Principles Of Plastic Surgery Research Articles

Extensive Ultrasonic Liposuction in Gynecomastia: An Alternative Approach without Surgical Gland Excision

Aim: Skin and gland removals made on the chest wall may result in noticeable scars that can be challenging for patients to tolerate. This study aimed to define an extensive ultrasonic liposuction approach without surgical excision for gynecomastia. We also investigated its effectiveness in reducing complications and improving cosmetic outcomes. Materials and Methods: Gynecomastia patients with Rohrich grades II and III were evaluated according to skin quality. 46 patients who met these criteria underwent ultrasonic liposuction performed by the senior author between February 2021 and April 2023. These patients were compared with 58 who underwent surgery using suction-assisted liposuction combined with peri areolar mastopexy and glandular excision. Results: Our study found that patients who underwent extensive ultrasonic liposuction had a complication rate of 8.7%. Of the total number of patients, only one experienced a seroma complication, and three experienced residual breast tissue/ptosis. None of the patients required revision surgery. In comparison, the control group that underwent peri-areolar mastopexy and glandular excision had a higher complication rate (10.3%). Conclusion: We used the basic principles of plastic surgery for wound contraction. Distributing the wound healing mechanisms to a broad surface allowed us to achieve better cosmetics without forming a noticeable scar on the chest wall. Keywords: Breast Ptosis, Extensive Liposuction, Gynecomastia Surgery, Ultrasonic Liposuction, Vaser Liposuction

Broadening Horizons: a 3-month structured webinar series for undergraduate and postgraduate plastic surgery education

BackgroundWe created a 3-month webinar series, entitled Broadening Horizons, which explored plastic surgery principles from each subspeciality according to the Intercollegiate Surgical Curriculum Programme (ISCP) for plastic surgery. This article reports on our experience of producing a teaching programme, its impact on our delegates, and provides a useful guide to creating future webinar series in plastic surgery and other specialities.MethodsPre- and post-course questionnaires were used to perform a needs analysis, collect feedback and assess our delegates’ career interests and perceptions of plastic surgery. Delegates rated their responses on 5-point Likert scales. Delegates also undertook a 60-question pre- and post-course exam to test their knowledge.ResultsOne thousand eight attendances were recorded for the entire 16-part webinar series. Sixty-three (53–73) delegates, including undergraduate, postgraduate and international students, attended each lecture on average. Seventy-five percent of delegates felt they had previously received inadequate plastic surgery teaching. Ninety-six percent were satisfied or very satisfied with Broadening Horizons. Confidence in their knowledge of plastic surgery increased significantly from 2 (1–3) (not very confident) to 3 (2–5) (somewhat confident) (p = 0.01). Post-course exam scores increased significantly from 49% (32–67) to 56% (23–85) (p = 0.05). Career interest and positive perceptions were maintained.ConclusionsThis is the first webinar series to provide undergraduates and postgraduates plastic surgery teaching based on ISCP learning objectives. The series increased delegates’ knowledge and confidence in their understanding of plastic surgery. This article describes the 5-E-Z step guide to developing future teaching programmes similar to Broadening Horizons.Level of evidence Not ratable

PC7. Competency-based, Time-variable Resident Education: A Programmatic Update

PURPOSE: In 2018, the University of Pittsburgh Medical Center (UPMC) adopted a Competency-Based, Time-Variable (CBTV) model for plastic surgery training, the first of its kind in the United States. This educational model emphasizes performance and skill mastery, rather than time-based benchmarks, as the measure by which residents are deemed fit for graduation. METHODS: Starting in the PGY1 year, each resident is evaluated regularly via oral exam to assess knowledge of plastic surgery principles. Resident self-assessment of technical competency is directly compared to faculty assessment utilizing the Zwisch Rating Scale, a validated scoring system in rating resident autonomy. Our department has reorganized its rotation schedule to shift Chief-level rotations from the PGY6 year to the PGY5 year. RESULTS: UPMC matched its first CBTV resident class in 2018. Of this three-resident cohort, two residents (66%) were deemed competent for graduation after five clinical years of training. One resident elected to defer graduation until after six years of training due to fellowship application timing constraints. The other resident elected to pursue a year of research and subsequently graduate after five clinical years of training. Thus, all three residents will graduate after six years at UPMC, but with customized experiences based on their specific interests and educational needs. CONCLUSION: The CBTV model has increased the flexibility of our training program to accommodate individualized educational needs of each resident, allowing them variable rotation schedules to address surgical deficiencies as well as to further develop their clinical interests. This is a paradigm shift in surgical education.

