Reconstructive Plastic Surgery Research Articles

3D Lipogluing: Preliminary Results of a Novel Technique for Direct Three-dimensional Fat Grafting in Breast Reconstruction Surgery.

Lipofilling has emerged as an effective technique in breast reconstruction for enhancing aesthetic outcomes and addressing residual deformities. Traditionally, fat grafting has been performed as a secondary step in implant-based breast reconstruction during the replacement of the expander with a breast implant or as a revisional procedure. Our study investigates the technical feasibility and presents preliminary results of a new promising technique for delivering fat grafting in a three-dimensional (3D) shape, directly during mastectomy with immediate breast reconstruction or in delayed breast reconstructive procedures. Our new 3D lipogluing technique involves securing the fat tissue in a 3D manner using fibrin glue. This method enhances the coverage of soft tissues and provides improved volume and shape supplementation. In selected cases between December 2015 and September 2023, we treated 24 patients using the 3D lipogluing technique and five patients using 3D lipocubing (without use of fibrin glue).The patient cohort consisted of different indications for breast reconstructions: direct-to-implant, expander-based breast reconstruction, and "conservative" surgery. Preliminary findings suggest the technique is a safe and effective approach that can enhance the soft-tissue envelope of reconstructed breasts by acting as an autologous scaffold, owing to its regenerative properties. This technique not only improves the overall aesthetic outcome but also has the potential to reduce implant-related complications. Furthermore, ongoing studies are investigating methods to optimize the results and explore the potential application of 3D lipogluing and 3D lipocubing in breast-conserving oncoplastic surgery, cosmetic breast surgery, and other areas of plastic reconstructive and aesthetic surgery.

Interdisciplinary plastic and reconstructive surgery of head and neck squamous cell carcinomas.

Squamous cell carcinomas are the most common malignancies in the oral cavity, pharynx, and larynx. Even in the age of the most modern drug treatment methods, radical resection of these tumors is and currently remains the therapeutic gold standard. The loss of anatomical structures associated with surgery inevitably increases the functional deficits caused by the tumor itself. In this context, the extent of functional deficits is largely determined by the extent of resection. Complete organ resections, such as glossectomy, complete palate resection, laryngectomy, or transverse pharyngo-laryngectomy, lead to severe functional deficits, such as swallowing disturbances with life-threatening aspiration and articulation disorders up to the inability to speak. With the help of plastic reconstructive surgery, the lost tissue can be replaced and the specific functions of the upper aerodigestive tract can be preserved or restored.In recent decades, reconstructive surgical procedures have developed enormously in the treatment of malignant tumors of the head and neck. In order to make optimal use of them, a comprehensive, interdisciplinary therapy concept is a prerequisite for positive oncological and functional outcome. In addition to general medical and social parameters, surgical parameters play a crucial role in the choice of the reconstruction method. The extent to which the surgical measures must be interdisciplinary depends on the localization of the defects in the head and neck region and on the type of replacement tissue required. Here, the expertise of plastic surgery, oral and maxillofacial surgery, and abdominal surgery comes into play in particular. The use of different tissues, the combination of different grafts and flaps, or the preforming of donor regions allow reconstructions far beyond the level of simply restoring surface integrity. The functional results and thus the quality of life of patients after surgical therapy of extensive tumors of the mentioned localizations depend decisively on the type of reconstruction. Therefore, in the following review, special emphasis 1 be placed on the choice of reconstruction method and reconstruction technique for tissue loss after resections of HNSCC.

