Standardized Photographs Research Articles

Evaluation of Different Breast Implant Shapes in the Same Patient: Is There Really a Difference between Round and Anatomical Implants?

The choice of the right implant shape is one of the most frequent debates in cosmetic breast augmentation. In current literature, the question of whether there is a difference in the appearance of different implant shapes is still an argument of highly controversial discussion. The aim of the present work was, therefore, to analyze whether any difference exists in terms of aesthetic outcome between round and anatomical implants, and if they can be distinguished from each other in a like for like swap, making sure the evaluation was made in exactly similar conditions. Fourteen consecutive patients who underwent aesthetic breast augmentations received primarily an implant of a given volume, projection, and shape (round or anatomical) and then decided to undergo implant replacement to a different shape but maintaining the same volume and projection. At 12-months follow-up, standardized photographs were taken, blinded and randomized. They were evaluated by 10 plastic surgeons and 10 nurses. All 20 observers could distinguish between round and anatomical shape in all 14 cases (100%), which was highly significant (P < 0.0001) for each observer. The present data indicate that there is a clear difference between anatomical and round-shaped implants in terms of aesthetic appearance, when a comparison is properly performed. With the use of both round and anatomical implant shapes, aesthetically appealing results can be achieved in cosmetic breast augmentation. The right implant choice must be made, based on patients' anatomy and desires.

Combining Diamond-Tip Dermabrasion Treatments and Topical Skincare in Participants with Dry, Hyperpigmented, Photodamaged or Acne-Prone/Oily Facial Skin: A Clinical Usage Study.

An in-office diamond tip microdermabrasion device (DG) was designed to simultaneously exfoliate, extract, and infuse topical cosmetic serums into the skin to improve its appearance. Combining in-office procedures with take-home skincare may enhance treatment outcomes. This study aimed to assess the efficacy of a novel combination of DG treatments with a take-home cosmetic skincare regimen (DGR) to address facial dryness, hyperpigmentation, photodamage, or acne-prone/oily skin. In this 12-week, open-label, single-center study, participants were assigned to 1 of 4 groups according to skin presentation: dry, hyperpigmented, photodamaged, or acne-prone/oily. All participants received 6 bi-weekly DG treatments with tailored DGR topical products. During the DG treatment, the dry, hyperpigmented, photodamaged, and acne-prone/oily groups received hydrating, brightening, antioxidant, and pore-clarifying serums, respectively. Study endpoints included investigator grading, standardized photography, and participant questionnaires. Sixteen participants aged 22 to 70 years with Fitzpatrick Skin Types I-V completed the study. Immediately after the first DG treatment, significant improvements in dryness, radiance, texture, photodamage, and fine lines were achieved (P<0.01). At 72 hours, significant improvements were maintained in all these parameters except fine lines (P<0.05). The DG and DGR combination provided significant long-term improvements at week 12 compared to baseline for dryness, radiance, texture, hyperpigmentation, photodamage, skin tone unevenness, and periocular/perioral fine lines (P<0.05). The combination of DG and DGR showed significant immediate and long-term improvements in skin appearance. These results show that the DG and DGR combination is a well-tolerated and effective intervention to enhance different aspects of facial skin quality.

Molar-incisor hypomineralization in a cohort of individuals born with cleft lip and palate.

This study aimed to investigate the frequency of molar-incisor hypomineralization (MIH) in individuals born with cleft lip and or cleft palate. Three hundred eighty-six individuals born with cleft lip and/or palate before orthodontic treatment. All the individuals were submitted to a clinical examination and intraoral standardized photos. The registration of MIH was taken by two orthodontists and analysed in association with the cleft type and laterality. The Kruskal-Wallis test and the regression test were used to compare the frequency of molars and incisors affected according to cleft type and laterality, sex and age. We found a frequency of 67.87% of MIH in the studied sample. The frequency varied from 25% (in individuals born with cleft palate) to 77% in individuals born with bilateral cleft lip and palate). The number of affected molars was statistically different depending on cleft type and laterality (P < .001- Kruskal-Wallis test). Differences were found between individuals born with unilateral cleft lip and palate and unilateral cleft lip and alveolus (P = .03), and with isolated cleft palate (P = .03), and between individuals born with bilateral cleft lip and palate and born with unilateral cleft lip and alveolus (P = .01), and cleft palate (P = .01). Sex (P = .21) and age (P = .36) had no influence on the frequency of MIH. A positive correlation was found between the number of molars affected and incisors affected (P < .001). Individuals born with cleft lip and palate have a higher frequency of MIH, and the complexity of cleft type was associated with the number of affected molars.