COMBINATION OF THE MULTIMODAL ALGORITHM AND THE RECONSTRUCTIVE-RESTORATIVE LADDER IN THE TREATMENT OF THE WOUNDED WITH FLAMMABLE DEFECTS SOFT FABRIC

Resume. Most wounds formed as a result of a gunshot wound require staged, and in some cases, multistage reconstructive and restorative operations and rehabilitation.
 Materials and methods. During treatment at the Military Medical Center of the Republic of Poland for 6 months (from 24.02.22 to 10.09.22), reconstructive and surgical treatment of 54 wounded soldiers was carried out using the principles of reconstructive and plastic surgery. The treatment process was based on a multimodal approach - dynamic screening of gunshot wounds with soft tissue defects, which was used in the pre-, intra- and postoperative periods.
 Results and their discussion. A total of 54 wounded people were included in the study. Methods of closure that were used during the recovery process: spontaneous epithelization — 3 (5.6 %) of the injured, secondary sutures — 10 (18.5 %), PHO with the use of a split skin flap - 12 (22.2 %), sliding flaps – 12 (22.2 %), propeller flaps – 17 (31.5 %). When using full-layer flaps (sliding, propeller) in wounded patients, inflammatory complications were not observed in the postoperative period, but the phenomena of venous stasis, marginal necrosis of the distal part of the flap were noted. The average number of postoperative bed days before independent movement or self-care was 7.5 days. The aesthetic component in wounded patients with the use of flaps increased by 1.8 times compared to the RSK technique.The functional component was restored in 35 % during further observation.
 Conclusions. As the experience of the VHP in previous military conflicts has shown, primary closure of a gunshot wound is not possible, and in some cases even harmful. Therefore, in our opinion, the preparation of a gunshot defect of soft tissues, based on multimodal monitoring, can be considered as a bright addition to the reconstructive-plastic ladder. Performing reconstructive and plastic closure of gunshot wounds with propeller flaps is an actual method of restoring the damaged anatomical area, which allowed to obtain better aesthetic, as well as anatomical and functional results, in some cases - without additional wound surfaces (places for the collection of RAS).

Gunshot injury to the face: a case report

Treatment of gunshot wounds in the maxillofacial region is complex. Current literature supports immediate treatment. Wounds vary widely. The nature of the injuries must be carefully assessed using the Kanzanjian and Converse’s principles of plastic surgery as guidance, but always adapting to specific needs. Management is dependent upon the type of weapon, the bullet’s characteristics, kinetic energy, place of impact, as well as the patient’s general health status. A case is presented of a gunshot injury to the face with a review of the literature.

A renovated method of performing over 258 cases of pedicled colon segment interposition for esophageal reconstruction with integration of plastic surgery principles into general surgery procedure

A renovated method of performing over 258 cases of pedicled colon segment interposition for esophageal reconstruction with integration of plastic surgery principles into general surgery procedure

Training Surgery Residents to be Leaders: Construction of a Resident Leadership Curriculum.

Historically, the traditional pathways into plastic surgery required board eligibility in a surgical specialty such as general surgery, orthopedics, urology, neurosurgery, otolaryngology, or ophthalmology. This requirement resulted in plastic surgery residents who had served as chief residents before plastic surgery training. Their maturity emotionally and surgically allowed them to immediately concentrate on the new language and principles of plastic surgery. They had led others and were capable of leading themselves in a new surgical discipline. Today, medical students typically match into surgical specialties directly out of medical school and need to spend their time learning basic surgical skills and patient care because of the contracted time afforded to them. Formal leadership training has historically been limited in surgical training. The authors set out to delineate the creation, implementation, and perceptions of a leadership program within a surgical residency and provide guideposts for the development of engaged, conscious, and dedicated leaders within the residencies they lead.