THE IMPORTANCE OF RECONSTRUCTIVE PLASTIC SURGERY IN POST-TRAUMATIC SITUATIONS

Restorative plastic surgery plays a crucial role in restoring form and function to areas of the body affected by trauma. The main aim of this specialty is to improve patients’ quality of life and self-esteem, providing satisfactory aesthetic and functional results. This paper aims to explore and highlight the importance of reconstructive plastic surgery in post-traumatic situations, emphasizing its benefits for patients’ physical and psychological recovery. This is a bibliographic review, using qualitative premises, with the PubMed, Scopus, Web of Science and Scielo databases. To better refine the research, the health descriptors “trauma”, “reconstructive surgery” and “reconstructive plastic surgery after trauma” were used. Restorative plastic surgery is essential for reconstructing areas of the body affected by trauma, such as burns, traumatic wounds, car accidents and firearm injuries. As well as restoring function and aesthetics, these procedures can also improve patients’ quality of life and self-image. Common procedures include soft tissue reconstruction, skin grafts, flaps and reconstructive microsurgery. These techniques allow complex anatomical structures such as bones, muscles, nerves and blood vessels to be restored, re-establishing the functionality and natural appearance of the affected region. As a result, in addition to the physical benefits, reconstructive plastic surgery can also have a significant impact on patients’ mental health. Improved physical appearance can increase self-esteem and confidence, helping with social reintegration and a return to daily activities. It can therefore be concluded that reconstructive plastic surgery plays a vital role in the recovery of patients after trauma, providing not only physical restoration, but also improved quality of life and psychological well-being. It is essential that patients have access to these procedures and that health professionals are aware of their importance in post-traumatic rehabilitation.

Fourteen-Year Experience in Burn Eyelid Reconstruction and Complications Recurrence: A Retrospective Cohort Study.

Loss of vision and other ocular defects are a concern with eyelid burn sequelae. This most commonly progresses from eyelid contracture to cicatricial ectropion and lagophthalmos. When left untreated, these may lead to exposure keratitis, ulceration, infection, perforation, and loss of vision. In the case of full-thickness eyelid burns, release and grafting are required. However, there is a paucity of studies on outcomes in eyelid burn surgery treatment, despite concern for permanent ocular damage or loss of vision. The aim of the study is to describe the complication rates in burn eyelid reconstruction at a single center for 14 years. A retrospective cohort study was performed of all patients who had sustained eyelid burns and required reconstruction between April 2009 and February 2023. Medical records were obtained from patients' charts. Collected data include demographics, medical history, type of injury, indication for surgery, procedure performed, and complications. A total of 14 patients and 25 eyelids underwent eyelid reconstruction of the 901 total patients with burn-related injuries requiring plastic surgery reconstruction. These patients underwent 54 eyelid surgeries with a mean follow-up time of 13.1 ± 17.1 months. Patients were 71% men and 29% women, with a mean age of 45.1 ± 15.6 years. In 53.7% (n = 29) of the cases, the simultaneous reconstruction of both the upper and lower eyelids was necessary. The reconstruction of the upper and lower eyelid alone represented a smaller percentage (25.9% and 20.4%, respectively). On average, the patients received 3.9 ± 3.5 eyelid surgeries. The overall complication rate was 53.7% (n = 29). The most common complication was ectropion (42.6%, n = 23). Other complications included eye injury (25.9%, n = 14), lagophthalmos (24.1%, n = 13), local infection (7.4%, n = 4), and graft loss (5.6%, n = 3). Periorbital burns represent a major challenge that may require complex surgical intervention. Full-thickness skin graft remains the standard of care for patients with eyelid burns. However, there is a high incidence of ectropion that may require reoperation. Further studies examining the conditions of successful eyelid burn procedures may provide guidance on when patients may benefit from eyelid reconstruction during their burn treatment.

Modern approaches to the treatment of primary multiple unilateral synchronous lung tumors (literature review)

The review article focuses on recent approaches to the treatment of primary multiple unilateral synchronous and metachronous lung tumors. Unilateral primary multiple lung cancer is diagnosed relatively rare. The introduction of modern computed tomography into clinical practice made it possible to diagnose a peripheral tumor at the initial stages. The second synchronous, usually central lung cancer is more often detected during surgery or during bronchoscopy. Despite the established criteria, differential diagnosis of primary tumor and intrapulmonary metastasis in synchronous PMRL remains a difficult task. Often histological signs do not allow differentiating the primary tumor from metastasis. The use of next generation genomic sequencing (NGS) makes it possible to distinguish a primary tumor from a metastasis. To date, there are no unambiguous recommendations for staging primary multiple unilateral lung cancer. There is no clear understanding of what criteria and classification to use to determine the stage of primary multiple cancer, and the type of surgical intervention depends on it. Based on the 8th classification of staging according to the TNM system, patients with primary multiple lung cancer often need to undergo extensive surgical interventions, up to pneumonectomy. Staging each tumor separately allows us to expand the indications for anatomical segmentectomies and reconstructive plastic surgery. For the treatment of PMLC, the main type of surgery is an operative manual with lobectomy. Reconstructive plastic surgeries and anatomical segmentectomies have little effect on increase in frequency of local relapses, on worsening of survival rates. However, the methods are a reasonable alternative for some types of tumors and poor functional indicators. Stereotactic radiation therapy is the standard of treatment for patients who refuse surgery or in patients with functional limitations with early stage primary multiple lung cancer. Moreover, systemic therapies such as targeted therapy in patients with driver mutations and immunotherapy have shown outstanding results.

