Plastic Surgery Procedures Research Articles

Clinical and Cost-Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta-Analysis.

Indocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost-effectiveness across various plastic and reconstructive surgery procedures. A systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta-analysis concerned perfusion-related complications and cost data. Twenty-five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty-one studies were AHRQ Standard 'Good'; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (n = 3310) and head and neck reconstruction (n = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta-analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, p < 0.0001), fat necrosis (OR 0.31, p < 0.001), infection (OR 0.66, p = 0.02), and re-operation (OR 0.40, p < 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, p = 0.57/OR 0.87, p = 0.56, respectively) or increase in dehiscence (OR 1.55, p = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, p = 0.04), although not partial flap loss (OR 0.37, p = 0.13) and reoperation (OR 0.92, p = 0.73). Lower limb (n = 104) and abdominal wall (n = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta-analysis. ICGFA appears to be a useful, cost-effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.

Comparing ChatGPT vs. Surgeon-Generated Informed Consent Documentation for Plastic Surgery Procedures

Abstract Background Informed consent is a crucial requirement of a patient’s surgical care but can be a burdensome task. Artificial intelligence (AI) and machine learning language models may provide an alternative approach to writing detailed, readable consent forms in an efficient manner. No studies have assessed the accuracy and completeness of AI-generated consents for aesthetic plastic surgeries. Objectives This study aims to compare the length, reading level, accuracy, and completeness of informed consent forms that are AI chatbot (ChatGPT-4, OpenAI, San Francisco, CA)-generated versus plastic surgeon-generated for the most commonly performed aesthetic plastic surgeries. Methods This study is a cross-sectional design comparing informed consent forms created by the American Association of Plastic Surgeons (ASPS) with informed consent forms generated by ChatGPT-4 for the five most commonly performed plastic surgery procedures: liposuction, breast augmentation, abdominoplasty, breast lift, and blepharoplasty. Results The average word count of ChatGPT forms was lower than for the ASPS generated forms (1023 vs 2901, p=0.01). Average reading level for ChatGPT forms was also lower than ASPS forms (11.2 vs 12.5, p=0.02). There was no difference between accuracy and completeness scores for general descriptions of the surgery, risks, benefits, or alternatives. The mean overall impression score for ChatGPT consents was 2.33, whereas it was 2.23 for ASPS consent forms (p=0.18). Conclusions Our study demonstrates that informed consent forms generated by ChatGPT were significantly shorter and more readable than ASPS forms with no significant difference in completeness and accuracy.

Advances in the Application of Microsurgical Techniques in Repairing Traumatic Auricular Defects

Objectives: Auricular reconstruction is one of the most challenging procedures in plastic surgery. However, traumatic auricular defects present more uncertainty and complexity than congenital microtia with various surgical options in auricular reconstruction. The purpose of this article is to review advances in the use of microsurgical techniques for the treatment of traumatic ear defects. Methods: Three databases, PubMed, Web of Science, and Google Scholar, have been used to gather the most relevant papers discussing the topic. This paper searched for studies from 1980 to 2023: searching for a range of keywords such as “post-traumatic ear deformities,” “free flap,” and “free facial flap.” Using this method, studies related to free flaps in posttraumatic ear reconstruction were reviewed and discussed. Results: Fifty-four studies related to auricular reconstruction using different free flaps were obtained through screening. Conclusion: The microsurgical technique for auricular reconstruction requires both exceptional auricular reconstruction skills and microsurgical expertise due to its intricate nature. Nevertheless, microsurgical techniques remain a valuable avenue of investigation and can provide satisfactory surgical outcomes in appropriately selected patients. Level of Evidence Level V.

Embracing Robotics in Microsurgery: Robotic-Assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

The integration of robotic-assisted surgery (RAS) has transformed various surgical disciplines, including more recently plastic surgery. While RAS has gained acceptance in multiple specialties, its integration in plastic surgery has been gradual, challenging traditional open methods. Robotic-assisted deep inferior epigastric perforator (DIEP) flap breast reconstruction is a technique aimed at overcoming drawbacks associated with the traditional open DIEP flap approach. These limitations include a relatively large fascial incision length, potentially increasing rates of postoperative pain, abdominal bulge, hernia rates, and core weakening. The robotic-assisted DIEP flap technique emerges as an innovative and advantageous approach in fascial-sparing abdominal autologous breast reconstruction. While acknowledging certain challenges such as increased operative time, ongoing refinements are expected to further improve the overall surgical experience, optimize results, and solidify the role of robotics in advancing reconstructive microsurgical procedures in plastic surgery. Herein, the authors provide an overview of robotic surgery in the context of plastic surgery and its role in the DIEP flap harvest for breast reconstruction.

