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Mortada H, Ibrahim EA, Alhumsi TR. Modified McKissock's Breast Reduction Technique: A Case Series and Description of Our Technique Modification. JPRAS Open 2024; 39:81-88. [PMID: 38186384 PMCID: PMC10770475 DOI: 10.1016/j.jpra.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background The modified McKissock breast reduction technique uses upper and lower vascular pedicles to reduce breast size and reshape the breasts. This technique has gained significant interest in recent years because of its potential to minimize surgical complications. The current study aims to report our experience and results with our refined version of the McKissock technique. Methods We conducted a prospective cohort study on patients with breast hypertrophy between 2022 and 2023 to evaluate the modified McKissock breast reduction technique. Two main alterations were made to the original McKissock technique. First, the superior pedicle was modified to create a superomedial pedicle. Second, the inferior pedicle was thinned to form a dermoseptal pedicle with a 4 cm wide base. Results A total of 13 patients underwent surgery using the modified McKissock breast reduction technique. The average age of the patients was 37.2 years. For the right breast, the weight of tissue resected during reduction ranged from 189 g to 695 g (average 379 g). For the left breast, the resection weight range was 160 g to 608 g (average 370 g). There were no complications except one patient who developed partial nipple necrosis on the left side. All patients expressed satisfaction with the outcomes. Conclusion Our modified McKissock breast reduction technique shows promise as a method for reducing breast size. It offers several potential advantages, including improved preservation of the nipple and areola complex, more precise breast shaping, contouring capabilities, and reduced risk of complications. Although the early results of this technique are encouraging, further research is required to evaluate its long-term benefits and risks fully.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
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Figueroa-Sanchez JA, Martinez HR, Riaño-Espinoza M, Avalos-Montes PJ, Moran-Guerrero JA, Solorzano-Lopez EJ, Perez-Martinez LE, Flores-Salcido RE. Partial Cranial Reconstruction Using Titanium Mesh after Craniectomy: An Antiadhesive and Protective Barrier with Improved Aesthetic Outcomes. World Neurosurg 2024; 185:207-215. [PMID: 38403012 DOI: 10.1016/j.wneu.2024.02.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Describe a new, safe, technique that uses titanium mesh to partially cover skull defects immediately after decompressive craniectomy (DC). METHODS This study is a retrospective review of 8 patients who underwent DC and placement of a titanium mesh. The mesh partially covered the defect and was placed between the temporalis muscle and the dura graft. The muscle was sutured to the mesh. All patients underwent cranioplasty at a later time. The study recorded and analyzed demographic information, time between surgeries, extra-axial fluid collections, postoperative infections, need for reoperation, cortical hemorrhages, and functional and aesthetic outcomes. RESULTS After craniectomy, all patients underwent cranioplasty within an average of 112.5 days (30-240 days). One patient reported temporalis muscle atrophy, which was the only complication observed. During the cranioplasties, no adhesions were found between temporalis muscle, titanium mesh, and underlying dura. None of the patients showed complications in the follow-up computerized tomography scans. All patients had favorable aesthetic and functional results. CONCLUSIONS Placing a titanium mesh as an extra step during DC could have antiadhesive and protective properties, facilitating subsequent cranioplasty by preventing adhesions and providing a clear surgical plane between the temporalis muscle and intracranial tissues. This technique also helps preserve the temporalis muscle and enhances functional and aesthetic outcomes postcranioplasty. Therefore, it represents a safe alternative to other synthetic anti-adhesive materials. Further studies are necessary to draw definitive conclusions and elucidate long-term outcomes, however, the results obtained hold great promise for the safety and efficacy of this technique.
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Affiliation(s)
- Jose A Figueroa-Sanchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurologia y Neurocirugia, Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Hector R Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurologia y Neurocirugia, Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico.