RECONSTRUCTION OF A PHARYNGEAL DEFECT IN THE SURGICAL TREATMENT
 OF LOCALLY ADVANCED LARYNGOPHARYNGEAL CANCER:
 LITERATURE REVIEW

Relevance: In 2022, 370 new cases of newly diagnosed patients with laryngeal cancer and 151 with laryngopharyngeal cancer were
 registered in the Republic of Kazakhstan, of which 12.1% of laryngeal cancer at stage IV of the disease and 18.9% of laryngeal cancer. The
 one–year mortality rate for laryngopharyngeal lesions was 40.5%, the ratio between one-year mortality and neglect (stage IV) was 2.3%.For T3-4 laryngopharyngeal cancer, today the only operation of choice is circular resection of the laryngopharynx with laryngectomy and
 the formation of stomas on the neck. The prospect of disability of patients – the formation of pharyngostomy, esophagostomy, tracheostomy,
 constant salivation, the need for probe nutrition, etc., causes irreparable psychological damage to the patient’s personality. In this regard,
 the problem of pharyngeal and laryngopharyngeal reconstruction in cancer patients becomes extremely important not only as a stage of
 rehabilitation, but also as a necessary element in terms of antitumor treatment of this complex category of patients.
 The aim of the study assessment of the significance of pharyngeal defect reconstruction in the surgical treatment of laryngopharyngeal
 cancer in order to improve the rehabilitation of cancer patients and optimize antitumor treatment.
 Methods: Scientific publications were searched in the following databases: PubMed, Medline, eLibrary, Cochrane Lab, using the scientific
 search engine Google Scholar. Criteria for inclusion of publications in the literary review: publications in Russian and English; publications
 included in the PubMed, Medline, e-Library databases; publications with clearly formulated conclusions; publications over the past 10 years.
 Criteria for excluding publications in the literary review: summaries, reports; articles with paid access; abstracts. A total of 82 sources were
 found, and 8 sources were included in the analysis.
 Results: The analysis of the world literature made it possible to widely consider the possibility of performing reconstructive plastic surgery
 using visceral autografts at the stage of surgical treatment of patients with pharyngeal edema. At the same time, the literature describes
 significant reductions in the duration of rehabilitation and improvement of the quality of life of patients, as well as a decrease in the level of
 disability of operated patients.
 Conclusion: Primary plasty of defects that occur after surgical treatment of laryngopharyngeal cancer, using local tissues, displaced and
 free flaps, is undoubtedly the most appropriate way to speed up the rehabilitation of patients and improve the quality of life in the shortest
 possible time.

THE USE OF A POLYVALENT KLEBSIELLA BACTERIOPHAGE IN INFECTION AFTER RECONSTRUCTIVE PLASTIC SURGERY ON THE SPINE IN A CHILD (A CLINICAL CASE)