Racial Disparities in Plastic Surgery Outcomes: A Systematic Literature Review and Meta-Analysis.

Racial disparities in surgical outcomes have been shown to lead to subpar results in various patients. Variability and contradictions in the current literature highlight the need for a crucial evaluation of the matter in studies focusing on plastic and reconstructive surgery. Investigating the matter is a pivotal step toward effective guidelines that mitigate factors contributing to racial disparities in outcomes and improve our perception of a patient-centered health-care system. The study aimed to identify whether racial disparities exist in plastic and reconstructive surgery procedures. Systematic review of the literature as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to find relevant articles assessing the impact of race on surgical outcomes. PubMed, Embase, MEDLINE, and Cochrane library were screened by both authors, and relevant articles were identified. Prevalence of complications were extracted from included studies, and odds ratio (OR) with 95% confidence interval (CI) was calculated and grouped for a statistical analysis. Meta-analysis of 13 studies, with a mean of 8059 patients per study, demonstrated a pooled OR of 1.21 (95% CI: 1.00-1.46), indicating an insignificant association between non-White race and postoperative complications. Subanalysis comparing African American patients to White patients (10 studies) showed an OR of 1.36 (95% CI: 1.06-1.74), signifying a statistically significant risk for African Americans. No publication bias was observed, but substantial heterogeneity (73% and 79%) suggested varied study factors influencing outcomes. Racial disparities exist in plastic and reconstructive outcomes. Physicians and medical staff should focus on patients' sociodemographic background, accessibility to care, support cycles, and language proficiency, while determining the surgical plan and postoperative care.

ChatGPT Virtual Assistant for Breast Reconstruction: Assessing Preferences for a Traditional Chatbot versus a Human AI VideoBot.

Recent advancements in artificial intelligence (AI) have reshaped telehealth, with AI chatbots like Chat Generative Pretrained Transformer (ChatGPT) showing promise in various medical applications. ChatGPT is capable of offering basic patient education on procedures in plastic and reconstructive surgery (PRS), yet the preference between human AI VideoBots and traditional chatbots in plastic and reconstructive surgery remains unexplored. We developed a VideoBot by integrating ChatGPT with Synthesia, a human AI avatar video platform. The VideoBot was then integrated into Tolstoy to create an interactive experience that answered four of the most asked questions related to breast reconstruction. We used Zapier to develop a ChatGPT-integrated chatbot. A 16-item survey adapted from the 2005 validated measurement of online trust by Corritore et al was distributed online to female participants via Amazon Mechanical Turk. A total of 396 responses were gathered. Participants were 18 to 64 years old. Perceptions of truthfulness, believability, content expertise, ease of use, and safety were similar between the VideoBot and chatbot. Most participants preferred the VideoBot compared with the traditional chatbot (63.5% versus 28.1%), as they found it more captivating than the text-based chatbot. Of the participants, 77% would have preferred to see someone who they identified with in terms of gender and race. Both the VideoBot and text-based chatbot show comparable effectiveness, usability, and trust. Nonetheless, the VideoBot's human-like qualities enhance interactivity. Future research should explore the impact of race and gender concordance in telehealth to provide a more personalized experience for patients.

Enhancing aesthetic outcomes: The role of biomechanics in periorbital and eyelid cosmetic surgery.

Cosmetic periorbital and eyelid surgery is a commonly performed procedure in facial plastic surgery. Understanding the biomechanics of periorbital anatomy and its role in aesthetic surgery is essential for achieving optimal outcomes. This review explores the biomechanical processes involved in periorbital age changes and analyzes the impact of cosmetic surgery approaches on these processes. By maintaining the initial mechanical equilibrium of the brows, eyelids, septal fat, and blepharoplasty folds, periorbital and eyelid cosmetic surgery can effectively rejuvenate the appearance. Disruption of this equilibrium can lead to the migration of anatomic components, resulting in signs of aging. Surgeons, by applying biomechanical concepts, can tailor the forces exerted upon the different structures to manifest the patient's aesthetic aspirations. The key to success in periorbital and eyelid cosmetic surgery lies in re-establishing a dynamic mechanical equilibrium within the periorbital framework.