| | | | - Pablo J Avalos-Montes
- Instituto de Neurologia y Neurocirugia, Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Jose A Moran-Guerrero
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurologia y Neurocirugia, Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - E J Solorzano-Lopez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Luis E Perez-Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurologia y Neurocirugia, Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Rogelio E Flores-Salcido
- Instituto de Neurologia y Neurocirugia, Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
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Khushalani A, Thakurani S, Garg P. Outcome Analysis of Two-Stage Paramedian Forehead Flap for Nasal Defects Reconstruction in Local Population: Experience of 3 Years at Our Center. Indian J Otolaryngol Head Neck Surg 2024; 76:559-566. [PMID: 38440631 PMCID: PMC10908939 DOI: 10.1007/s12070-023-04212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 03/06/2024] Open
Abstract
The nose is a key aesthetic element of face. Nasal defect reconstruction by forehead flap has been done since ancient times. The aim of this study is to review our experience of the outcomes of two- stage paramedian forehead flap in nasal defects of various aetiologies in the local population. This prospective study was done from January 2020 to December 2022 in the Department of Plastic and Reconstructive Surgery at SMS Medical College and Hospital. A total of 29 patients were included in this study who were candidates for a forehead flap for nose reconstruction due to any aetiology. After informed and written consent, two- stage paramedian forehead flap was done and patients were followed up to 6 months for analysis of outcomes. 29 participants were included in the study. Age range was 18-72 years (mean age 38.5 ± 16.78). 21 (72.4%) were male and 8 (27.6%) were female.23 (79.3%) patients had multiple subunit involvement, 4 (13.8%) patients had single subunit defect and 2 (6.9%) had total nasal defect. Most common aetiology was trauma (58.7%). Early complications including flap and donor site healing related complications were present in 8 (27.5%) patients. Delayed complications were grouped into cosmetic and functional complications and were seen in 22 (75.8%) patients. Cosmetic dissatisfaction was high with the two- stage paramedian forehead flap. Forehead flap is an established gold standard reconstructive option for nasal defects. In a two stage paramedian forehead flap, flap and donor site related issues are minor but cosmetic dissatisfaction is high. With some additional stages, satisfaction among patients increases significantly.
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Affiliation(s)
- Asha Khushalani
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital, Jaipur, Rajasthan India
| | - Sangeeta Thakurani
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital, Jaipur, Rajasthan India
| | - Paheli Garg
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital, Jaipur, Rajasthan India
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Kumari N, Shukla AK, Malviya R, Raj A, Sutaria B, Kumari L, Makkad RS. Influence of Zirconia/Glass Veneer Thickness and Implant Abutment Material on the Final Shade of Implant Restorations. J Pharm Bioallied Sci 2024; 16:S862-S864. [PMID: 38595607 PMCID: PMC11001075 DOI: 10.4103/jpbs.jpbs_1062_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 04/11/2024] Open
Abstract
Background Achieving an optimal shade match for these restorations is crucial for aesthetic outcomes. The thickness of zirconia/glass veneer and the choice of implant abutment material play vital roles in determining the final shade of implant restorations. Materials and Methods This study investigated the influence of zirconia/glass veneer thickness (0.5 mm and 1.0 mm) and implant abutment material (zirconia and titanium) on the final shade of implant restorations. A total of 60 identical implant restorations were fabricated and divided into four groups based on the combinations of veneer thickness and abutment material. The shade of each restoration was assessed using a shade guide, and color differences (ΔE) were measured with a spectrophotometer. Data were analyzed using statistical tests (e.g., ANOVA). Results The results indicated that the veneer thickness significantly influenced the final shade of implant restorations. Restorations with 0.5 mm veneer thickness exhibited a lower ΔE value (indicating a closer shade match) compared to those with 1.0 mm veneer thickness. Additionally, the choice of implant abutment material had a minor but statistically significant effect on shade. Zirconia abutments yielded slightly better shade-matching results compared to titanium abutments. Conclusion In implant restorations, the thickness of the zirconia/glass veneer plays a critical role in achieving a desirable shade match. A veneer thickness of 0.5 mm is recommended for optimal aesthetic outcomes.