Vessels characteristics in familial exudative vitreoretinopathy and retinopathy of prematurity based on deep convolutional neural networks.

The purpose of this study was to investigate the quantitative retinal vascular morphological characteristics of Retinopathy of Prematurity (ROP) and Familial Exudative Vitreoretinopathy (FEVR) in the newborn by the application of a deep learning network with artificial intelligence. Standard 130-degree fundus photographs centered on the optic disc were taken in the newborns. The deep learning network provided segmentation of the retinal vessels and the optic disc (OD). Based on the vessel segmentation, the vascular morphological characteristics, including avascular area, vessel angle, vessel density, fractal dimension (FD), and tortuosity, were automatically evaluated. 201 eyes of FEVR, 289 eyes of ROP, and 195 eyes of healthy individuals were included in this study. The deep learning system of blood vessel segmentation had a sensitivity of 72% and a specificity of 99%. The vessel angle in the FEVR group was significantly smaller than that in the normal group and ROP group (37.43 ± 5.43 vs. 39.40 ± 5.61, 39.50 ± 5.58, P = 0.001, < 0.001 respectively). The normal group had the lowest vessel density, the ROP group was in between, and the FEVR group had the highest (2.64 ± 0.85, 2.97 ± 0.92, 3.37 ± 0.88 respectively). The FD was smaller in controls than in the FEVR and ROP groups (0.984 ± 0.039, 1.018 ± 0.039 and 1.016 ± 0.044 respectively, P < 0.001). The ROP group had the most tortuous vessels, while the FEVR group had the stiffest vessels, the controls were in the middle (11.61 ± 3.17, 8.37 ± 2.33 and 7.72 ± 1.57 respectively, P < 0.001). The deep learning technology used in this study has good performance in the quantitative analysis of vascular morphological characteristics in fundus photography. Vascular morphology was different in the newborns of FEVR and ROP compared to healthy individuals, which showed great clinical value for the differential diagnosis of ROP and FEVR.

Iris colour and subjective emotional status in Chinese adolescents

BackgroundUnderstanding the iris colour might be a useful biomarker in predicting emotional health status. We aimed to examine the relationship of iris colour with subjective emotional status in a sample of Chinese adolescents aged 13 to 14 years. MethodsA total of 2346 students from ten middle schools in Mojiang participated the examination. The emotional health status was measured by the adolescent self-reported PedsQL 4.0. We obtained standardized slit-lamp photographs and developed a grading system assessing iris colour (higher grade denoting darker). Logistic regression models were fitted to assess the relationship between iris colour and emotional status. ResultsThe trend of decreasing negative emotional status with darker iris colour was significantly. Compared with grades 1 and 2 of iris colour, the students with grades 4 and 5 had less negative emotional status (ORfear = 0.56, 95 % CI: 0.41, 0.76; ORsadness = 0.67, 95 % CI: 0.49, 0.92; ORanger = 0.71, 95 % CI: 0.52, 0.98). In addition, the trend did not change after adjusting for potential confounders, including height, waist circumstance, sleep habits and computer times in logistic regression models. LimitationsOnly negative emotional indexes were selected as evaluative materials, it is unclear whether the pattern found in the present study also exists with regard to positive emotional indexes, such as happiness. ConclusionDarker iris colour might be associated with less negative emotional status in Chinese adolescents.

Preliminary Results of Measurements of Frontal Plane Knee Alignment Using a Standardized, Sonographic-Assisted Digital Photograph—A Reliable and Accurate Alternative to a Full-Leg Radiograph?