COVID-19 and postoperative complications after plastic surgery procedures: More than just hypercoagulability

BackgroundWhile plastic surgery procedures generally demonstrate a less than 2% incidence of VTE outcomes, the post-COVID era data remains elusive. This study sought to elucidate the relationship between COVID-19 infection and the risk of VTE outcomes across plastic surgery procedures. MethodsPlastic surgery procedures were identified in the 2012-2022 National Surgical Quality Improvement Program databases. The outcomes of interest were the postoperative occurrence of VTE, defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), and the occurrence of any postoperative complication. Propensity score matching was used to 1) compare overall rates of VTE between pre-pandemic era and pandemic era cohorts, and 2) compare rates of VTE and overall postoperative complications in cases with and without COVID-19 diagnosis in years 2021-2022 (p<0.05). Results269,006 plastic surgery cases were identified, comprising largely general breast (76%) and trunk (9.4%) procedures. Non-breast free tissue transfer cases were associated with the highest rates of DVT (1.3%) and trunk procedures with the highest rates of PE (0.7%). After propensity score matching, the overall rate of VTE after the onset of the COVID-19 pandemic was not significantly different from the pre-pandemic era (p=0.40). In a separately matched cohort, COVID-19 diagnosis did not significantly predict risk of VTE (p=0.48) but did significantly predict risk of overall postoperative complications (p<0.001). ConclusionsWhile COVID-19 diagnosis itself did not predict risk of VTE upon matched analysis, it significantly predicted overall postoperative complications. Future studies may further investigate effects of COVID-19 infection over longer periods of follow up.

Zoom Boom or Bust? Understanding Post-Pandemic Interest in Facial Plastic Surgery via Google Trends.

To understand post-pandemic interest in plastic surgery procedures via Joinpoint analysis of Google Trends search data. Google Trends was used to quantify search volumes from January 2019-December 2022 for select cosmetic face and body procedures in the United States. A keyword analytic tool (Keywords Everywhere) extracted absolute search volumes (average monthly searches). Joinpoint analysis assessed search trends over time reported as monthly percentage change (MPC). All procedures queried, including a non-cosmetic control (cataract surgery), demonstrated expected declines at the start of the COVID-19 pandemic. Blepharoplasty, face lift, neck lift, and Botox demonstrated statistically significant increase in search volumes that remained elevated relative to pre-pandemic levels. Rhinoplasty, fillers, and abdominoplasty interest increased initially followed by return to pre-pandemic levels by the end of 2022. The remainder of search terms did not show a clear temporal associated with COVID-19 lockdowns. The "Zoom Boom" appears to be a real phenomenon reflected by sustained increase in public interest in relation to facial plastic procedures. NA Laryngoscope, 2024.

From Healing to Regeneration: A Comprehensive Review of the Efficacy of Platelet-Rich Fibrin in Periodontal Plastic Surgery Procedures.

This review examines platelet-rich fibrin (PRF) efficacy in periodontal plastic surgery, highlighting its crucial role in promoting periodontal regeneration and healing. Various forms of PRF are discussed, like leukocyte- and platelet-rich fibrin, advanced PRF, and injectable PRF, in addition to their application in different periodontal procedures such as root coverage and increasing the width of keratinized tissue surrounding the teeth. This review emphasizes the biological benefits of PRF, such as faster wound healing, reduced postsurgical pain, and better management of bleeding. The presence of growth factors, cytokines, and leukocytes in PRF significantly aids in promoting tissue regeneration, thereby improving the clinical outcomes of periodontal therapy. This review also provides recommendations for further research using standardized PRF protocols to optimize the benefits of PRF in clinical practice.