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Affiliation(s)
- Nishu Kumari
- Department of Oral Pathology, Private Practitioner at Patna, Bihar, India
| | - Anuj K. Shukla
- Department of Dentistry, Dr. Laxminarayan Pandey Government Medical College and Hospital, Ratlam, Madhya Pradesh, India
| | - Rohit Malviya
- Department of Prosthodontics and Crown and Bridge, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Aman Raj
- Department of Prosthodontics and Crown and Bridge, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
| | - Bhagyashree Sutaria
- Department of Prosthodontics and Crown and Bridge, Sidhpur Dental College and Hospital, Dethali, Gujarat, India
| | - Lalima Kumari
- Department of Orthodontics and Dentofacial Orthopaedics, Patna Dental College and Hospital, Patna, Bihar, India
| | - Ramanpal S. Makkad
- Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
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Ren JH, Wang Y, Zhang X, Cheng Q, Wang K, Liu Q, Tang R, Yang L, Gong J, Xu J, Li H. A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study. Aesthetic Plast Surg 2023:10.1007/s00266-023-03631-5. [PMID: 37821554 DOI: 10.1007/s00266-023-03631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Approximately 25-30% of patients suffer from breast deformity and/or asymmetry after conventional breast-conserving surgery (CBCS). Generally, it is thought that oncoplastic breast-conserving surgery (OBCS) results in an improved cosmetic result; however, studies comparing the prognosis and aesthetic outcomes of CBCS and OBCS in early breast cancer (EBC) are inadequate. METHODS A total of 143 patients were included in this retrospective cohort study; 53 underwent OBCS and 90 underwent CBCS. The resected weight, complications, esthetic results, patient satisfaction, and recurrence rate were compared between the groups. Patient-reported outcomes (PRO) were assessed by the BREAST-Q questionnaire. RESULTS The mean age of the patients in OBCS group was 43.8 years. This was younger than that in CBCS group (49.1 years, p < 0.001). Postoperative complications (11.3% vs. 8.9%, p = 0.64) and re-excision (5.7% vs. 6.7%, p > 0.99) rates were similar. The OBCS group had higher breast satisfaction and psychosocial well-being than the CBCS group (75 vs. 63, p < 0.001 and 84 vs. 77, p = 0.05); however, sexual well-being (56 vs. 66, p = 0.05) and physical well-being (65 vs. 76, p < 0.001) were worse in OBCS. After 42.3 (range: 12.6-69.2)-month median follow-up, no difference in event-free survival (EFS) was demonstrated between the groups (p = 0.13). CONCLUSION Although OBCS has the better aesthetic outcomes and identical oncological safety in comparison with CBCS, the sexual and physical well-being in OBCS are not improved for Asian patients. Hence, choosing an appropriate procedure may be more important for the typically small to moderate-sized breasts characteristic of Asian females unlike Westerners. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- J H Ren
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiang Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qiao Cheng
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kang Wang
- Department of Oncology-Pathology, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Qiang Liu
- The People's Hospital of Dazu, Chongqing, China
| | - Renxi Tang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ling Yang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Junge Gong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jiawei Xu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hongyuan Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Wijesinghe K, Abeywickrama T, Chamara Y, De Silva S, Tharshan S, Jayarajah U, De Silva A. Oncoplastic breast conserving surgery versus standard breast conserving surgery for early and locally advanced breast cancer: a retrospective analysis from Sri Lanka. BMC Surg 2023; 23:273. [PMID: 37697322 PMCID: PMC10496197 DOI: 10.1186/s12893-023-02182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Breast aesthetics is becoming increasingly important in breast cancer surgery due to changes in patient expectations and greater emphasis been placed on the psychosocial outcomes. Studies have shown no difference in local recurrence risk between mastectomy and breast conserving surgery (BCS) and also a higher overall survival rate after BCS. Breast preservation improves the quality of life substantially compared to mastectomy. Oncoplastic breast-conserving surgery (O-BCS) involves tumour excision whilst overcoming the limitations of standard breast conserving surgery (S-BCS) by allowing larger resection volumes, avoiding deformities with better aesthetic results. Our study aims to compare the oncosurgical and aesthetic outcomes of O-BCS versus S-BCS among women in Sri Lanka. METHODS We conducted a retrospective study over a 4-year period including patients who underwent breast conservation surgery for primary non-metastatic breast cancer in two tertiary care units. We assessed outcomes in terms of re-excision rates, resection margin, complications and aesthetic outcomes using a Likert scale questionnaire to grade specific outcomes such as symmetry, volume, nipple position, scar visibility. Non-parametric tests were used for statistical analyses. RESULTS Fifty-four and seventy-three patients underwent S-BCS and O-BCS respectively. The median specimen volume and the maximum tumour diameter were significantly higher in O-BCS [160(range:65-220); 4.2(range: 1.2-5.2)] compared to S-BCS [65(range:45-86); 2.4(range: 1.0-2.6)]. The median closest tumour margin was 16 mm (range:4-25 mm) in O-BCS while 6 mm (range:<1 - 12 mm) in S-BCS (p = 0.01). Close (< 1 mm) and positive margins needing re-excision were seen mostly in S-BCS. Superior aesthetic outcomes with statistical significant difference were reported in the O-BCS compared to S-BCS group with better symmetry, volume, nipple position and scar visibility. The re-excision rates were significantly lower in O-BCS group. There was no significant difference in the operative time and complications while the aesthetic outcomes were significantly superior in OBCS. CONCLUSIONS Overall, Level 2 perforator flap based reconstruction had superior aesthetic outcomes. O-BCS is safe and more aesthetically acceptable with no difference in oncological outcome and operative time. More consideration should be given to aesthetic parameters such as scar visibility, nipple position, breast volume and shape when considering the best surgical option for the patients.