(1) Clinical alternatives to the full-leg radiograph (FLR) for determining frontal plane lower limb alignment have shown mixed results so far concerning reliability and accuracy. In addition, intercondylar respectively intermalleolar distance (ICD/IMD) measurement is limited in the interpretation of its results. The purpose of the study is to present a standardized, sonographic-assisted photographic measurement (SPM) of the leg axis in the frontal plane using a digital photograph and compare it with the gold standard of the anterior–posterior FLR. (2) Adults who had recently received an FLR were included in the study. After determining the center of the hip joint and knee joint gap in a standing position via ultrasound, a standardized digital photograph was taken. Subsequently, the hip–knee–ankle angle (HKA) was measured using an image editing program for SPM and FLRs. Mean deviation (MD), Pearson’s correlation coefficient and the clinical method’s interclass correlation coefficient (ICC) were calculated. (3) Of 18 subjects (8 male and 10 female), respectively, 34 lower extremities have been included in the study. Their mean BMI was 25.5 kg/m2. The correlation between the two measurement methods for subjects with BMI &lt; 30 kg/m2 was reliably high (r = 0.93, p &lt; 0.001). The HKAs derived from SPM and FLRs showed a mean deviation (MD) of 2.4° (range 0.1–6.0°) for subjects with BMI &lt; 30 kg/m2. The average ICC among all examiners conducting the SPM was 0.99 (CI 0.95–0.99, p &lt; 0.001). The MD for subjects ≥ 30 kg/m2 increased significantly (MD = 5.5°; n = 10, p &lt; 0.001). (4) SPM of the leg axis in the frontal plane allows sufficiently accurate results in patients with a BMI lower than 30 kg/m2. The methodology is limited in cases of increased BMI and needs well-trained examiners. Nevertheless, as a screening method in the field of children and adolescents, this method can be recommended in clinical daily routine.

In vivo efficacy proof of concept of a large-size bioprinted dermo-epidermal substitute for permanent wound coverage.

Introduction: An autologous split-thickness skin graft (STSG) is a standard treatment for coverage of full-thickness skin defects. However, this technique has two major drawbacks: the use of general anesthesia for skin harvesting and scar sequelae on the donor site. In order to reduce morbidity associated with STSG harvesting, researchers have developed autologous dermo-epidermal substitutes (DESs) using cell culture, tissue engineering, and, more recently, bioprinting approaches. This study assessed the manufacturing reliability and in vivo efficacy of a large-size good manufacturing practice (GMP)-compatible bio-printed human DES, named Poieskin®, for acute wound healing treatment. Methods: Two batches (40cm2 each) of Poieskin® were produced, and their reliability and homogeneity were assessed using histological scoring. Immunosuppressed mice received either samples of Poieskin® (n = 8) or human STSG (n = 8) immediately after longitudinal acute full-thickness excision of size 1 × 1.5cm, applied on the skeletal muscle plane. The engraftment rate was assessed through standardized photographs on day 16 of the follow-up. Moreover, wound contraction, superficial vascularization, and local inflammation were evaluated via standardized photographs, laser Doppler imaging, and PET imaging, respectively. Histological analysis was finally performed after euthanasia. Results: Histological scoring reached 75% ± 8% and 73% ± 12%, respectively, displaying a robust and homogeneous construct. Engraftment was comparable for both groups: 91.8% (SD = 0.1152) for the Poieskin® group versus 100% (SD = 0) for the human STSG group. We did not record differences in either graft perfusion, PET imaging, or histological scoring on day 16. Conclusion: Poieskin® presents consistent bioengineering manufacturing characteristics to treat full-thickness cutaneous defects as an alternative to STSG in clinical applications. Manufacturing of Poieskin® is reliable and homogeneous, leading to a clinically satisfying rate of graft take compared to the reference human STSG in a mouse model. These results encourage the use of Poieskin® in phase I clinical trials as its manufacturing procedure is compatible with pharmaceutical guidelines.