The Association of Abdominoplasty with Breast Reduction (Mommy Makeover): Experience in An African University Hospital

Background: The popularity of breast reduction and abdominoplasty has significantly increased over the years, according to statistics from the American Society of Plastic Surgeons 2022. As a result, the Mommy Makeover, a procedure combining breast surgery and abdominoplasty, is not uncommon. Patients and Methods: A retrospective descriptive study was conducted over a four-year period within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco. Results: Five cases of Mommy Makeover were operated on within the Plastic and Aesthetic Surgery Department of the IBN SINA University Hospital, Rabat, Morocco. One case was addressed two years after bariatric surgery. The procedure combined breast reduction with the superior-internal pedicle technique with Wise’s pattern and abdominoplasty. No major complications were observed. Discussion: Since the introduction of abdominoplasties combined with breast surgery, several concerns have been associated with this combination. Venous thromboembolism is the most commonly discussed consequence in combined plastic surgery procedures. The risk of venous thromboembolism is not elevated when abdominoplasty and breast reduction are combined. The study emphasizes the importance of careful patient selection and attentive venous thromboembolism prevention. It assesses the validity of the Davison-Caprini framework for venous thromboembolism risk stratification and prophylaxis in plastic surgery. Other measures to prevent complications were cited in the literature and followed by our operating team. Conclusion: With the help of a simple risk stratification tool that takes into account diabetes, age, BMI, and ASA status, we can guarantee favorable results for women who may want combined surgery.

ChatGPT for improving postoperative instructions in multiple fields of plastic surgery

BackgroundClear discharge instructions are vital for patients and caregivers to manage post-op care at home. However, they often exceed the sixth-grade reading level recommended by national associations. We hypothesize that ChatGPT could help rewrite instructions to this level for increased accessibility and comprehension. We aim to assess readability, understandability, actionability, and safety of ChatGPT rewritten post-op instructions in four Plastic Surgery subspecialties: Breast, Craniofacial, Hand, and Aesthetic surgery. MethodsWe obtained post-op instructions from four index procedures in Plastic Surgery. We utilized ChatGPT to rewrite at the sixth- and fourth-grade reading levels. Readability was determined by seven readability indexes, understandability and actionability by the PEMAT-P questionnaire, and safety by the primary surgeons. ResultsOverall, average readability of the original post-op instructions ranged between seventh-eighth grade. Of the sixth-grade ChatGPT instructions, only one was lowered to the sixth-grade level. Of the fourth-grade ChatGPT instructions, all were reduced to sixth-grade or below, but none achieved fourth-grade level. Understandability scores increased as reading level decreased while actionability scores decreased for fourth-grade rewrites. Safety was not compromised in all rewrites. ConclusionsOur findings suggest that ChatGPT can adapt post-op instructions to a more readable sixth-grade level without compromising safety. We suggest prompting ChatGPT to write 1-2 grade levels lower than the desired reading level. While understandability increased for all ChatGPT rewrites, actionability decreased for fourth-grade level instructions. Sixth-grade remains as the optimal reading level for post-op instructions. This study demonstrates that ChatGPT can help improve patient care by improving readability of post-op instructions.

Auricle reconstruction with autologous costal cartilage versus polyethylene implants in microtia patients: a meta-analysis.

Auricle reconstruction is among the most challenging procedures in plastic and reconstructive surgery, and the choice of framework material is a critical decision for both surgeons and patients. This meta-analysis compared the outcomes of autologous auricle reconstruction using costal cartilage with those of alloplastic reconstruction using porous polyethylene implants. A literature review was conducted using the PubMed and Embase databases to retrieve articles published between January 2000 and June 2024. The outcomes analyzed included postoperative complications such as framework exposure, infection, skin necrosis, hematoma, and hypertrophic scars, as well as patient satisfaction. The proportions of reconstructive outcomes from each selected study were statistically analyzed using the "metaprop" function in R software. Fourteen articles met our inclusion criteria. The group undergoing polyethylene implant reconstruction exhibited higher rates of framework exposure, infection, and skin necrosis, whereas the autologous reconstruction group experienced higher rates of hematoma and hypertrophic scars. Of all the complications, framework exposure was the only one to show a statistically significant difference between the two groups (p < 0.0001). In terms of patient satisfaction, those who underwent autologous cartilage reconstruction reported a higher rate of satisfaction, although this difference did not reach statistical significance in the meta-analysis (p = 0.076). There is no statistically significant difference in postoperative complications such as infection, hematoma, skin necrosis, and hypertrophic scars between auricle reconstructions using autologous costal cartilage and those using polyethylene implants. However, reconstructions with polyethylene implants show a significantly higher rate of framework exposure.