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Affiliation(s)
- Kanchana Wijesinghe
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenapura, Nugegoda, Sri Lanka.
| | | | - Yohan Chamara
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenapura, Nugegoda, Sri Lanka
| | - Sumali De Silva
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Umesh Jayarajah
- University Surgical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - Ajith De Silva
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Villavisanis DF, Blum JD, Cho DY, Carlson AR, Heuer GG, Swanson JW, Bartlett SP, Taylor JA. Long-term aesthetic and photogrammetric outcomes in non-syndromic unicoronal synostosis: comparison of fronto-orbital distraction osteogenesis and fronto-orbital advancement and remodeling. Childs Nerv Syst 2023; 39:1283-1296. [PMID: 36738322 DOI: 10.1007/s00381-023-05857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fronto-orbital advancement and remodeling (FOAR) is among the most common surgical approaches for unicoronal craniosynostosis (UCS), although some data demonstrate failure to achieve long-term aesthetic normalcy, leading some to seek alternative treatment paradigms such as fronto-orbital distraction osteogenesis (FODO). This study compares long-term aesthetic outcomes of patients with UCS treated with FOAR and FODO. METHODS Twenty patients (four males) with non-syndromic UCS presenting to our institution and undergoing distraction were compared to a matched cohort of 20 patients (six males) undergoing FOAR. Clinical photographs and ImageJ were used to quantify periorbital anatomy including palpebral fissures, pupil-to-brow distance (PTB), and margin-reflex distance (MRD1) in pixels. Whitaker classification was blindly assigned by craniofacial surgeons. RESULTS Photogrammetric analysis and Mann-Whitney U tests demonstrated significantly improved postoperative symmetry in distraction patients for palpebral width (p = 0.020), MRD1 (p = 0.045), and canthal tilt (p = 0.010). Average Whitaker classification scores between FOAR (1.94) and distraction (1.79) cohorts were similar (p = 0.374). CONCLUSIONS UCS patients demonstrated significant postoperative improvements in periorbital symmetry, with distraction patients demonstrating superior results in palpebral width and canthal tilt. FOAR and FODO patients achieved similar Whitaker classification scores. These cohorts will be followed until craniofacial maturity prior to making any definitive conclusions.
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Affiliation(s)
- Dillan F Villavisanis
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica D Blum
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Y Cho
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anna R Carlson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory G Heuer
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Nair S, Aishwarya JG, Jain A, Pavithra V, Mohan S. Mini-Incision Parotidectomy-Our Technique. Indian J Otolaryngol Head Neck Surg 2022; 74:6174-6179. [PMID: 36742673 PMCID: PMC9895246 DOI: 10.1007/s12070-021-02882-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/18/2021] [Indexed: 02/07/2023] Open
Abstract
Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to improve the aesthetic outcome and at the same time for complete disease clearance with reduced complications. In this study, we evaluated the feasibility of our mini-incision parotidectomy technique along with the surgical and quality of life (QOL) outcomes. This prospective case series was conducted at Apollo Hospitals, Bangalore over a period of 2 years (June 2018-August 2020) and includes 20 patients. The surgical outcomes were assessed in terms of feasibility of mini-incision technique with respect to levels of parotid involved and functional outcomes in terms of presence or absence of complications like facial palsy (temporary or permanent), seroma and Frey's syndrome. Patient related quality of life (QOL) outcomes were assessed in terms of post-operative pain score, patient comfort score and cosmetic score by using numerical rating scale-11 (NRS-11). The mini-incision parotidectomy technique is feasible for lesions in all the parotid levels and conversion or lengthening of incision was not needed in any of the cases. 2(10%) patients had temporary facial palsy (House-Brackman grade III) which was recovered within 3 weeks after surgery. One patient (5%) with adenoid cystic carcinoma had permanent facial palsy. Out of 20 patients 2(10%) had seroma and 1(5%) patient presented with Frey's syndrome. Mean post-operative pain score at 0, 6 and 24 h were 4.8, 3.4 and 1.8 out of 10 respectively. Mean comfort score was 9 out of 10 and mean cosmetic score was 9.5 out of 10. Mini-incision parotidectomy technique can render improved functional as well as aesthetic outcomes after parotidectomy without compromising the surgical clearance of the disease process.