Photogrammetry of “Wet” Pathology Museum Specimens: A Pilot Project

Medical museums around the world have many specimens of historical and teaching value in their collections. Some of these are bones that have been prepared to illustrate normal anatomy. Others consist of organs preserved in liquid fixative (“wet” specimens) and mounted in glass or plexiglass containers that demonstrate the pathology of disease. Digitization of these specimens has the advantage of making them available for viewing by more students or website visitors than is possible in the museum itself. Photogrammetry is one method for doing this that enables the reconstruction of high-quality 3D models using standard specimen photographs. However, although relatively easy to perform on bones, its use with “wet” objects is more difficult and special steps are required to achieve optimal results. Using specimens from the Sir William Osler aortic aneurysm collection at the Maude Abbott Medical Museum, we developed a relatively simple and cost-effective photogrammetry process that gave good reconstructions of most specimens. We expect that future developments, such as the use of artificial intelligence-based techniques, may improve this result.

Temporal Facelift: A New Method for Temporal and Mid-face Lifting.

Lifting the temporal and mid-face areas creates a very dynamic change in the facial appearance and different planes of dissection were described before. In this article, a new plane of dissection is described which allows the surgeon to perform a very quick and safe dissection in both the temporal and mid-face regions. Patients were operated on using the presented technique and brow lift, cantopexy, and mid-facelift were performed. The outcome of the surgery was analyzed by the authors from standardized photos before and 6 months after the surgery with measurements of the brow and lateral canthus. The plane of dissection is just over the subgaleal fascia which is actually the sub-superficial musculoaponeurotic system layer in the mid-face. This plane of dissection is easy and quick and creates a very mobile mid-face and temporal flap. Forty female patients were operated using the presented technique with a mean follow-up period of 15 months, the longest follow-up was 26 months. No major complication was encountered in these patients. In 5 patients, transient unilateral frontal branch palsy was encountered. In 1 patient, bilateral temporal area depression was observed 8 months after the surgery and treated with a fat injection under local anesthesia. One patient had alopecia in the temporal suture line which can be covered with hair. Temporal facelift is a versatile method with long-lasting results due to its important features; creating a very mobile flap for suspension dissection area, a large surface for adherence, and numerous sutures sharing the tension on the key sutures. Despite its slightly difficult early healing period, the technique should be kept in mind for the rejuvenation of the periorbital area and mid-face. Level of Evidence: Level I.

Playing Football as a Risk Factor for Lower Leg Malalignment?—Comparing Lower Leg Axis of Male Adolescent Football Players and Referees

The prevalence of varus knee malalignment among junior and adult football players (FP) has proven to be higher compared to other sports. No causal relationship has yet been found, as genu varum can be assumed to be an independent risk factor for the development of knee osteoarthritis. The purpose of this study is to compare knee alignment measurements and sport-specific data of adolescent football players and referees (REF). Knee alignment was detected by measuring the intercondylar/intermalleolar distance (ICD/IMD) as well as the Hip–Knee–Ankle angle (HKA) using a standardized digital frontal-plane photograph. Anthropometric and sports-related data (training/match exposure, seasons actively played, etc.) were collected by means of questionnaires (Clinical trial registration number: DRKS00020446). A total of 28 male FP and 29 male adolescent REF were included in the survey. The mean age was 17.4 ± 0.7 years. The two groups did not differ significantly in age, height, weight, BMI, and overall football/refereeing exposure per week (FP vs. REF: 274 vs. 285 min/week, p = 0.61). The HKA of the FP was significantly lower (toward varus) than that of the REF (177.6° ± 2.4° vs. 179.0° ± 2.4°; p &lt; 0.001). However, ICD did not significantly differ (FP: 17 ± 25 mm, REF: 13 ± 27 mm; p = 0.55). The football environment with frequent football exposure seems to have an influence on leg axis deviation in FP compared to REF. For prevention of knee osteoarthritis in FP, an advanced understanding of leg axis development in adolescent players is essential and, therefore, needs further research.

Aesthetic Implications of Bilateral Profunda Artery Perforator Flaps on Thigh and Buttock Proportions.