The incidence of infection after reconstructive plastic surgery on the spine (in particular, spondylodesis) in children remains at a fairly high level and ranges from 0.4% to 8.7%. These complications are often caused by polyresistant bacterial pathogens; this accentuates the need for new effective therapeutic approaches. Bacteriophage preparations in combination with antibiotics can optimize existing strategies for the treatment of infectious diseases, since they are able to selectively destroy bacteria, including biofilm-forming ones. The aim of the study was to draw the attention of practitioners to modern problems of treating polyresistant infections on the example of a case of purulent complication after spinal surgery in a child. Materials and methods. On the basis of the FSBI "Federal Center for Traumatology, Orthopedics and Endoprosthetics" under the Health Ministry of the Russian Federation (the town of Cheboksary) a retrospective analysis of a clinical case of treating early infection after reconstructive plastic surgery on the spine caused by a polyresistant strain of Klebsiella pneumoniae was conducted. Research results. Patient P., 2.2 years old, with congenital pathology of the musculoskeletal system, who repeatedly received medical care in various medical organizations, underwent surgical spine stabilization. In the early postoperative period, an infectious complication developed caused by a polyresistant strain of Klebsiella pneumoniae (a producer of extended-spectrum beta-lactamases and carbapenemases). Along with surgical debridement of the postoperative wound, a combined etiotropic antibacterial therapy was performed (12 weeks). However, complete healing of the postoperative wound was achieved in combination with the administration of a polyvalent klebsiella bacteriophage (10 weeks). Conclusions. This clinical case demonstrates that the use of a polyvalent klebsiella bacteriophage can increase the effectiveness of antibacterial pharmacotherapy in surgical treatment with preservation of metal structures.

Possibilities of using topical retinoids and azelaic acid in acne therapy

Background. Acne is a common, complex and multifactorial inflammatory disease that results from a variety of causes. Acne therapy is an urgent problem of dermatocosmetology. The clinical manifestations of dermatosis can be alleviated, and its long-term consequences can be prevented by early diagnosis and timely initiation of treatment, affecting multifaceted all parts of the pathogenesis.
 Aims. To evaluate the clinical efficacy and safety of the use of monotherapy of 0.1% adapalene cream (Adaclean) with combined external therapy of 0.1% adapalene cream (Adaclean) with 20% azelaic acid cream (Azix-Derm) in the treatment of mild to moderate acne.
 Methods. Under our supervision at the Department of Plastic Reconstructive Surgery, Cosmetology and Regenerative Medicine of the State Budgetary Educational Institution of Higher Professional Education Rost of the State Medical University of the Ministry of Health of Russia, the clinics “Ekaterininskaya” and “MIR-O-MED” there were 50 patients aged 12 to 50 years (18 (36%) men and 32 (64%) women) with mild and moderate acne. Patients with comedonal acne, in the absence of multiple inflammatory elements, which made up group 1 of observation (n = 16), were prescribed Adaclean cream, 1 time per day (evening) against the background of skin care. In the group with mild to moderate papulo-pustular acne and post-inflammatory changes (group 2, n = 34), patients were prescribed a combination of 0.1% adapalene cream and 20% azelaic acid cream (Adaclean (evening) and Azix-Derm (morning)). The follow-up period was 6 months.
 Results. Total clinical remission after 6 months therapy was achieved in 70% of cases, a significant improvement — in 28%, improvement — in 2%. In patients with a comedonal form of acne against the background of monotherapy with Adaclean cream, clinical recovery was obtained in 44% of patients, a significant improvement — in 50%, and an improvement — in 6%. In patients from the group of papulo-pustular acne of mild to moderate severity, after 3 months the use of complex therapy Adaclean and Azix-Derm noted almost complete relief of the inflammatory process; after 6 months therapy clinical recovery was recorded in 58%, significant improvement — in 36%; 6% showed partial improvement, which is associated with irregular use of drugs and skin care products. After 6 months combined treatment was able to achieve regression of dyschromia in 18–46% of patients, atrophic scars — in 5–22%, which significantly improved the results of therapy and made it possible to achieve a good cosmetic effect.
 Conclusion. The combined use of drugs for external use of adapalene (Adaclean) and AK (Azix-Derm) in the treatment of papulo-pustular acne of mild and AK (Azix-Derm) in the treatment of papulo-pustular acne of mild and moderate severity can significantly increase the effectiveness of treatment, achieve a stable clinical effect and remission of the disease, as well as improve the quality of life of patients.