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Affiliation(s)
- Satish Nair
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - J. G. Aishwarya
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - Aditya Jain
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - V. Pavithra
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - Sneha Mohan
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
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Regan A, Kent S, Morrison R. Facial feminisation surgery in NHS Scotland. Br J Oral Maxillofac Surg 2021:S0266-4356(21)00134-0. [PMID: 34272108 DOI: 10.1016/j.bjoms.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/01/2021] [Indexed: 11/20/2022]
Abstract
Facial feminisation surgery (FFS) is integral to the management of transgender adult females. Literature detailing the conduct and outcomes of FFS is lacking. The aim of this project was to review surgical practices in NHS Scotland. We identified Gender Identity Clinics throughout Scotland. These clinics were then contacted to discuss which services were available regarding FFS and to whom they refer patients. Retrospective review of electronic case notes between June 2014 and June 2019 was carried out and data was recorded on patient demographics, procedures employed, surgical complications, and postoperative outcome. FFS was carried out in two centres. Sixty patients received FFS during the study period, in 160 separate surgical procedures. Patients were all transitioning from natal biological male to female gender, with an average age of 36 years. The most common procedure was rhinoplasty (n = 36). Surgical complications occurred in eight procedures, and negative outcomes were recorded in 12/88 operating sessions. Increasing demand for surgery was noted throughout the study period. These results suggest that a wide variety of procedures are used, and that FFS is well accepted with relatively few surgical complications and negative outcomes. In depth understanding of patient's perceptions and views of their experiences, alongside objective measures, are essential to determine the impacts of FFS.
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10
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Seyidova N, Anderson K, Abood A. Comparison of patients satisfaction with aesthetic outcomes following lower extremity reconstruction: Muscle vs. fasciocutaneous free flaps. J Plast Reconstr Aesthet Surg 2020; 74:65-70. [PMID: 33039309 DOI: 10.1016/j.bjps.2020.08.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/10/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The microsurgical reconstruction of complex lower limb defects has become a routine procedure with high success rates. The emphasis has changed from ensuring flap 'success' to providing a reconstruction, which is also aesthetically pleasing. The aim of this study was to compare patients' satisfaction with aesthetic outcomes, following muscle or fasciocutaneous free flap reconstruction to the lower limb. METHODS Data were collected retrospectively between July, 2013 and May, 2018 at a single institution. The inclusion criteria were adult patients who had successful free tissue transfers to the lower limb following any aetiology. A Likert Scale questionnaire was sent to all patients who met these criteria. The questionnaire included questions related to the reconstruction and donor site. RESULTS Questionnaires were sent to 83 patients who met the inclusion criteria. Forty-seven (57%) patients responded, of which 22 (47%) underwent reconstruction with muscular flap and 25 (53%) with fasciocutaneous flap. A statistically significant difference between the two groups was found in relation to flap texture (p = 0.003). Patients with fasciocutaneous flap reconstruction being more satisfied. No significant difference was observed for contour, similarity to the contralateral side, bulkiness of flap, colour match, scar, or overall appearance. The comparison of donor site results revealed no significant difference between the two groups CONCLUSIONS: Despite increase in success in lower extremity reconstruction, many patients still find aesthetic results suboptimal and this affects an individual's global sense of well-being. Aesthetic restoration should be viewed as an integral part of lower limb reconstruction. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02215, USA.