A Novel Method for Correction of the Tethered and Contracted Facial Scars: The Three-Dimensional Subcutaneous Z-Plasty

Scar revision is 1 of the basic surgery in the field of plastic and reconstructive surgery. The classic treatment of the scar is excision scarless tissue, wide undermining and suture by planes. This method has had unsatisfying results on contracted and tethered scars. The aim of this study is to present the three-dimensional subcutaneous z-plasty technique for correction of tethered facial scars without scar lengthening. Twenty tethered scars were corrected using this technique. All scars were located on the face. Objectively, the final result was evaluated by using the Stony Brook Scar Evaluation Scale. Subjectively, patients' overall satisfaction was assessed 1 year after the surgical operation. In addition, the information on the age, gender, etiology, scar location, scar length, type of anesthesia, and follow-up period were examined. This procedure was used in nineteen patients (8 males and eleven females). The mean follow-up period was 15.3 months. There was a mean increase of 2.85 points increase in the Stony Brook Scar Evaluation Scale value. The overall success rates for the procedure, as assessed by the patients, were: very satisfied in 12 patients, satisfied in 5 patients, and slightly satisfied in 2 patients. One patient had minimal wound dehiscence. No complications including hypertrophic scar, infection, hematoma, and suture reaction were observed in any patients. The three-dimensional subcutaneous z-plasty technique is a procedure that uses only basic plastic surgery principles. It offers a good solution for the correction of tethered and contracted scars without recurrence. This technique combines the advantages of elliptical excision and z-plasty by enabling the augmentation of the depressed area without extending the scar length.

Applying plastic surgery principles to ovarian tissue transplantation.

Ovarian tissue cryopreservation (OTC) and transplantation is an innovative procedure increasingly utilized to help preserve fertility after gonadotoxic treatments especially in cancer patients. Approximately 30% of autotransplanted patients are able to achieve live birth, typically with the help of in-vitro fertilization. Numerous techniques and grafting sites have been described to continue to increase this figure. In the field of plastic surgery, tissue grafting has been successful performed for thousands of years and knowledge in this area has been significantly refined. A qualitative review of the literature using PubMed, Cochrane, SCOPUS and Medline databases was performed to look for articles relating to ovarian tissue transplantation (OTT) and comparisons made to plastic surgery tissue grafting. Many parallels were found between the principles of grafting in plastic surgery and the principles of OTT, including pre-operative patient optimization, suitable donor site selection, tissue harvest and preparation, graft site choice, immobilization of the graft and post-operative care. Consideration of the benefits and risks of using orthotopic versus heterotopic recipient sites is also highly important with regards to graft take, morbidity and ease of access of oocyte collection. We believe that ongoing discussion between disciplines can have the potential to improve knowledge, surgical techniques and patient outcomes.

Reconstructive Management of Gunshot Wounds to the Frontal Sinus: An Urban Trauma Center's Perspective.

In the last decade, we have seen a steady increase in the incidence of frontal sinus trauma due to gunshot wounds and a decrease in motor vehicle trauma. Penetrating gunshot wounds to the frontal sinus present a unique challenge to the reconstructive surgeon because they require careful consideration of the management principles of plastic surgery. Despite previous reviews on frontal sinus trauma, there are no studies examining the management techniques of frontal sinus fractures due specifically to gunshot wounds. In this study, we aim to retrospectively evaluate the use of a variety of tissue flaps in intervention and associated outcomes. A retrospective chart review was completed on all patients with gunshot wound(s) to the frontal sinus from January 2010 to January 2018 at a single institution. The patients were classified based on the fracture pattern (anterior vs posterior table vs both), degree of displacement, presence of nasofrontal outflow tract injury, and evidence of cerebrospinal fluid leak. Patients were then stratified according to the type of reconstruction performed (cranialization, obliteration and need for free flap) and evaluated for major and minor complications after reconstruction. In this study, we present outcome data from 28 cases of frontal sinus trauma due to gunshot wounds. There was a statistically significant difference (P = 0.049) in the type reconstructive strategy employed with each type of flap, with pericranial flaps primarily used in cranialization, temporal grafts were more likely to be used in obliteration, and free flaps were more likely to be used in cranialization. The overall major complication rate was 52% (P = 0.248), with the most common acute major complication was cerebrospinal fluid leak (39%) and major chronic was abscess (23.5%). This report explores the management of frontal sinus trauma and presents short-term outcomes of treatment for penetrating gunshot wounds at a tertiary referral center.