Standards of Femininity in Traditional and Contemporary China: Stereotypes and Beliefs on Women’s Appearance, Roles and their Cultural Influences

Technological advancements have advanced patriarchal society. Modern society is bombarded with media, which introduces new styles and trends daily. These new fashion standards often have negative effects and reinforce social norms and stereotypes. Female roles and fashion trends are stereotyped worldwide, but they are rarely rigid. However, many in Eastern Asia, especially China, are concerned about this issue because cultural and media influences shape many stereotypes and perceptions about women’s physical appearances and social roles. People used to embrace their own beauty standards. However, modern society has adopted a standardised ideal, leading many to undergo extensive plastic surgery procedures like nose bridge enhancement, V-shaped face, skin lightening, and double eyelids. It seems like everyone is identical and can be easily replicated. Without inner beauty and values, outer beauty is just a decorative vase. Beauty, like anything else, is harmful in excess. Self-improvement and personal values should be prioritised before cosmetic enhancement. Through impact of social media, Chinese people set beauty standards and keep them for female generations .

Aqua Breast Augmentation (ABA): Hydrodissection Breast Augmentation Technique.

Breast augmentation is a prevalent procedure in plastic surgery. In this article we present the Aqua Breast Technique (ABA), an approach aimed at enhancing patient satisfaction and reducing downtime. This technique leverages tumescent anesthesia and a small incision in the inframammary fold, avoiding electrocautery and surgical drains, to fulfill the growing demand for painless procedures with minimal recovery periods. The study retrospectively analyzed 238 patients who underwent breast augmentation using the ABA technique at Instituto Rubi between 2021 and 2024. The ABA protocol involves detailed preoperative design, local anesthesia, a precise 3-centimeter incision, careful dissection, and specific postoperative care, emphasizing hydrodissection for tissue separation and the use of smooth round silicone implants through a Keller funnel. The application of the ABA technique to 238 patients, with a mean follow-up time 14months. Ten patients required surgical intervention due to complications. Hematoma and infection rates were 0.42%, while capsulectomies were required in 2.1% of cases. Aqua Breast Augmentation technique has been successfully applied as ahydrodissection-based breast augmentation technique method, with low complication rates, short downtime, and reduced postoperative pain. Level V, therapeutic study. 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 .

A Novel Approach to Incision Marking in Abdominoplasty Using 3D Printing Technology: A Description of Technique.

Abdominoplasty is one of the most common plastic surgery procedures used to improve the appearance and contour of the abdominal region. Despite advances in surgical techniques, achieving optimal aesthetic results with minimal scarring remains a challenge. In this study, we describe a feasible approach to incision marking in abdominoplasty using a three-dimensional-printed incision marking tool. This technique with open source nature has the potential to revolutionize the field of plastic surgery and enhance patient satisfaction. Further studies are needed to confirm our findings and explore the potential applications of three-dimensional printing technology in other aesthetic procedures.

Reduction Mammoplasties: Risk Factors and Early Complications-About 1442 Cases.

Breast reduction surgery is a widely performed plastic surgery procedure. The incidence of such complications has been steadily decreasing in recent years but is still nonetheless 5.6%. The primary aim of this study was to analyze the incidence of the main postoperative complications of breast reduction surgery. In addition, we identified cause-and-effect links between complications and characteristics of the patients, such as smoking, age, weight resection, BMI, and wound drainage. This retrospective study was performed on a population of 1442 women who underwent breast reduction surgery between January 2016 and October 2022 in the plastic surgery unit at Saint-Louis Hospital, Paris, France. At the follow-up examination, we evaluated the patients for complications. The average resection weight was 1297.7 g in a population for which the average BMI was 28.9. We found 19.9% rate of total complications, of which 3.5% were major complications. We found that only the resection weight was a risk factor for complications. The main strength of our study is the size of our sample. The large number of patients allowed us to conduct numerous analyses and obtain significant results despite the rarity of certain events. This large cohort was also responsible for the high statistical power of our results. The risk of developing a postoperative infection was 7.5% for resections of less than 2.4 kg, increasing to 13.9 % when greater than that. Thus, the administration of prophylactic antibiotic therapy to affected women to reduce the risk of infection is a distinct consideration. For the other factors, while none of them appeared to promote the occurrence of adverse events and, therefore, do not formally contraindicate breast reduction surgery, some preventive measures still strike us as being relevant, such as blade drainage, weight loss, diabetes control, and smoking cessation. 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 .