| | - Keith Anderson
- Plastic Surgery Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, 303 Hills Rd, Cambridge, CB2 0XY, United Kingdom
| | - Ahid Abood
- Plastic Surgery Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, 303 Hills Rd, Cambridge, CB2 0XY, United Kingdom
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11
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Papanikolaou IG, Dimitrakakis C, Zagouri F, Marinopoulos S, Giannos A, Zografos E, Zografos CG, Kritikou D, Rodolakis A, Zografos GC, Loutradis D. Paving the way for changing perceptions in breast surgery: a systematic literature review focused on oncological and aesthetic outcomes of oncoplastic surgery for breast cancer. Breast Cancer 2019; 26:416-427. [PMID: 30955172 DOI: 10.1007/s12282-019-00968-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emphasis on aesthetic outcomes and quality of life after breast cancer surgery has motivated breast surgeons to develop oncoplastic breast conserving surgery (OPS). Training programs are still rare in most countries, and there is little standardization, which challenges the scientific evaluation of these techniques. This systematic review aims to assess oncological and cosmetic outcomes of OPS. METHODS After a strict selection process with precise inclusion and exclusion criteria, oncologic and aesthetic outcomes of oncoplastic surgery were searched, using the MEDLINE database up to September 30th, 2017. Available published literature was classified in levels of evidence. After a thorough screening process, only studies with the best level of evidence were included on selection. Systematic reviews and meta-analyses were not included for methodological reasons. RESULTS Titles and abstracts of 2.854 citations were identified and after screening 15 prospective studies including 1.391 patients were reviewed and scored in detail. Local relapse was found in 2.8% of cases with a wide range of follow-up (from 6 to 74 months). Close margins were retrieved in 11% of cases and positive margins in 9.4% of cases. Mastectomy was implemented in 6.9% of breast cancer patients to whom OPS was performed. Good cosmetic outcomes were detected in 90.2% of patients undergoing OPS, leaving open issues for who should perform cosmetic evaluation and which method should be used. CONCLUSION Tumor margins, mastectomy rates, and cosmetic outcomes of OPS have to be further improved by standardizing various aspects of OPS. Research efforts should focus on level I evidence assessing both oncological and aesthetic outcomes of OPS and survival rates.
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Affiliation(s)
- I G Papanikolaou
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece.
| | - C Dimitrakakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Marinopoulos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - A Giannos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - E Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Kritikou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Rodolakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - G C Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Loutradis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
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12
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Logan Ellis H, Asaolu O, Nebo V, Kasem A. Biological and synthetic mesh use in breast reconstructive surgery: a literature review. World J Surg Oncol 2016; 14:121. [PMID: 27102580 PMCID: PMC4839154 DOI: 10.1186/s12957-016-0874-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/13/2016] [Indexed: 02/05/2023] Open
Abstract
Mesh use in surgical breast reconstruction is becoming increasingly common; however, there is still no consensus on whether synthetic matrices or biological matrices produce the best outcomes. This review analyses these outcomes, namely the differences in aesthetic outcomes, cost, and the rates of the most commonly reported complications. The results indicate that breast reconstruction with a synthetic matrix produces comparable aesthetic outcomes to a biological matrix, with lower costs and complication rates. The individual results for complication rates show that biological matrixes are associated with lower infection rates and slightly lower capsular contracture, but higher haematoma rates, and slightly higher rates of skin necrosis and explantation—although many had post-op radiotherapy. The majority of the studies evaluated used biological matrices, and there are no randomised controlled trials directly comparing the two types of meshes; definite conclusions cannot be drawn from the available evidence. The authors suggest that a randomised controlled trial comparing these outcomes in synthetic and biological matrix use is needed.
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Affiliation(s)
| | | | - Vivien Nebo
- King's College London University, London, UK
| | - Abdul Kasem
- Medway Maritime Hospital , Gillingham, Kent, UK
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13
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ALICANDRI-CIUFELLI M, PICCININI A, GRAMMATICA A, MOLTENI G, SPAGGIARI A, DI MATTEO S, TASSI S, GHIDINI A, IZZO L, GIOACCHINI F, MARCHIONI D, DI SAVERIO S, PRESUTTI L. Aesthetic comparison between synthetic glue and subcuticular sutures in thyroid and parathyroid surgery: a single-blinded randomised clinical trial. Acta Otorhinolaryngol Ital 2014; 34:406-11. [PMID: 25762833 PMCID: PMC4347000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 12/09/2013] [Indexed: 10/26/2022]
Abstract
The aim of our study was to compare, in terms of aesthetic results, the use of synthetic glue to intradermal absorbable sutures in postthyroidectomy and parathyroidectomy wound closure in a single blinded, randomised, per protocol equivalence study. From September 2008 to May 2010, patients undergoing thyroid or parathyroid surgery (with an external approach) at the Otolaryngology Department of the University Hospital of Modena were assessed for eligibility. In total, 42 patients who had had synthetic glue application on surgical incisions (A) and 47 patients who had subcuticular sutures on their surgical incisions (B) were enrolled. The mean of the endpoint (based on the Wound Registry Scale) of group A at 10 days was 1.4, while that in group B (based on the Stony Brook Scar Evaluation Scale) was 2.9. Statistically significant (p = 0.002) and clinically significant (difference of the means = 1.5) differences in the aesthetic results were found between groups A and B at 10 days, with better results in group B. On the other hand, at 3 months, the mean of the endpoint in group A was 3.1 while that in group B was 2.8; no statistically significant (p = 0.62) or clinically significant (difference in means = 0.3) differences were found between groups A and B. In conclusion, synthetic glue differs from subcuticular suture in post-thyroidectomy or post-parathyroidectomy incision for early aesthetic results, with better outcomes for subcuticular sutures. At 3 months, there were no differences in aesthetic outcomes between groups. Moreover, sex, incision length, age, cold/hot blade and correspondence of the incision with a wrinkle in the skin did not seem to influence aesthetic outcomes with this type of incision.