Relationship between quality of life, emotional symptomology and perceived emotional intelligence in a sample of burn victims

The main objective of this study is to analyse the association between Quality of Life (QOL), Emotional Symptomology and perceived Emotional Intelligence (EI) in burn patients. Additionally, it is intended determine the predictor models of QOL, and confirm the mediating effect of emotional symptomology between QOL and perceived EI. This is a transversal study developed in the Hospital da Prelada, Porto, Portugal, with a sample of 92 patients that were hospitalized in the Burn Unit and the Reconstructive Plastic Surgery Service. The assessment protocol consisted of a sociodemographic and clinical data sheet. To assess the perception of QOL of the burn patient it was used the Burn Specific Health Scale – Revised (BSHS-R), the emotional symptomology was measured by the Brief Symptom Inventory (BSI) and Trait Met-Mood Scale-24 (TMMS) was used to assess Emotional Intelligence (EI). The cross-sectional and correctional data were analysed through descriptive statistics, correlations, regressions and simple mediations. The results obtained suggest significant associations between QOL, perceived EI and Emotional Symptomology in burn patients. The results of the predictor models of the QOL domains encompass the Positive Symptom Distress Index (PSDI of Emotional Symptomology), where the total variance is explained mainly by the models of QOL Affect and Body Image 46% and Treatment 31%. The mediating effect of the PSDI in the relationship between QOL in the Affect and Body Image dimension and the Mood Repairs (MR) was also tested, having proved to have a total mediation (the Mood Repairs loses its contribution in the QOL model when the PSDI variable is introduced). This study underscores the importance of perceived Emotional Intelligence and its association with the burn impact in the different dimensions of QOL of the patients. The intention of this study is to alert health professionals for patient support in the search for strategies that aim for positive adaptation which promotes QOL and emotional adjustment of burn patients to their new condition.

Revisiting Level of Evidence Ratings in Plastic Surgery: A Call To Action.

Evidence-based medicine (EBM) underpins medical and surgical practice, with Level of Evidence (LOE) being a key aspect that allows clinicians and researchers to better discriminate the methodological context by which studies are conducted to appropriately interpret their conclusions and more specifically, the strength of their recommendations. The aim of this study was to reassess the LOE of articles published in plastic surgery journals. A review of the following plastic surgery journals: Aesthetic Surgery Journal (ASJ), Annals of Plastic Surgery (Annals), Journal of Plastic Reconstructive and Aesthetic Surgery (JRPAS), Plastic and Reconstructive Surgery (PRS) and Plastic and Reconstructive Surgery Global Open (PRS GO) was performed to assess the overall LOE of publications from January 1 to December 31, 2021. From 3698 PUBMED articles, 1649 original articles and systematic reviews were analyzed. The average LOE for each journal was: ASJ 3.02 ± 0.94, Annals 3.49 ± 0.62, JPRAS 3.33 ± 0.77, PRS 2.91 ± 0.77, and PRS GO 3.45 ± 0.70. The collective average LOE was 3.28 ± 0.78. Only 4.4% were LOE I and 7.3% were LOE II. Compared to past studies, PRS showed a significant LOE improvement (p = 0.0254), while ASJ and JPRAS saw non-significant changes; Annals experienced a significant decrease (p = 0.0092). ASJ and PRS showed the highest LOE among the journals analyzed. Despite this, low LOE studies remain prevalent in plastic surgery. This paper serves as a call to action for both researchers and academic journals to elevate the standard, offering several strategies to help improve the LOE in plastic surgery.

[Postbariatric plastic surgery for body reconstruction].

Massive weight loss following bariatric surgery is often accompanied by functional impairments due to the resulting excess skin and soft tissues. To achieve both functional reconstruction and restoration of the body silhouette, it is imperative to undergo body contouring surgery involving the strategic transposition of tissues. Several surgical techniques are available for the affected body regions and their application for treatment is determined by the unique circumstances specific to each patient. When conducted by skilled practitioners, postbariatric body reconstruction can be executed safely, leading to outcomes that are both functionally and esthetically satisfying, ultimately contributing to an enhanced quality of life for patients. This article provides the fundamental principles for patient selection, surgical preparation, treatment planning, surgical techniques and the postoperative care following bariatric surgery.

Modeling the Lifetime Impact of Reconstructive Plastic Surgery Training: Implications for Building Capacity in Global Surgery.