The profunda artery perforator (PAP) flap has emerged as an excellent secondary option for autologous breast reconstruction. Despite the increased acceptance, potential secondary benefits concerning aesthetic proportions of proximal thigh and buttock at the donor site have never been systematically investigated. A retrospective review of 151 patients who underwent breast reconstruction with horizontally designed PAP flaps (292 flaps) from 2012 to 2020 was performed. Patient characteristics, complications, and numbers of revision surgeries were collected. In bilateral reconstructions, pre- and postoperative standardized patient photographs were analyzed to identify postoperative changes in proximal thigh and buttock contour. The patients' own perception of postoperative aesthetic changes was determined by an electronic survey. The patients had a mean age of 51 and a mean body mass index of 26.3 kg/m2. The most common complications were minor and major wound complications affecting 35.1% of patients, followed by cellulitis (12.6%), seroma (7.9%), and hematoma (4.0%). A total of 38 patients (25.2%) underwent revision of the donor site. After reconstruction, patients were found to have aesthetically improved proximal thigh and buttock proportions, indicated by a wider thigh gap (thigh gap-hip ratio: 0.05 ± 0.04 vs. 0.13 ± 0.05, p < 0.0001) and reduction in lateral thigh-to-buttock ratio (0.85 ± 0.05 vs. 0.76 ± 0.05, p < 0.0001). Among the 85 patients who responded to the survey (56.3% response rate), 70.6% felt that PAP surgery had aesthetically either improved their thigh contour (54.12%) or not changed it (16.47%), whereas only 29.4% reported that the surgery negatively impacted their thigh contour. PAP flap breast reconstruction leads to improved aesthetic proportions of the proximal thigh and buttock. This approach is ideal for patients with ptotic tissue of the inferior buttocks and medial thigh, a poorly defined infragluteal fold, and inadequate anterior-posterior buttock projection.

Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study.

Resorption of primary teeth and eruption of permanent teeth involves a complex series of changes. The cellular and histological changes occurring during the process of resorption vary stagewise. The knowledge of the changes occurring in the pulp of deciduous teeth would provide information about the resorptive process. To evaluate the histologic changes of the pulp of deciduous teeth related to different stages of physiologic root resorption. To establish the cause and effect relationship, a contrived histologic study design was planned. A total of 60 extracted deciduous incisors, canines, and molars were included in the study. The remaining root length (RRL) was determined based on the standardized photographs. The teeth were then grouped into three based on the percentage of RRL. The teeth were subjected to decalcification with 5% nitric acid, following which histological processing was performed. The present study being a qualitative study design, descriptively explains the histologic findings, and no statistical tests have been applied. During the initial stages of resorption, there were no histological alterations noted in the pulp, particularly in the cervical 3rd, with the cellular structure relatively maintained. As the resorption progresses, reversal lines were evident, indicating a process of repair occurring simultaneously during the process of resorption. With further advancement, the repair is overtaken by the resorption indicated by the presence of resorptive cells. Neovascularization and an increase in immune cells are also evident in advanced stages. The pulp exhibits progressive changes as the resorption continues from stage I to stage III. The changes vary from a smaller number of immune cells and odontoclasts in stage I to increasing number of the same as resorption progresses. Murthy P, Bhojraj N, Hegde U. Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study. Int J Clin Pediatr Dent 2023;16(3):437-443.

Surgical Tips for Aesthetic Lower Lid Blepharoplasty: Prevention of Round Eye

Purpose: In the present study, we highlight surgical tips based on our experience in lower eyelid blepharoplasty. These have been shown to be crucial in the prevention of several complications, specifically lateral lower-lid displacement. Methods: A series of bilateral lower-lid blepharoplasties were performed on 280 patients at Humanitas-Research-Hospital (Milan, Italy) between January 2016 and January 2020. Patients with a history of lower-lid blepharoplasty and patients requiring canthopexy/canthoplasty were excluded. Needing to singularly evaluate and correct several lower-eyelid structures to obtain a harmonic result, we preoperatively assessed the amount of skin excess, the eyelid margin malposition relative to the globe, and the presence/absence of herniated fat-pads. Pre- and postoperative standard photographs were collected. Patients were evaluated by measuring scleral show, snap-back test, and distraction test. Blinded-fashioned photograph analysis was performed by independent plastic and oculoplastic surgeons who did not execute the procedures. A visual analogue scale was administered to all patients to assess satisfaction. Results: In total, 280 patients underwent successful lower blepharoplasty, with satisfactory results of scleral show, snap-back test, and distraction test. Of the 280 patients, four presented postoperative complications. At 10-month follow-up visit, we achieved a mean patient visual analogue scale satisfaction score of 8.4. Postoperative surgeon’s photographs mean score was 4.5. Conclusions: Without the use of muscle flaps, our technique averts tarsal ligament misposition, preserves orbicularis-muscle innervation, and limits thermal spread, assuring excellent stability of results and high patient and surgeon satisfaction. Cosmetic outcome in terms of symmetry, appearance, and lower lid line definition revealed high satisfaction with the result over time, with a remarkably low complication rate.