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Affiliation(s)
| | - A. PICCININI
- Otolaryngology Department, University Hospital of Modena, Italy
| | - A. GRAMMATICA
- Otolaryngology Department, University Hospital of Modena, Italy
| | - G. MOLTENI
- Otolaryngology Department, University Hospital of Modena, Italy
| | - A. SPAGGIARI
- Plastic Surgery Department, University Hospital of Modena, Italy
| | | | - S. TASSI
- Otolaryngology Department, University Hospital of Modena, Italy
| | - A. GHIDINI
- Otolaryngology Department, University Hospital of Modena, Italy
| | - L. IZZO
- Department of General Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - F.M. GIOACCHINI
- Otolaryngology Department, University Hospital of Modena, Italy;,Address for correspondence: Federico Maria Gioacchini, Otolaryngology- Head and Neck Surgery Department, University Hospital of Modena, via del Pozzo 71, 41100 Modena, Italy. E-mail:
| | - D. MARCHIONI
- Otolaryngology Department, University Hospital of Modena, Italy
| | - S. DI SAVERIO
- Department of Emergency, Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| | - L. PRESUTTI
- Otolaryngology Department, University Hospital of Modena, Italy
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14
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Abstract
This article highlights reconstructive principles in flap selection, use, and insetting to optimize functional and aesthetic outcomes after upper extremity reconstruction. The concept of respecting the aesthetic units of the hand during reconstruction is discussed. A current literature review of the aesthetic outcomes using various flaps, such as fasciocutaneous, fascia only, and muscle flaps, is provided. An approach based on aesthetic unit principles to upper extremity reconstruction is also highlighted to help optimize outcomes.
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Mioton LM, Gaido J, Small W, Fine NA, Kim JY. Differences in breast aesthetic outcomes due to radiation: A validated, quantitative analysis of expander-implant reconstruction. Can J Plast Surg 2014; 21:73-7. [PMID: 24431945 DOI: 10.1177/229255031302100206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The potential ramifications of radiation use can be of particular concern in the breast reconstruction population, in which both surgical and aesthetic outcomes are important. Presently, there remains a paucity of data detailing the influence of radiation on specific reconstruction aesthetic outcomes. OBJECTIVE To conduct a quantitative evaluation of aesthetic outcomes for expander-implant breast reconstruction in radiated and nonradiated patients using a validated scoring scale. METHODS A series of consecutive expander-implant breast reconstruction operations performed by the senior author between 2004 and 2012 were reviewed. Four blinded members of the Division of Plastic and Reconstructive Surgery at Northwestern University (Illinois, USA) independently rated postoperative photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains. RESULTS Of the 206 patients meeting the inclusion criteria, 69 received radiotherapy and 137 did not. The radiated cohort had lower scores in each aesthetic domain, with significant differences in contour (1.33 versus 1.51; P=0.041) and placement (1.45 versus 1.73; P<0.001). Linear regression analysis revealed a significant association between placement scores and radiation, and radiated patients had a significantly higher overall rate of complications. DISCUSSION Variances in scores may represent the relative difficulty of expansions and proper implant placement in irradiated tissue, with possible skin fibrosis and decreased flexibility hindering prosthesis manipulation. CONCLUSION Radiation adversely impacts breast contour and placement, with possible negative contributions to volume, scarring and inframammary fold definition, and results in higher rates of complications. Such detailed evaluation of the impact of radiation on aesthetics will enhance the management of patient expectations.
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Affiliation(s)
| | - Jessica Gaido
- Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine
| | - William Small
- Department of Radiation Oncology, The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Neil A Fine
- Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine
| | - John Y Kim
- Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine
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