Training local surgeons and building local surgical capacity is critical to closing the gap in unmet surgical burden in low- and middle-income country (LMIC) settings. We propose a conceptual framework to quantify the impact of a single surgeon's training across multiple generations of trainees. A literature review was conducted to identify existing models for quantifying the impact of training. A model to estimate the attributable impact of surgical training was devised, based on a surgeon's attributable impact on a trainee and the lifetime number of cases trainees would perform. A quantitative survey was sent to high-income country and LMIC-based surgeons to determine the model's inputs across eight index procedures in reconstructive plastic surgery. We found no existing models for quantifying the multigenerational impact of training in surgery, medicine, or nonmedical fields. Twenty-eight US-based academic plastic surgeons and 19 LMIC-based surgeons representing 10 countries provided responses. The lifetime impact of multigenerational surgical training ranged from 4100 attributable cases (skin graft) to 51,900 attributable cases (cleft lip repair) in high-income countries and from 18,200 attributable cases (carpal tunnel release) to 134,300 attributable cases (cleft lip repair) in LMICs. There is a sizeable impact in the first generation of training, and this impact is even greater in the second generation of training, highlighting the importance of a "multiplier effect," particularly in LMIC settings. Given the paucity of surgeons, this multiplier effect is critical in closing the surgical gap, as efforts are underway to train new cohorts of reconstructive plastic surgeons.

Management of Gynecomastia: Retrospective, Epidemiological, Clinical and Therapeutic Study about 16 Cases, Experience of the University Hospital Tangier-Tetouan -Al Hoceima

Gynecomastia is a benign glandular proliferation of the male breast, which can be unilateral or bilateral, acute or chronic. It can be a source of psychological discomfort, raise fears of breast cancer and sometimes be a sign of serious endocrine or systemic disease. In the case of symptomatic gynecomastia, medical treatment is likely to be ineffective and surgery is the ideal treatment. In general, surgery frequently consists of mastectomy preceded by liposuction. The aim of our study was to analysis the epidemiological, anthropometric and clinical aspects of gynecomastia in our structure. A comparative study of the different surgical techniques will also be included, in order to obtain the best possible result, especially in aesthetic aspects. This is a retrospective study of 16 patients treated for gynecomastia who underwent surgical treatment at the Department of Aesthetic Plastic Reconstructive and Burn Surgery, CHU Tanger-Tétouan-Al Hoceima between March 2021 and October 2023. The average age of our patients was 27 years. 56% had a history of pubertal gynecomastia, 12.5% had a history of drug use, 37.5% were overweight and 31.25% were obese. The reasons for consultation were aesthetic problems in the majority of cases (81%) and cancer phobia in 19%. 62.5% were classified as having predominantly glandular gynecomastia, with Simon's grade IIa (44%) being the most common. The hormonal check-up was normal in all our patients. Concerning surgical techniques, subcutaneous mastectomy preceded by liposuction was applied in the majority of patients 94%, and subcutaneous mastectomy alone was applied in only 1 patient. We didn't observe any post-operative complications in any of our patients, and most of them were satisfied with the aesthetic results. The combination of mastectomy and liposuction is indispensable, as almost all types of gynecomastia consist of glandular and fatty hypertrophy, so these two techniques have guaranteed fewer complications and more ..........

Reparative plastic surgery: an overview of the Unified Health System

INTRODUCTION: A repairing plastic surgery is an area of medical practice that has the purpose of correcting deformities or funcional deficits (partial or total) that require surgical resources for plastic surgery, such as the anatomy as close as possible to the original. OBJECTIVE: The objective of this article is to expose the panorama of reconstructive plastic surgery in the Unified Health System (SUS) in 2019, in order to compare its findings with the official specifications of the year 2009. METHOD: A cross-sectional, quantitative study based on data of the Informatics Department of the Unified Health System in the form of a simple frequency analysis regarding hospitalizations for plastic surgery procedures. RESULTS: Data covering 4.5% of all surgical repair procedures performed in Brazil in 2019 were collected, being the most prevalent among these, 72.33% breast reconstructive plastic surgeries, 10.22% cicatricial retraction correction 6.25% labiopalatais, 5.26% dermolipectomies not related to bariatric surgery, 4.1% after bariatric surgery, 1.35% of congenital skull and buccomaxillofacial deformities, and 0.49% of facial lipoatrophy and lipodystrophies. CONCLUSION: There is an increase in reparative surgeries between 2009 and 2019 (from 5.07% to 12.09%). However, the proposed scenario can not be accurately performed due to the various unavailability and non-specifications provided by the Informatics Department of the Unified Health System regarding the data recording of the same.

Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?-A Systematic Review and Meta-Analysis.

Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35, p = 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59, p < 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82, p < 0.001). UE was not associated with a worse five-year OS (RR = 0.90, p = 0.16), higher amputation rate (RR = 0.77, p = 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25, p = 0.244). Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.

Locoregional recurrences of breast cancer after reconstructive plastic and organ-preserving surgery

Objective. To analyze locoregional relapses (LRR) after reconstructive plastic and organ-preserving operations in breast cancer (BC)Materials and methods. A retrospective analysis of the results of the treatment of 303 patients with BC who underwent reconstructive plastic and organ-preserving operations in the period from 2014 to 2019 in the Oncological Department of General Oncology and Rehabilitation of Gomel Regional Clinical Oncological Dispensary was carried out. The median age was 44 years (25-70 years). Statistical data processing was carried out using the application software package “Statistica”, 10.0. To characterize the surveyed groups, a standard methodological approach based on the calculation of descriptive statistics data was used. In order to statistically assess the relationship between the frequency of relapses depending on the stage and the molecular biological type of neoplasm, the Spearman correlation coeffi cient was used. The accepted level of statistical signifi cance (p) was 0.05.Results. Locoregional relapses were recorded in 11 (3.6%) patients, of which local — in 8 (2.6%), regional — in 3 (1.0%). The minimum period of development of LRR was 15 months, the maximum was 74 months; the median period of occurrence of LRR was 47 months. Depending on the stage of breast cancer, relapses developed: at stage I — in 4 (3.7%) cases, II — 5 (3.5%), III — 2 (4.2%). Depending on the molecular biological subtype of the neoplasm, LRR were distributed as follows: with luminal A — 1 (1.3%) case, luminal In HER2-negative — 1 (0.9%), luminal In HER2-positive — 6 (9.7%), non-luminal HER2-positive 1 (6.3%), three times negative — 2 (5.6%). Discordance of the receptor status was detected in 8 (72.7%) patients with recurrent tumor, most often due to the loss or decrease in the number of progesterone receptors (PR). The level of tumor-infi ltrating lymphocytes (TILs) in primary neoplasm ranged from 4 to 12%, in recurrent tumors it remained low: 5-10%.Conclusion. Given the heterogeneity of BC, the risk of developing LRR depends on many factors. LRR developed in luminal HER2-positive cancer in 9.7% of cases (p 0.05), stage III breast cancer — 4.2% (p 0.05). One of the important predictive factors is the evaluation of TILs. We noted a low level of TILs in both primary and recurrent tumors. There is a high discordance in the receptor status — 72.7%, which is important to take into account when prescribing systemic therapy.

Gender distribution of Top Doctors in otolaryngology-head and neck surgery.

Our study seeks to understand the profiles of otolaryngologists selected by Castle Connolly's Top Doctor list and how this compares to the entire field of otolaryngology. Top Doctor lists published in Castle Connolly affiliated magazines were analyzed for Otolaryngology, Otolaryngology/Facial Plastic Surgery, or Pediatric Otolaryngology physicians. Only lists published in 2021 or representing the 2021 Top Doctor lists were analyzed. Of the total 39 partnered magazines, 27 met our criteria. Information on the physician was analyzed from the Castle Connolly website and included: gender, education, faculty position, years as a Top Doctor, and certifications of each physician. 879 doctors, 742 (84%) men and 137 women (16%), were included in our analysis. 509 physicians completed a fellowship, 85 (62%) women and 424 (57%) men. The fellowship type varied significantly between gender (p = .002). 122 (14%) Top Doctors completed facial and plastic reconstructive surgery and 111 (91%) were men. Of the women Top Doctors completing a fellowship, 29 (34%) completed a fellowship in pediatric otolaryngology. A logistic regression found that men have an increased odds of being on the Top Doctors list for more years than females (OR: 1.36, p < .001). The percentage of women named as Top Doctors was less than the proportion of women in otolaryngology. This may be attributed to gender differences we found in fellowship type and certification. Further research into the role of otolaryngology subspecialties in selection of Top Doctors is needed to better understand gender differences.

