Plastic Surgery Treatment Research Articles

Yearning for Youth and Vitality: A Plastic Surgeon's View of "The House of the Sleeping Beauties" by Yasunari Kawabata.

The aim of this study was to analyze "The House of the Sleeping Beauties" (れる) by Yasunari Kawabata from the perspectives of plastic surgery, and psychiatry/psychology. The central theme of the novel focuses on aging, desire, and the human connection to beauty and mortality. The protagonist, Eguchi, frequents a brothel where elderly men lie next to young women who are drugged and remain unconscious. This setting highlights the longing for youth and vitality, themes that are prevalent in plastic surgery. From this perspective, the novel offers a somber reflection on the extremes to which individuals might go in an effort to reconnect with their youth, even if it is only symbolic or temporary. Eguchi's journey serves as a metaphor for aging individuals who turn to beauty treatments or cosmetic enhancements in an attempt to regain their lost youth. Unlike the temporary illusion of rejuvenation provided by plastic surgery or anti-aging treatments, the novel highlights the futility and inherent sadness of attempting to recapture what is irretrievably lost. From a psychiatric perspective, the novel may be seen as an exploration of escapism, sexual repression, or unresolved trauma. The setting, characterized by the objectification and infantilization of women, could represent a dissociative mechanism. In this scenario, elderly men project their fantasies and desires onto unconscious women, thereby sidestepping the harsh realities of aging, intimacy, and rejection. In the anti-aging surgery of male patients, it is crucial to recognize their longing for youth and vitality, a sentiment shared by both Kawabata and Eguchi.

AESTHETIC SURGICAL APPROACH FOR STURGE-WEBER SYNDROME AND FACIAL ARTERIOVENOUS TUMORS

Introduction: Sturge-Weber Syndrome (SWS) is a rare, congenital neurovascular condition associated with facial cutaneous capillary or venous malformations. The manifestations are intrinsically related to vascular malformations, resulting in neurological symptoms, soft tissue abnormalities, and restricted bone growth. Methodology: This is a case report of a single patient diagnosed with SWS, following the guidelines established by Resolution 466/12 of the National Health Council of Brazil (CNS). Results and Discussion: A Vascular Surgery approach with embolization was performed prior to the Plastic Surgery intervention. It is important to note that this particular patient did not present the common neurological manifestations. Additionally, port-wine stains manifested as giant hemangiomas on the face. Conclusion: A multidisciplinary team is essential for patients with this condition, as it can facilitate surgical resection when vascular studies are performed prior to surgery. Moreover, a multidisciplinary approach is crucial due to the varied clinical presentation and chronic conditions that require treatment.

Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes.

Complex surgical back wounds represent significant morbidity in patients who have undergone spinal procedures requiring closure or revision by plastic surgeons. This study aimed to assess the utility of bacterial wound culture data for predicting surgical outcomes of wound management. This study is a single-institution retrospective review of consecutive patients who required plastic surgery intervention for wound infection following spinal procedures between the years 2010 and 2021 (n = 70). Statistical analysis was performed for demographics, comorbidities, perioperative laboratory studies, and treatment methods. The primary outcomes of interest were rate of postoperative complications after soft tissue reconstruction and reconstructive failure. The secondary outcome of interest was time to healing in number of days. The overall complication rate after wound closure was 31.4%, with wound infection in 12.9%, seroma in 10%, dehiscence in 12.9%, and hematoma in 1.4%. Increasing number of debridements before wound closure increased the likelihood of a surgical complication of any kind (odds ratio [OR], 1.772; 95% confidence interval [CI], 1.045-3.002). Positive wound cultures before reconstruction were associated with development of seroma only (OR, 0.265; 95% CI, 0.078-0.893). Use of incisional vacuum-assisted closure devices significantly decreased the odds of postoperative wound dehiscence (OR, 0.179; 95% CI, 0.034-0.904) and increased odds of healing (hazard ratio, 3.638; 95% CI, 1.547-8.613). Positive wound cultures were not significantly associated with negative outcomes after complex closure or reconstruction of infected spinal surgical wounds. This finding emphasizes the importance of clinical judgment with a multidisciplinary approach to complex surgical back wounds over culture data for wound closure timing.

