastic surgery department especially in trauma management have been emphasized in the light of our findings.

The treatment of facial asymmetry: Review.

Some degree of congenital or acquired asymmetry is normal and universal. Significant facial asymmetry, however, causes both aesthetic, as well as functional problems. The comprehensive management of facial symmetry is scarcely addressed.1-5 Differing etiologies, heterogeneous material, and different ages of patients tend to produce fragmentary reports, the more so as evidence-based evaluation of outcomes is almost impossible. Therefore, a presentation of the general rules of treatment, illustrated by our own material collected from the Hospital and Clinic of Plastic Surgery in Polanica-Zdrój and from private surgical and orthodontic practice, could be regarded as useful and justified. Special attention has been given to both functional and cosmetic problems encountered in severe congenital and acquired asymmetries. The management of selected craniofacial malformations in so-called rare clefts, cleft lip and palate, and craniofacial microsomia (CFM), as well as large hemangiomas and neurofibromas, have been discussed. Additionally, the treatment of extensive and asymmetrical post-traumatic deformities and defects is discussed with particular attention given to problems related to ankylosis of the temporomandibular joints. Numerous examples of one-stage procedures, as well as combined, multidisciplinary treatments are presented.

Epidemiology of lip and palate clefts in northwest of Iran: Prevalence, surgery complications and unrepaired patients younger than 18 years old

BackgroundThis study investigated the prevalence of lip and palate clefts, need for reoperation and primary surgery in unrepaired patients younger than 18 years old in Zanjan province, northwest of Iran. MethodsAll urban and rural healthcare centers and the education department of Zanjan province were informed about this project. After identifying all patients with cleft lip and palate, they were sent to the plastic surgery clinic of our hospital. Their data were gathered, including sex, age, clinical classification, surgical modality, complications, surgery satisfaction and un-repaired patients. ResultsA total of 87,356 people were examined by social workers. Among them 120 children and adolescents had cleft lip and palate (1.37 per 1000). 59 (49.1%) patients had cleft lip and palate, 35 (29.1%) patients had only cleft lip and 26 (21.6%) patients had only cleft palate. 25 patients (20.8%) had not done surgery (detection rate was 2.86 per 10,000). Secondary surgery was done in 39 patients (41.05%). In spite of a referral health system in Iran, 25 children with cleft lip had not been operated. ConclusionAlthough most of the identified patients had been operated before, almost half of them had to undergo surgery again. Given the lack of studies on this topic in Iran, our findings can form the basis for further studies to precisely identify the roots of cleft lip and palate and properly plan to decrease its risk factors. Further studies are needed to identify reasons of missed detections and why primary surgeries are not satisfying.

Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty

Facial Plastic Surgery Clinics of North America: Functional Rhinoplasty

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis.

External surgical treatment of involutional ptosis with normal levator function is challenging owing to lack of an established algorithm. Developing an algorithm-based technique could improve postoperative results while limiting intraoperative inefficiencies. To investigate the postoperative success of an algorithmic external levator aponeurosis resection technique for aponeurotic ptosis with good levator function. This retrospective cohort study included patients with involutional ptosis and normal levator function who were treated from July 1, 2015, through November 30, 2016, at a private ophthalmic plastic surgery clinic. The technique involved a small incision in the eyelid crease, with dissection through the orbital septum to expose the levator aponeurosis. The leading edge of the aponeurosis was then clamped to a medical-grade spring scale to standardize the stress on the eyelid between patients. Two millimeters of aponeurosis were resected for every 1 mm of desired ptosis correction. Two sutures were then placed to connect the aponeurosis to the tarsus at predetermined locations. Preoperative predicted (goal) vs actual margin reflex distance-1 (MRD1). Twenty-six eyelids of 15 patients (6 men and 9 women; mean [SD] age, 65 years [range, 17-84 years]) met inclusion criteria. The mean follow-up was 189 days (range, 63-343 days). The mean preoperative MRD1 was 0.44 mm (range, -0.5 to 2 mm; 95% CI, 0.18-0.70 mm) compared with the final mean MRD1 of 3.2 mm (range, 2.5-4.0 mm; 95% CI, 3.1-3.4 mm; P < .001). The mean predicted goal MRD1 was 3.4 mm (range, 2.5-4.0 mm; 95% CI, 3.2-3.5 mm). The final MRD1 of all eyelids was within 1 mm of the goal MRD1. The mean surgical time per eyelid was 14.6 minutes (range, 10.5-34.0 minutes). Twelve eyelids (46%) did not have intraoperative suture adjustments. In correcting aponeurotic ptosis, a small-incision levator aponeurectomy incorporating an algorithm and consistent stress on the aponeurosis during resection achieves the goal MRD1 efficiently. The algorithm closely estimates the desired height intraoperatively such that only small intraoperative suture height revisions, if any, are needed. No intraoperative adjustments were made in 12 eyelids, necessitating future studies to determine whether any adjustments are needed. 3.