Scalp arteriovenous malformations - 20 years of experience in a tertiary healthcare centre.

Scalp arteriovenous malformations (SAVM) are extremely uncommon vascular malformations, with only ~200 cases published in the English language in the past years. The objective of the present study was to describe the experience of a single reference service in neurosurgery. This is a descriptive and retrospective study conducted at our institution, which included cases of SAVM treated between 2001 and 2022. All information were extracted from the medical records of our institution. Patient confidentiality was preserved. Furthermore, an illustrative case has been described in detail. Seven patients were included. The male-to-female ratio was 2.5: 1 and the mean age was 23.3 (3-42) years. Most cases (56.4%) were spontaneous and the lesions were located in the frontal (28.7%) and parietal (28.7%) regions. All lesions were supplied by more than one feeder, with the superficial temporal and occipital arteries being the most commonly involved (71.5%). Six patients underwent preoperative embolization, and 56.4% patients had scalp necrosis. Five patients underwent surgical resection, all without recurrence and with good postoperative evolution. More than one artery was involved in all cases, and the properties of the involved vessel influences the approach strategy. Surgical treatment is curative, and preoperative embolization helps reduce bleeding during the surgery. Complete resection of the lesions prevents associated complications, such as bleeding or recurrence. Scalp necrosis is a frequent complication in the treatment of these lesions, and a multidisciplinary approach involving reconstructive plastic surgery should always be considered.

Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases.

Pressure injuries (PIs) arise from sustained pressure on tissue, leading to reduced blood flow to the affected area. In patients with spinal cord injuries (SCIs), these PIs can significantly diminish their independence and overall quality of life. This research sought to assess the frequency of surgical complications in treatment regimens for large sacral PIs involving the anus. Specifically, the study focused on the incorporation of stoma formation in patients with SCIs. A retrospective review identified 25 SCI patients who had extensive sacral PIs. These patients underwent intestinal stoma formation as a preparatory step before plastic reconstructive surgery to address the wounds between 2015 and 2020. Successful wound closure was achieved in all instances. Notably, each patient had experienced a minimum of three unsuccessful reconstructive surgeries elsewhere before this intervention. The observed rate of surgical complications aligned with findings from previous analogous studies. While often viewed as a treatment of last resort, an intestinal stoma might serve as a valuable strategy, particularly for SCI patients with extensive PIs near the anal region, to promote the healing of such injuries. Tailored decision-making is essential to ensure the best possible patient outcomes.

LIP CANCER: THE DIFFERENT MEANS OF RECONSTRUCTION (REVIEW OF 8 CASES)

Lip cancer is a frequent tumor of the head and neck region. Surgery is the treatment of choice for most of these cancers. Although there are several strategies to reconstruct lip tumors after tumor ablation this reconstruction is a challenge for the plastic surgeon. A retrospective review of the patients treated for lip cancer in the plastic reconstructive and esthetic Surgery Department of University Hospital Mohammed VI , from march 2021 to June 2023. Only patients withhistological confirmation of lip cancer were included. All the cases were evaluated for demographic features, tumor characteristics, and lip reconstructive surgery used. There were 5 male and 3 female patients. (5/3 ratio). with an average age of 57 years. the lower lip was the most frequently affected (63%), Most tumors were squamous cell carcinomas in 6 cases (75 %) a basal cell carcinoma (BCC) in 2 case (25%), and were located in the lower lip in 5 cases (63 %). Different surgical techniques were used for lip reconstruction after tumor ablation: a V-shaped wedge excision and direct repair was performed in 2 (25 %) patients W-shaped wedge excision in 1 patient (13%) (figure 5) The Karapandzic flap was performed in 5 cases (62) (4 patients karapandzicbilatéral and 1 case unilateral The most significant aspect of lip cancer surgery is tumor ablation, and that is not affected by the subsequent reconstructive strategy. Careful preoperative assessment and planning will allow the surgeon to reach an acceptable balance between form and function with the reconstruction.