Effectiveness of Hyperbaric Oxygen Treatment in Facial Plastic and Reconstructive Surgery: A Systematic Review.

Effectiveness of Hyperbaric Oxygen Treatment in Facial Plastic and Reconstructive Surgery: A Systematic Review.

A fully integrated flexible wireless sensing system for wound flatness diagnosis

In both plastic surgery and burn treatment departments, the management of postoperative wounds is a crucial element of surgical care, profoundly influencing patient recovery and the broader spectrum of healthcare outcomes. The monitoring of wound flatness after surgery, although a pivotal component of this process, is frequently underemphasized. In most cases, this parameter can only be judged based on doctors’ personal experience. Here, we propose a compact, fully integrated wireless sensing system encapsulated by soft biocompatible materials for quantitative assessment of wound flatness and long-term temperature. The absence of physical tethers and the ion-gel-based construction of the micro-structured sensor represent key defining features, resulting in high measurement resolution of 2 mm radius and 0.096 Ω/°C and reliable capabilities. In addition, these sensors can be connected to the server network or mobile clients to evaluate the state of postoperative suture wounds and monitor the patient’s recovery status. With our devices, detailed data on smoothness and temperature of sutured wounds can be collected, analyzed, and stored for medical assistance as well as being used to improve the quality of surgery.

AI As the New Age Estimator: Pioneering Customized Facial Surgery Outcomes

Abstract Goals/Purpose The imperative for precision in aesthetic surgery necessitates a robust framework for evaluating the impact of facial interventions on perceived age. Our study introduces a cutting-edge AI model aimed at discerning an individual's perceived age from facial characteristics. This tool is designed to augment the assessment of various plastic surgery procedures, facilitating the tailoring of interventions to each patient's unique facial aging pattern. Methods/Technique We harnessed a deep convolutional neural network (DCNN), pre-trained on the extensive ImageNet dataset, and further refined using 523,051 pre-annotated facial images from the IMBD-WIKI database, normalized as per the Mathias et al. face detection paradigm. Faces were processed into a 299x299 pixel matrix, maintaining a 40% margin around the face for uniformity. The Xception architecture was employed for its advanced feature extraction capabilities. The model was refined and tested against a diverse set of 100 patient faces from the Mayo Clinic's database, categorized by demographic and procedural data. The AI model employed regression analysis and softmax probability for precise age estimation. Results/Complications The AI model exhibited a remarkable accuracy rate of 92.5% in age estimation for pre procedural patients, with a standard deviation of 3.2 years. It significantly outperformed traditional methods in identifying fine-grained age-related features. The AI model discerned an average perceived age reduction of 3.5 years across all patients post-procedure, with a notable variance among different types of surgeries. Certain procedures, such as rhytidectomy and blepharoplasty, showed a more pronounced age-reduction effect. Conclusion The AI model presents an accurate and objective method for quantifying perceived age, serving as a significant benchmark in facial aesthetic evaluation. By illustrating measurable age reduction following various procedures, with some surgeries yielding more substantial changes in perceived age, the model stands as a testament to the effectiveness of plastic surgery interventions. The precision of our model in predicting age pre- and post-procedure underscores its potential to assist surgeons in custom-tailoring surgeries to individual aging patterns. This innovation is poised to refine the decision-making process in aesthetic surgery, ensuring treatments are aligned with the desired outcomes for rejuvenation and patient-specific needs, ultimately advancing the frontier of personalized plastic surgery.

Caring for Patients With Body Dysmorphic Disorder Seeking to Undergo Plastic Surgery and/or Aesthetic Interventions.

In the field of medical aesthetics and plastic surgery, it is not uncommon to interact with clients who never seem to be satisfied, regardless of the success of an intervention. Medical professionals may attribute this to the patient having an overly critical nature; however, this continual dissatisfaction could also be the result of a mental health disorder known as body dysmorphic disorder (BDD) that is significantly underdiagnosed and prevalent within the plastic surgery and aesthetic patient population. According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5; American Psychiatric Association, 2013), BDD is defined as, "a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others" (Substance Abuse and Mental Health Services Administration, 2016, Table 23). Having the ability to identify the signs of BDD, utilize appropriate communication skills with individuals who may have BDD, and understand the implications of providing additional aesthetic treatments for patients who present with BDD allows aesthetic practitioners to prioritize and promote patient safety, well-being, and satisfaction.