Summary of the Experience in the Diagnosis and Treatment of Complex Preauricular Fistulas in 78 Children.

Objective: This study aimed to investigate the application of mini-incisions in complex preauricular fistula resection in children.Methods: A total of 78 children who were diagnosed with preauricular fistula infection between January 2017 and December 2019 were included in the study. Their clinical data were analyzed retrospectively, and surgical treatment with mini-incisions based on plastic surgery principles and techniques was provided.Results: All the patients achieved healing following the first application of the treatment. The patients were followed up for 6–42 months, and no recurrence or local auricular deformation occurred.Conclusion: The application of mini-incisions and plastic surgery techniques in complex preauricular fistula resection in children can achieve a good effect and improve the satisfaction of the children and their parents.

Comparison of Long-Term Oncological Outcomes in Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery for Breast Cancer: A Propensity Score-Matched Analysis.

PurposeThe oncoplastic breast-conserving surgery (OPS) technique, combined with the principles of oncological safety and plastic surgery, results in complete tumor resection while preserving the natural appearance of the breast. The purpose of this study was to evaluate the long-term oncological results after OPS compared with conventional breast-conserving surgery (BCS) for early breast cancer.MethodsThe medical records of patients who underwent breast cancer surgery and adjuvant radiation therapy at Seoul National University Hospital between 2011 and 2014 were reviewed. Ipsilateral breast tumor recurrence (IBTR)-free survival rate and recurrence-free survival (RFS) rates were compared between the OPS and BCS groups.ResultsOne-to-one propensity score matching was conducted, yielding 371 patients in each group. The mean tumor distance from the nipple was shorter, and the mean retrieved specimen size and pathologic tumor size, including ductal carcinoma in situ, were larger in the OPS group than in the conventional BCS group (p < 0.001). Surgical margin positivity was not significantly different between the two groups (p = 0.777). The surgical technique was not significantly associated with IBTR (OPS versus conventional BCS, 5-year survival rate, 96.9% vs. 98.6%; p = 0.355) and RFS (5-year survival rate, 92.9% vs. 94.5%; p = 0.357) on the log-rank test. Multivariate analysis revealed that OPS versus conventional BCS was not significantly associated with survival outcomes.ConclusionWe observed no significant differences in long-term IBTR and RFS between the OPS and conventional BCS groups in this retrospective analysis. OPS can be an oncologically and surgically safe alternative option for conventional BCS for early breast cancer.

Reconstruction of wound defects in the perineum.

Surgical procedures in the perineum can cause major soft-tissue defects that require reconstruction with plastic surgery. In this article we present plastic surgery principles for the reconstruction of wound defects and common methods used to reconstruct wound defects in the perineum.

Breast Oncoplastic Resections: No Innovation Without Evaluation

Oncoplastic breast surgery combines the principles of surgical oncology and plastic surgery to achieve satisfactory cosmetic outcome without jeopardizing oncological safety. Despite innovations in surgical techniques, they were hardly evaluated. We have conducted a case series prospective analysis of 150 breast cancer patients who presented with palpable unilateral breast cancer to our unit between June 2016 and September 2017 assessing aesthetic outcome as well as patients’ satisfaction of different volume displacement oncoplastic surgical techniques. We aimed to use objective as well as subjective tools to evaluate patients’ satisfaction after unilateral oncoplastic volume displacement surgery. Our aesthetic results according to the objective Breast Cancer Conservative Treatment (BCCT) core assessment were excellent in 24% (36 cases), good in 38% (57 cases), fair in 32% (48 cases), and poor in 6% (9 cases). Successful oncoplastic breast surgery not only decreases the need for ipsilateral re-excision as well as shape correction procedures but also leads to better patient satisfaction and favourable outcomes.