Attractiveness Differentially Affects Direct Versus Indirect Face Evaluations in Two Cultures.

Although decades of research have identified facial features relating to people's evaluations of faces, specific features have largely been examined in isolation from each other. Recent work shows that considering the relative importance of these features in face evaluations is important to test theoretical assumptions of impression formation. Here, we examined how two facial features of evolutionary interest, facial attractiveness and facial-width-to-height ratio (FWHR), relate to evaluations of faces across two cultures. Because face evaluations are typically directly measured via self-reports, we also examined whether these features exert differential effects on both direct and indirect face evaluations. Evaluations of standardized photos naturally varying in facial attractiveness and FWHR were collected using the Affect Misattribution Procedure in the United States and Turkey. When their relative contributions were considered in the same model, facial attractiveness, but not FWHR, related to face evaluations across cultures. This positive attractiveness effect was stronger for direct versus indirect evaluations across cultures. These findings highlight the importance of considering the relative contributions of facial features to evaluations across cultures and suggest a culturally invariant role of attractiveness when intentionally evaluating faces.

174. Autologous Breast Reconstruction With Simultaneous Bilateral Lumbar Artery Perforator Flaps Improves Waistline Definition

PURPOSE: The lumbar artery perforator (LAP) flap is a valuable secondary option for autologous breast reconstruction when traditional abdominal donor sites are not available. Sociodemographic morphometric analyses have shown that the ideal waistline is characterized by a waist-to-hip ratio (WHR) of 0.7. How the LAP donor site affects truncal proportions and whether LAP flaps may lead to potential secondary benefits concerning waistline definition has never been systematically investigated. METHODS: A retrospective review of 50 patients who underwent bilateral breast reconstruction with lumbar artery perforator flaps (100 flaps) from 2018 - 2022 was performed. Patient characteristics and postoperative complications were recorded. Pre- and postoperative standardized patient photographs were analyzed to identify postoperative changes in WHR to assess waistline definition. The patients’ individual perception of postoperative aesthetic changes to their waistline was determined by an electronic survey. RESULTS: The patients had a mean age of 51 (24 - 63 years) and a mean BMI of 26.9 kg/m2 (19.3 - 37.4 kg/m2). Postoperative donor site complications included seromas (n = 10), wound dehiscence requiring operative revision (n = 5), hematomas (n = 4), and wound infections requiring oral antibiotic therapy (n = 2). Flap loss rate was 2%. After reconstruction, patients were found to have an improved waistline definition, indicated by a significantly decreased WHR (0.85 vs. 0.80, P = 0.005). Patient reported outcomes were obtained from 53% of patients. Among those, 81% of patients felt that their waistline had aesthetically improved after reconstruction, 14% reported no changes to their waistline aesthetics, and only 5% reported that their waistline had aesthetically worsened. CONCLUSION: Bilateral LAP flap breast reconstruction leads to improved waistline definition bringing patients closer to ideal aesthetic proportions. This reconstructive approach is ideal for patients that are not candidates for abdominal free flaps, however, demonstrate excess flank tissue and seek a more defined waistline.