Plastic Surgery Involvement With Surgical Management of Infected Ventricular Assist Devices Decreased Lifetime Return to Operating Room and 90-Day Infectious Complications.

The use of left ventricular assist devices (LVADs) for patients with end-stage cardiac failure awaiting heart transplantation has become increasingly common. However, ventricular assist device-related infections remain a major problem complicating their long-term use. Retrospective review has previously shown a decrease in lifetime return to operating room (RTOR) with no change in 90-day complications when a muscle or omental flap is used for coverage after washout for infection. We wished to determine if early plastic surgery intervention led to a decreased length of stay for these patients. Patients with LVAD readmitted for LVAD infection at a single institution from 2008 to 2021 were identified using a preexisting database. Patients were followed retrospectively for an average of 3.2 years. Patient demographics, preoperative diagnosis/disease state, type of ventricular assist device inserted, postoperative day of ventricular assist device infection onset, definitive device coverage, timing of coverage procedure after the initial washout for infection, type of flap used for coverage, 90-day complications after definitive coverage, and lifetime return to operating room for infection were reviewed. Comparison analysis with χ2 and analysis of variance testing was used to analyze outcomes. Of 568 patients admitted with an LVAD infection, 104 underwent operative debridement and closure by plastic and reconstructive surgery (PRS) or cardiothoracic surgery (CTS). Fifty-three underwent PRS closure, and 51 underwent CTS closure. There was an increased incidence of diabetes among the PRS group (P < 0.001); otherwise, there was no difference in baseline characteristics. There was increased RTOR over a lifetime with CTS closure compared with PRS (P = 0.03) and increased 90-day risk of infection (P = 0.007). Patients with PRS closure had an increased risk of postoperative hematoma (P = 046). Plastic and reconstructive surgery was typically consulted on hospital day 10. Both PRS and CTS closure patients were discharged on postoperative day 7, on average (P = 0.542). Plastic surgery involvement with surgical decision making and closure of infected LVAD devices has a decrease in lifetime RTOR and decreased 90-day complications related to infections. There may be a benefit to earlier PRS consultation for coverage assessment.

CICATRICIAL DEFORMITIES MANAGEMENT: A NARRATIVE REVIEW

Background: Treatment and prevention of the development of pathological scars (hypertrophic and keloid) is an important issue in modern dermatology and plastic surgery due to a violation of aesthetic perception (aesthetics), and in severe cases, the function of various areas of the human body. The purpose of this systematic review of the literature was to analyze the proposed effective methods for treating scar deformities of the skin. Methods: The systematic review included articles from Google Scholar, Medline, Scopus, Web of Sciences, PubMed. Search keywords terms included: pathological scar, therapy, botulinum toxin, laser, cryodestruction, hyaluronidase, skin scar prevention, new methods of wound treatment, wound and skin scarring, bioengineering surgery. Results: Conducted a preliminary search and reviewed 132 titles and abstracts in this review and 50 full-text articles were selected of high methodological quality. This review concluded the necessity of developing pre-surgical methods for preventing pathological scarring, which could potentially become a universal standard for any plastic and aesthetic surgery intervention. Treatment depends on the clinical and morphological characteristics of athological scars. Conclusion: The current systematic review demonstrated the need to develop presurgical methods for the prevention of pathological scarring, which could in the future become a universal standard for any intervention in plastic surgery, since the issue of treating skin scars is sufficiently covered in the available world literature.

Undergraduate deficits in plastic surgery exposure and awareness of the specialty: a systematic review.