Cleft Lip

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review. This review contains 16 figures, 3 tables, and 119 references. Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair

Органозберігаючі принципи реконструктивних оперативних втручань при атрезії тонкої кишки ІV типу у новонароджених дітей

Органозберігаючі принципи реконструктивних оперативних втручань при атрезії тонкої кишки ІV типу у новонароджених дітей

Limberg flap as simplest solution for covering skin defects of different sizes and localizations

&amp;lt;p&amp;gt;Introduction. Whether it is a classic version of the flap or its modification, the Limberg flap is an appropriate solution for covering small and medium-sized defects, as well as for covering largesized defects where certain localizations are concerned. It represents a local, transposition flap that has proven to be a safe option. Methods. The defect coverage was achieved by marking a defect that was in the form of an equilateral rhombus by means of extending a shorter diagonal by the length of its side and drawing a parallel with the defect side, which created four different flaps. We included 50 patients surgically treated at the Varis Clinic for Plastic and Reconstructive Surgery in Belgrade and the University Hospital in Foca for the period 2018-2020. In all patients, we used the Limberg flap as a method for defect reconstruction. Case presentations. The sample was comprised of up to 50 patients, with an average respondent age of 60.3 years. According to etiology, the most common changes in the skin belonged to Basal cell carcinoma (58%), Squamous cell carcinoma (24%) and melanoma (8%), with the most common predilection sites associated with the face in 22 patients and with the lumbosacral region in 8 patients. A well-planned Limberg flap caused minor complications in terms of mild marginal infection in one patient, and mild marginal infection as an early complication and a stretched scar as a late complication in one patient as well. Other complications in the sample were not recorded. Conclusion. To obtain the best possible functional and esthetic result with minimal disruption of the region, respecting the anatomy and the basic principles in plastic surgery, the Limberg flap is an excellent solution for the reconstruction of defects of different sizes.&amp;lt;/p&amp;gt;

Scar orientation: Principles in plastic surgery.

For biopsy proven skin cancers that are deemed to be high risk, a wide local excision (WLE) is recommended to reduce the risk of local recurrence. For this reason, it is pragmatic to account for the likelihood of a WLE at the time of the initial biopsy. We illustrate a staged approach to excision of lesions to facilitate this, bearing in mind the optimal reconstruction is primary closure. In our experience as plastic surgeons, having to perform a locoregional flap or skin graft prevents the opportunity to perform a local anesthetic procedure. This increases the risk of postoperative complications, especially if adjuvant radiotherapy further exposes reconstructed tissues to radiation toxicity. Collectively, this often results in an inferior aesthetic outcome. We value the referrals from allied colleagues and want to share the principles we adhere to when planning an excision biopsy, which aid in the delivery of the optimal reconstruction.

Bilobed Gracilis Flap: A Novel Alternative for Pelvic and Perineal Reconstruction.

Perineal reconstruction historically has been guided by the vertical rectus abdominis myocutaneous flap. In oncologic patients, because of prior surgical intervention, this donor site is often unavailable, the pelvis has been irradiated, and defects can be deep or irregularly contoured. Using plastic surgery principles of perforators, geometrically defined local tissue rearrangement, and flap inset, the authors have developed a modification of the gracilis flap to include a second soft-tissue arm similar to a bilobed flap. The authors performed five bilobed gracilis/medial circumflex femoral vascular pedicle myocutaneous flaps for perineal reconstruction secondary to oncologic defects and one secondary to Fournier gangrene at a tertiary care center. Oncologic patients had undergone adjuvant chemotherapy and radiation therapy and had compromised abdominal donor sites. Given their results, the authors recommend that a bilobed gracilis flap be used in patients with moderate to large defects, defects that require ample soft-tissue bulk, or in patients with limited abdominal donor sites. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

ACTUAL ISSUES OF ONCOPLASTIC ORGAN-PRESERVING SURGERY OF BREAST CANCER

Surgical treatment of breast cancer (BC) has undergone significant changes over the past half century. Oncoplastic operations are a relatively new variant of organ-preserving surgical treatment of breast cancer. Its idea is to combine the principles of oncology and plastic surgery in order to obtain oncological safe and cosmetic acceptable results. Despite the widespread implementation of these operations, high-quality studies on the benefits of oncoplastic operations in comparison with other methods are not enough. Actual issues of breast cancer oncoplastic surgery was considered in this literature review, such as indications for surgery, classification of oncoplastic techniques, determination of positive resection margins, evaluation of recurrence and survival, postoperative complications, cosmetic result.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study (Conclusion of the local Ethics Committee at Northern State Medical University of 08.04.2015, Protocol No. 02/4-15). Author Guidelines contains the detailed information.