Therapeutic Aspects of Lipofilling, Abdominoplasty in Combination with Body Liposuction and Bariatric Surgery

This review article is dedicated to the therapeutic aspects of various plastic surgery procedures. Nowadays, improving appearance and quality of life through plastic surgery is becoming increasingly popular. Managing patients after lipofilling and abdominoplasty combined with liposuction is an interdisciplinary challenge. Intraoperative risks in plastic surgery are associated with anesthesia and comorbidities. The immediate response of the cardiovascular and respiratory systems to the administration of anesthetic agents and the anesthesiologist's qualifications determines the immediate success of the operations. The duration of the surgery, volumetric disturbances, reduction of body surface area, and changes in metabolic and immunological status after mechanical impact on adipose tissue significantly alter the rate of compensatory-adaptive reactions of the body. In the long-term period after lipofilling, abdominoplasty, liposuction, and augmentation mammoplasty, systemic complications are often observed. These include insomnia, chronic kidney disease, protein-energy malnutrition, arthropathies, nonspecific interstitial lung lesions, unverified hepatitis, lupus-like syndrome, antibodies to transplanted fats and silicone materials, idiopathic limb edema, as well as autoinflammatory syndromes. The presented work also provides data on propofol infusion syndrome and the clinical-prognostic significance of vascular endothelial growth factor in plastic surgery. The authors’ team also presents their own clinical data on obesity and associated diseases. To maintain the aesthetic effect and prevent long-term complications after lipofilling, liposuction, augmentation mammoplasty, blepharoplasty, and rhinoplasty, it is recommended to follow a hypoallergenic and low-calorie diet for the next 3-6 months, avoid night work, excessive physical exertion, simultaneous intake of antibiotics and anti-inflammatory drugs, sun exposure, trips to mountainous areas, and long flights.

Periodontal management during orthodontic-surgical treatment of maxillary impacted incisors: Acase report

The treatment of impacted teeth is a multidisciplinary process requiring close collaboration between periodontics and orthodontics. Impaction can have several causes, including physical obstructions in the eruption pathway, arch length discrepancies, or dental deformity. The management of these cases lies in the diagnosis established after an appropriate clinical and radiological examination. The age, position, etiology, and amount of space in the dental arch of an unerupted tooth determine how it should be treated. In several cases, orthodontic creating space, removing physical obstructions, and exposing the patient surgically with or without traction are general guidelines for treatment. In addition, ensuring adequate access to the tooth and the possibility of attaching an orthodontic anchor, the periodontal plastic surgery procedures associated with surgical clearance must preserve the integrity of the periodontium of the impacted tooth, as well as that of adjacent teeth, and above all promote the long-term maintenance of their periodontal health.

Patient Weight and Chemoprophylaxis in Abdominoplasty: Does It Result in More Bleeding Events?

Bariatric surgery has gained popularity in recent decades as an effective treatment for obesity. Abdominoplasty is one of the most often performed aesthetic procedures all over the world. In post-bariatric patients undergoing abdominoplasty, the diameter size and number of the abdominal wall perforators increase proportionally with increased body weight. Postoperative complications that may occur are haematoma, and venous thromboembolism (VTE). In plastic surgery procedures VTE prophylaxis grades vary due to the lack of consensus and clear guidelines. The aim of this study was to explore the frequency of postoperative bleeding and VTE in patients undergoing abdominoplasty and to explore the risk factors associated with major bleeding. A retrospective single-centre study of adult patients who were operated on by abdominoplasty between 2011 and 2020. Chemoprophylaxis including low molecular weight heparin (LMHW) was recommended when the operating time exceeded 2h. A total of 102 patients were included. There were no patients with VTE. Eight patients were re-operated for major haematoma. The weight loss (peak weight to weight before the abdominoplasty) was 14.4kg larger in the re-operation group (p = 0.03). Eighty-eight percent in the re-operation group and 67% in the other group were treated with LMWH (p = 0.43). Multivariable logistic regression showed that with each decrease from the peak in BMIkg/m2 the risk of re-operation for major haematoma was increased by 22% (p = 0.02). Abdominoplasty in patients after massive weight loss has a higher risk of postoperative bleeding. Having a clear protocol for chemoprophylaxis should be considered. 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 .