Plastic surgery is an important specialty that involves widespread medical knowledge, some of which is taught in undergraduate curricula. The General Medical Council provides a well-defined plastic surgery curriculum for postgraduate training. However, there is no consensus on the provision for undergraduates in this specialty, potentially giving rise to a deficit in undergraduate medical education and a suboptimal basis for plastic surgery postgraduate training. Our aim was to identify the gap in undergraduate plastic surgery teaching and to understand student perceptions of the specialty as well as any trialled interventions. A prospectively registered systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE®, Embase™, PubMed® and Google Scholar™ databases were searched for literature relating to undergraduate exposure to plastic surgery and relevant teaching interventions. Ten studies were included in this review, categorised into three main themes: exposure during medical school, determining factors and perceptions for pursuing a plastic surgery career, and teaching interventions. Surveys assessing medical student perceptions indicate a significant deficit in exposure to plastic surgery in the undergraduate curriculum. Medical students' interest in the specialty is affected by multiple factors, including the amount of surgical exposure in medical school. Interventions to address the deficit mostly involve one-day courses. Although the literature is currently limited, studies are needed to effectively assess the outcomes of plastic surgery teaching methods in undergraduate training. Moreover, there is a need for consensus around the provision of undergraduate teaching in plastic surgery. This should be reflected in the latest undergraduate curricula in medical education.

Polish Translation and Linguistic Validation of the SCAR-Q.

Introduction Patient-reported outcome measurements (PROMs) are gaining considerable popularity as tools to assess the effectiveness of the treatment in plastic surgery, being a complement to surgical outcomes. The SCAR-Q questionnaire has been recently developed for patients with surgical, traumatic, and burn scars. Aim The study aims to describe the process of translation and linguistic validation of the scar questionnaire (SCAR-Q) for use in Polish patients undergoing scar treatment. Material and methods An official Polish translation and language validation of the SCAR-Q were done in adherence to International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. The process consisted of four steps: two independent forward translations, a back translation, a review of the back translation, and cognitive participant interviews. Results The field-tested version of the SCAR-Q consisted of 29 items across three scales measuring appearance concerns, symptoms, and the psychosocial impact of the scar. The forward translation was done by two independent translators and revealed specific difficulties in translation to the Polish language (4/29 items). The back translation showed no significant differences compared to the original English version. Cognitive debriefing interviews involved nine Polish patients with postraumatic scars, burn scars, and scars after skin tumor resection. Participants have not reported any major difficulties in understanding the content of the questionnaire. Conclusions The ISPOR provides a straightforward and thorough guideline for the PROMs translation process. The new SCAR-Q is an accessible and efficient PROM that can be implemented in Polish patients to assess the effectiveness of scar treatment.

Pharmacokinetics of Locally Applied Antibiotic Prophylaxis for Implant-Based Breast Reconstruction

Antibiotic irrigation of breast implants is widely used internationally, but no clinical study has investigated the pharmacokinetics of antibiotic prophylaxis in the breast implant pocket. To evaluate how long locally applied gentamicin, cefazolin, and vancomycin concentrations in the implant pocket remain above the minimum inhibitory concentration (MIC) for the most common bacterial infections and to measure systemic uptake. This prospective cohort study was performed at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark, between October 25, 2021, and September 22, 2022, among 40 patients undergoing implant-based breast reconstruction who were part of the ongoing BREAST-AB trial (Prophylactic Treatment of Breast Implants With a Solution of Gentamicin, Vancomycin and Cefazolin Antibiotics for Women Undergoing Breast Reconstructive Surgery: a Randomized Controlled Trial). Patients were randomized to receive locally applied gentamicin, cefazolin, and vancomycin or placebo. Samples were obtained from the surgical breast drain and blood up to 10 days postoperatively. The breast implant and the implant pocket were irrigated with 160 μg/mL of gentamicin, 2000 μg/mL of cefazolin, and 2000 μg/mL of vancomycin in a 200-mL saline solution. The primary outcome was the duration of antibiotic concentrations above the MIC breakpoint for Staphylococcus aureus according to the Clinical and Laboratory Standards Institute: gentamicin, 4 μg/mL; cefazolin, 2 μg/mL; and vancomycin, 2 μg/mL. Secondary outcomes included the time above the MIC for Pseudomonas aeruginosa and other relevant bacteria, as well as systemic uptake. The study included 40 patients (median age, 44.6 years [IQR, 38.3-51.4 years]; median body mass index, 23.9 [IQR, 21.7-25.9]) with a median number of 3 drain samples (range, 1-10 drain samples) and 2 blood samples (range, 0-6 blood samples). Vancomycin and cefazolin remained above the MIC for S aureus significantly longer than gentamicin (gentamicin, 0.9 days [95% CI, 0.5-1.2 days] for blood samples vs 6.9 days [95% CI, 2.9 to 10.9 days] for vancomycin [P = .02] vs 3.7 days [95% CI, 2.2-5.2 days] for cefazolin [P = .002]). The gentamicin level remained above the MIC for P aeruginosa for 1.3 days (95% CI, 1.0-1.5 days). Only cefazolin was detectable in blood samples, albeit in very low concentrations (median concentration, 0.04 μg/mL [range, 0.007-0.1 μg/mL]). This study suggests that patients treated with triple-antibiotic implant irrigation during breast reconstruction receive adequate prophylaxis for S aureus and other common implant-associated, gram-positive bacteria. However, the protection against P aeruginosa may be inadequate.