72 Multi-Spectral SWIR Imaging in Humans Reveals Correlations with Distinct Skin Burn Depths

Abstract Introduction Burn depth determination is a critical aspect of burn patient care but currently lacks accuracy in clinical practice. We have shown first in animal models and then in a two-patient characterization that Short Wave Infrared (SWIR) imaging, which penetrates tissue better than visual or near-infrared light and is very sensitive to water content, can distinguish between superficial and deep tissue necrosis. Here we present the findings from our pilot study of 10 patients showing the use of multi-spectral SWIR imaging of human burn injury as a potential technique for burn depth determination. Methods Ten patients admitted for mixed depth thermal injuries between 5-40% TBSA were analyzed using our SWIR assessment tool. Prior to burn excision the SWIR system was used to image burn areas and normal skin at 4 different SWIR wavelengths (Figure 1A). Standard photographs from imaged areas were collected and presented for 5 independent, blinded, surgeons’ assessments. Using the visual and SWIR images, 5-15 regions of interest (ROI) were selected from each of the burned areas and normalized to adjacent normal skin and the reflected light intensity in each ROI was averaged at each wavelength. Statistics were done using Mann-Whitney U tests. Results Visual and SWIR images were collected from burn areas in 10 patients for a total of 273 burn ROIs. The ROIs were assessed by the surgeons with ROIs being agreed upon as being superficial or superficial partial thickness (SPT) (n=47), deep partial thickness (DPT) (n=97), or full thickness (FT) (n=129) burns by a majority (60% or above) consensus. As seen in Figure 1B, the reflectance intensities (RIs) from superficial and SPT burns were significantly different than the DPT burns at the 1940 nm wavelength (p=0.05) and significantly different than FT burns at 1200 nm (p=0.008) and 1940 nm (p=0.009). When DPT and FT burns were compared there was a significant difference a 1200 nm (p=0.003) and 2250 nm (p=0.01). Conclusions Here we present a 10 patient SWIR pilot study demonstrating distinct ROIs of SWIR wavelengths for different burn depths based on consensus surgeon assessments. Overall, as burn depth increases, the 1200 and 2250 nm wavelengths show increasing RIs and 1940 nm show decreasing RIs. These results motivate further studies of SWIR imaging including pending histological analysis in the hope to non-invasively and accurately identify operative versus non-operative burns. Applicability of Research to Practice This new SWIR technology may enable us to more objectively assess burn depth, leading to improved surgical decision making and better patient outcomes.

Ionization Activity Detected During Dark Periods in Long Air Positive Sparks

AbstractThe dark period in long air gap discharges has been assumed in the literature as the time between consecutive streamer current pulses when ionization and luminosity are absent. These dark periods are also present in natural lightning, in processes such as the inception and propagation of upward positive leaders, the development of needles, as well as transient luminous events in the upper atmosphere. Only recently, faint luminosity has been observed during dark periods, challenging this assumption. This paper aims to study any possible electrical activity during dark periods by means of experiments supported by computer simulation. Therefore, an experimental platform, including low‐current measurements, Schlieren and standard photography as well as ultraviolet (UV)‐photon detection was used to observe the electrical‐optical‐thermal characteristics of the dark period. A complementary numerical model was used to estimate the streamer space charge spatial distribution and its drift during dark periods. It is found that faint UV and visible light during the dark period is emitted exactly at the location of the low‐density streamer stem channel. This process is accompanied by the generation of an electronic current in the order of hundred microamps to milliamps. The simulation results show that this ionization activity occurs due to strong reduced electric fields in the residual stem channel above 112 Td, which is mainly determined by a combination of applied voltage, space charge distribution, and localized heating. Thus, the presented results show that there is indeed ionization activity during dark periods in long air gaps, which maintains a continuous glow‐like discharge.