Health Inequities in the Epidemiology, Diagnosis, Treatment, and Outcomes of Plastic Surgery: A Scoping Review

Background: Plastic surgery is routinely sought after for the treatment of breast cancer, cleft lip and palate, and gender-affirming care. Inequities exist in plastic surgery in regard to the epidemiology, diagnosis, treatment, and outcomes experienced by patients. The purpose of our scoping review was to (1) outline current literature addressing health inequities in plastic surgery and (2) draw attention to the gaps in this literature. Methods: This scoping review was developed following guidelines from the Joanna Briggs Institute and PRISMA extension for scoping reviews. An initial search of MEDLINE (via PubMed), Ovid Embase, Cochrane Database of Systematic Reviews, and Scopus databases was performed to locate published articles on health inequities in plastic surgery. Articles had to address at least one of the National Institutes of Health's inequity groups we examined. Results: After reviewing full text, 153 studies were included in our final sample. We found race/ethnicity (94/153) and age (90/153) to be the 2 most commonly evaluated inequities in the scoping review. We discovered that patient populations that were older had public or no insurance and/or were in historically marginalized racial/ethnic groups were often less likely to be offered plastic surgery treatments. Conclusion: This scoping review describes the current literature on health inequities in plastic surgery and highlights gaps in the literature that warrant further research. We found significant findings regarding how vulnerable patient populations are affected by health inequities. Research should be conducted to investigate these inequities more thoroughly and discover the best solutions to bridge the gaps in providing equitable care.

Face Plastic Surgery Recognition Model Based on Neural Network and Meta-Learning Model&amp;nbsp;

Facial recognition is a procedure of verifying a person&amp;#39;s identity by using the face, which is considered one of the biometric security methods. However, facial recognition methods face many challenges, such as face aging, wearing a face mask, having a beard, and undergoing plastic surgery, which decreases the accuracy of these methods. This study evaluates the impact of plastic surgery on face recognition models. The motivation for conducting the research in that aspect is because plastic surgery treatments do not only change the shape and texture of any face but also have increased rapidly in this era. This paper proposes a model based on an artificial neural network with model-agnostic meta-learning (ANN-MAML) for plastic surgery face recognition. This study aims to build a framework for face recognition before and after undergoing plastic surgery based on an artificial neural network. Also, the study seeks to clarify the collaboration between facial plastic surgery and facial recognition software to determine the issues. The researchers evaluated the proposed ANN-MAML&amp;#39;s performance using the HDA dataset.&amp;nbsp; The experimental results show that the proposed ANN-MAML learning model attained an accuracy of 90% in facial recognition using Rhinoplasty (Nose surgery) images, 91% on Blepharoplasty surgery (Eyelid surgery) images, 94% on Brow lift (Forehead surgery) images, as well as 92% on Rhytidectomy (Facelift) images. Finally, the results of the proposed model were compared with the baseline methods by the researchers, which showed the superiority of the ANN-MAML over the baselines.&amp;nbsp;

Identifying the Variables for Oncoplastic Reconstruction: Preoperative Assessment Tool for Breast Conserving Treatment.

A wide range of surgical techniques has been described for breast conservation treatment (Oncoplasty) based on breast size and shape, as well as tumor size and location. However, there is a lack of standardization regarding the indications for oncoplastic reconstruction. This study aims to identify the presurgical parameters associated with poor cosmetic outcomes post-breast conserving treatment. We hope this preoperative model can assist in evaluating whether there is a need for oncoplastic intervention. The study group involved 136-adult females (age 35-77) who previously undergone breast conserving surgery and radiation, without oncoplastic intervention between 2007 and 2017. Patient demographics, medical and physical parameters were collected, and each patient filled Breast-QTM-questionnaire and six angles' photographs were taken. Patients' photographs were evaluated by 15 board-certified plastic surgeons. Both univariate and multivariate logistic regression analysis was performed to identify potential confounders for poor outcome in each of the experts' and patients' average-grades. Our analysis identified several variables correlated with poor surgical outcome: high BMI, high chest-wall-circumference, high breast-width and larger volume-removed. The general-aesthetic-result as evaluated by our experts was favorably influenced by an upper lateral quadrant tumor while the breast shape was negatively influenced by a lower medial quadrant tumor. Interestingly, no correlation was found between the patients' and panel's evaluations, nor did we find any clinically significant parameter related to the patients' reported well-being. Patients with high BMI, high chest-wall-circumference, large breast-width and larger inferomedial tumors could benefit from early plastic surgery evaluation and intervention. Patient's psychosocial well-being as well as sexual well-being are independent from positive surgical outcome evaluated by plastic surgeons. 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 .

Sex-Dependent Skin Aging and Rejuvenation Strategies

The skin, the largest external organ, serves as the primary defensive barrier against various environmental factors such as ultraviolet exposure, pollution, dietary habits, pathogens, and chemical compounds. Consequently, the skin reflects our age through visible signs of aging, such as wrinkles, age spots, dullness, and sagging. This review explores the gender-related aspects of cutaneous aging and the associated dermatological conditions. It highlights the different manifestations of aging in females and males that become evident after the age of 12, emphasizing the susceptibility to conditions such as seborrheic eczema, acne, and rosacea. Treatment strategies often vary between genders due to these disparities. While men tend to experience accelerated skin aging, most anti-aging products and strategies primarily target females. However, there has been a recent shift in men’s priorities, leading to increased interest in maintaining a youthful appearance and seeking cosmetic treatments. The manuscript covers a comprehensive range of modern dermal anti-aging and rejuvenation procedures, including plastic surgery, bio-revitalization methods, lasers, microneedling, and topical treatments. Additionally, it explores promising natural and synthetic therapeutics for combating age-related skin changes. The focus is on understanding the physiological aspects of gender-related cutaneous structure and aging to guide effective and tailored approaches in dermatological practice.

Immediate Plastic Surgery Intervention after Soft Tissue Sarcoma Resection: Examining Wound Healing, Readmission, and Reoperation.

Adult patients who underwent index STS resection between 2005 and 2018 were queried from an institutional database. Main outcomes analyzed were 90-day same-site reoperation, any-cause readmission, and wound healing complications. Univariate and multivariate logistic regression were used to identify risk factors. Additional evaluation was then performed for the following two cohorts: patients with and without plastic surgeon involvement. In total, 228 cases were analyzed. Multivariate regression demonstrated the following predictors for 90-day wound-healing complications: plastic surgery intervention [OR = 0.321 (0.141-0.728), P = 0.007], operative time [OR = 1.003 (1.000-1.006), P = 0.039], and hospital length of stay [OR = 1.195 (1.004-1.367), P = 0.010]. For 90-day readmission, operative time [OR = 1.004 (1.001-1.007), P = 0.023] and tumor stage [OR = 1.966 (1.140-3.389), P = 0.015] emerged as multivariate predictors. Patients whose resection included a plastic surgeon experienced similar primary outcomes despite these patients having expectedly longer operative times (220 ± 182 versus 108 ± 67 minutes, P < 0.001) and hospital length of stay (3.99 ± 3.69 versus 1.36 ± 1.97 days, P < 0.001). Plastic surgeon involvement emerged as a significant protector against 90-day wound healing complications. Cases that included plastic surgeons achieved similar complication rates in all categories relative to cases without plastic surgery intervention, despite greater operative time, hospital length of stay, and medical complications.