Efficacy Differences of Platelet Rich Plasma for Treatment of Androgenetic Alopecia between Men and Women

Background: Almost 50% males face a health issue called androgenic alopecia and even almost 21 million women are affected too. Aim: To determine the efficacy difference of platelet rich plasma for treatment of androgenic alopecia among patients. Study design: Quasi experimental method. Methodology: In order to collect the data, the purposive sampling technique was used. Enrolled patients (n=102) were divided into two groups. Each group received PRP infections after every 1 month for 3 months. Follow up was done at 3 and 6 months. Results were assessed by standard photographs and Hamilton Norwood scale for men and Ludwig scale for women. SPSS v 23 evaluated data. Chi-square test was used to compare the efficacy of Platelet Rich Plasma for treatment of androgenic alopecia between genders. Results: Mean age of the study participants was 27.1±4.5 years. Independent sample t test revealed that the mean age of the female participants was significantly higher than male participants (p &lt; 0.001). There was 100% response rate of PRP treatment for androgenic alopecia in both genders. Practical Implication: This study helped researchers in exploring the efficacy of PRP as a remedy for hair re-growth as it is cheap and safe. Secondly, it added to local literature regarding androgenic alopecia. Conclusion: It was concluded that sub-dermal PRP injections were effective among both genders with androgenic alopecia. Keywords: Efficacy, Androgenic alopecia, Response Rate, Treatment Options and Plasma Rich Proteins.

How do Mandibular Osteotomies with and without Le Fort I osteotomy affect the Mentolabial Groove from the frontal view?

Purpose: The aim of this study was to determine how the mentolabial groove at the frontal view is affected by orthognathic surgery. Materials &amp;amp; Methods: Sixty-two patients were appointed into two groups (Group 1: Class II skeletal deformity, Group 2: Class III skeletal deformity). In each patient, pre and postoperative standardized sixth-month photos (lateral and frontal view) were obtained in natural head position to investigate mentolabial groove length (MGL), mentolabial groove depth (MGD), mentolabial groove angle (MGA) and mentolabial angle (MLA). Results: Out of the 62 patients, 41 had Class III skeletal deformity (66.2%) and 21 Class II skeletal deformity (33.8%). In Group 1, the average ratio of MGL decreased significantly from 0.59±0.14 to 0.45±0.09 (p&amp;lt;0.001). Contrary to Group 1, the ratio of MGL increased significantly from 0.41±0.11 to 0.50±0.13 in Group 2 (p=0.001). There was a negative correlation between MGA and MGL (p=0.001, r=-0.439). MGD positively correlated with MGL (p&amp;lt;0.001, r=0.499). Conclusion: After orthognathic surgery, the mentolabial groove decreases in class II patients and increases in class III patients. Orthognathic surgery significantly affects mentolabial anatomy and therefore should be planned carefully to obtain an aesthetic appearance in the mentolabial region.

D162. Aesthetic Implications of the Profunda Artery Perforator Flap on Thigh And Buttock Proportions

PURPOSE: Profunda artery perforator (PAP) flaps are a secondary option for autologous breast reconstruction when abdominal donor sites are not available. The goal of this study was to investigate the impact of PAP flap reconstruction on aesthetic proportions of the proximal thigh and buttock. METHODS: A retrospective review of 151 patients who underwent PAP flap breast reconstruction (292 flaps) from 2012-2020 was performed. Patient characteristics and postoperative complications were recorded. Pre- and postoperative standardized photographs were analyzed to identify postoperative changes to thigh and buttock contour. The patients’ perception of postoperative aesthetic changes was determined by an electronic survey. RESULTS: The patients’ mean age was 51 years and mean BMI was 26.3 kg/m2. Complications included major and minor wound complications (35.1%), cellulitis (12.6%), seroma (7.9%) and hematoma (4.0%). After reconstruction, patients were found to have aesthetically improved proximal thigh and buttock proportions, indicated by a wider thigh gap (thigh gap-hip ratio: 0.05±0.04 vs. 0.13±0.05, P < 0.0001) and reduction in lateral thigh-to-buttock ratio (0.85±0.05 vs. 0.76±0.05, P < 0.0001). Among the 85 patients who responded to the survey (56.3 % response rate), 70.6% felt that PAP surgery had aesthetically either improved (54.12%) or not had an impact on their thigh contour (16.47%), whereas only 29.4% reported a negative impact on their thigh contour. CONCLUSION: PAP flap breast reconstruction improves aesthetic proportions of the proximal thigh and buttock. This approach is ideal for patients with ptotic tissue of the inferior buttocks and medial thigh and inadequate anterior-posterior buttock projection.