86. 5 Years of Lower Limb Osseointegrated Prostheses: Anticipating the “Who and What” of Poor Outcomes

PURPOSE: Osseointegrated prostheses are a novel alternative to socket-suspended prostheses, especially when the latter are complicated by poor fit, soft tissue damage, or pain. However, osseointegrated prostheses can also lead to post-operative issues that rely on plastic surgery intervention. Little is known about the timeline of or risk factors for these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Fisher’s exact test and unpaired t-tests were performed (alpha=0.05). RESULTS: 70 patients met our study criteria: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. These patients had an average age of 38.2 years at initial amputation, and 46.7 years at osseointegration. They were followed for 20 months on average. Indications for amputation were trauma (56), prior surgical complication (7), cancer (4) and other (3). Postoperative complications included soft tissue infection (26), need for soft tissue revision (7), neuroma (6), osteomyelitis (5), limb fracture (4), and hardware failure (2). Statistically significant linear correlations existed between increased age at implantation and neuroma development, as well as decreased time from amputation to implantation and limb fracture. Additionally, transfemoral implants, as compared to transtibial implants, were associated with increased risk of limb fracture (OR=4.3). Soft tissue infection was significantly correlated with obesity (OR=3.1) and female gender (OR=3.5). Decreased surgeon experience, defined as the first 20 cases, was associated with increased risk of osteomyelitis (OR=4.6) and neuroma (OR=6.6). Subgroup analysis by amputation indication or level did not affect outcomes. Hypertension (15), tobacco use (27), and history of infection (23) did not correlate with any complications. CONCLUSION: Certain modifiable factors (BMI, timing of surgery, surgeon experience) and unmodifiable factors (age, gender) correlate with increased risk of complications following lower limb osseointegration. These results can aid surgeons in better selecting appropriate candidates and anticipating post-operative outcomes.

16. 5 Years of Lower Limb Osseointegrated Prostheses: Anticipating the “Who, What, and When” of Poor Outcomes

PURPOSE: Osseointegrated prostheses are a novel alternative to socket-suspended prostheses, especially when the latter are complicated by poor fit, soft tissue damage, or pain. However, osseointegrated prostheses can also lead to post-operative issues that rely on plastic surgery intervention. Little is known about the timeline of or risk factors for these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Fisher’s exact test and unpaired t-tests were performed (alpha=0.05). RESULTS: 70 patients met our study criteria: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. Indications for amputation were trauma(56), prior surgical complication(7), cancer(4) and other(3). Postoperative complications included soft tissue infection(26), osteomyelitis(5), neuroma(6), limb fracture(4), soft tissue revision(7), and hardware failure(2). Statistically significant correlations existed between increased age at implantation and neuroma development, decreased time from amputation to implantation and limb fracture, obesity and soft tissue infection, and female gender and soft tissue infection. Decreased surgeon experience was significantly associated with increased risk of osteomyelitis and neuroma. Subgroup analysis by amputation indication or level did not affect outcomes. Hypertension(15) and tobacco use(27) did not correlate with any complications. CONCLUSION: Certain modifiable factors (BMI, timing of surgery) and unmodifiable factors (age, gender) correlate with increased risk of complications following lower limb osseointegration. These results can aid surgeons in better selecting appropriate candidates and anticipating post-operative outcomes.

32. When to Expect the Unexpected: A Timeline of Complications in Lower Limb Osseointegrated Protheses

PURPOSE: Osseointegrated prostheses are a novel alterative to socket-suspended prostheses that have been shown to improve mobility, nerve pain, and other issues associated with poorly tolerated sockets. However, osseointegrated prostheses themselves can lead to post-operative complications that rely on plastic surgery intervention. Little is known about the timeline of these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Time-to-event analyses were performed for identified complications. RESULTS: Our study included 70 patients: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. Patients were followed for 19.6 months on average. Hardware failures(2) occurred on postoperative days 7 and 245. Limb fractures(4) occurred on average at 135 days post-op. Neuromas(3) occurred on average at 306 days post-op. Cases of osteomyelitis(5) occurred on average at 332 days post-op. Revisions of soft tissue(7) occurred on average at 389 days post-op. Soft tissue infections(26) occurred on average at 129 days post-op. 50% of soft tissue infections occurred within one month post-operatively, and 81% within four months. CONCLUSION: Certain postoperative complications often occur shortly after implantation (Soft tissue infections, limb fractures), while others occur at later timepoints (neuromas, osteomyelitis, soft tissue excess). These results can help elucidate the etiologies of observed complications, and aid surgeons in anticipating when osseointegrated prostheses complications may occur in future patients.