bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Life 9-13 years after Autologous or Alloplastic Breast Reconstruction: ‘Which Breast Remains Best?’
Authors: Sadok N. , Refaee M. , Eltahir Y. , de Bock G.H. , van Veen M.M. , Werker P.M.N.
Published: February 2023

Background:

The aim of this study was to evaluate the long-term patient satisfaction and quality of life 9-13 years after autologous versus alloplastic breast reconstruction (BR) and compare the data to those of an earlier study.

Methods:

This is a nine-year follow-up study of 92 women who underwent BR (47 autologous, 45 alloplastic) between 2006 and 2010 and filled out the Breast-Q questionnaire in 2010. Changes in Breast-Q scores were analyzed by using a change score from baseline (2010) to follow-up (2019), which was presented by a mean change score with 95% confidence intervals. Linear regression analyses were performed to test which patient characteristics were related to the Breast-Q change scores.

Results:

The response rate at follow-up was 60% (25 autologous, 30 alloplastic). Responders at follow-up had a lower Body Mass Index and had less frequently undergone unilateral BR compared to the non-responders. Both women undergoing autologous and alloplastic BR significantly decreased in satisfaction with breasts (-4 points), satisfaction with outcome (-8 points) and satisfaction with nipples (-20 points) over time. None of the patient characteristics, including reconstruction technique, were related to the Breast-Q change scores.

Conclusion:

Satisfaction with breasts, outcome and nipples slightly decreases over time for women undergoing alloplastic and autologous BR. Women undergoing autologous BR seem to remain more satisfied with their breasts 9-13 years after BR compared to women undergoing alloplastic BR. Due to the small sample size, conclusions should be carefully drawn. However, the results were in line with the expectations based on previous literature.
Breast Hypertrophy – A Real Pain in The Back
Authors: Lessard Lucie , Papanastasiou Constantine , Fortin Maryse , Ouellet Jean A.
Published: February 2023

Background:

Bilateral breast hypertrophy (BBH) comes with signs and symptoms ranging from mild to debilitating. Bilateral breast reduction (BBR) is one of the most frequently performed plastic surgery procedures and its effects on parameters such as spinal balance, paraspinal muscle function, and physical performance have not been thoroughly evaluated. The objective of this study is to evaluate the effects of BBR using advanced spine imaging modalities, and pain resolution.

Methodology:

A prospective, observational cohort study was carried out at the McGill University Health Centre. The following measures were recorded preoperatively and postoperatively for each patient: patient questionnaires (Breast-Q and Pain), MRI, and EOS low-radiation spinal scan.

Results:

Significant postoperative pain reduction was recorded and up to 148% improvement in physical tests. Improvement in all questionnaire and Breast-Q categories was documented. Preoperative and postoperative MRI did demonstrate a statistically significant absence of permanent anatomic skeletal sequelae. Postoperative improvement in thoracic kyphosis was documented.

Conclusion:

Quality of life scores are uniformly improved following BBR. Key findings following BBR include significant pain reduction and no evidence of spinal skeletal change.

This is a finding of major importance in view of the practice of many insurance companies/third-party payer and health care systems which utilize the Schnur scale. The Schnur scale associates a weight for resection with body size which is not directly predictive of pain relief.

This may beckon the need for more precise or different guidelines based on these quantitative findings.
“Systematic Analysis of time- and dose-dependent Effects of Hyaluronidase on the Degradation of different Hyaluronan-based Fillers in vitro.”
Authors: Gerber Peter Arne , Buhren Bettina A. , Bölke Edwin , Philipp-Dormston Wolfgang G. , Homey Bernhard , Schrumpf Holger
Published: February 2023

Background:

Hyaluronidase (HYAL) is regarded the gold standard for the management of complications associated with Hyaluronan (HA)-based fillers (HA-fillers). Therefore, the understanding of interactions of HA-fillers and HYAL is essential.

Methods:

Nine different commercially available HA-fillers (Belotero range, Juvederm range, Restylane range) with varying degrees of crosslinking were used for the analysis. Fluorescently dyed HA-fillers were individually incubated with varying doses of HYAL (bovine HYAL “Hylase Dessau”, Riemser Pharma, Germany; 5, 10, and 20 U/ml) or NaCl and monitored by time-lapse microscopy. HA-filler degradation was assessed as a decrease in fluorescence intensity of HA-filler plus HYAL compared to HA-filler plus control, quantified by computerized image analysis.

Results:

HA-fillers show significant differences in their reaction to HYAL. Levels of degradation of HA-fillers are positively correlated with increasing concentrations of HYAL. At the highest concentration of HYAL (20 U/ml) all fillers except one (Belotero Volume; BELVOL) reached a significant level of degradation at 5 to 9 hours.

Conclusions:

Here we show that most HA-fillers can be dissolved by HYAL in a dose- and time-dependent manner. Of note, the fillers´ technology and degree of crosslinking seem to exert stronger effects on the degradability by HYAL as compared to the concentration of HA.
“Indocyanine Green Angiography Overpredicts Postoperative Necrosis Compared to Multispectral Reflectance Imaging in a Prospective Cohort of Patients Undergoing Breast Reconstruction”
Authors: George Robert E. , Elwood Eric T. , Jones Glyn E.
Published: February 2023

Background:

Sufficient perfusion is foundational to successful reconstructive surgery. Various technologies have been developed to help determine if tissue is adequately perfused, or if it will be prone to necrosis postoperatively. Indocyanine green (ICG) angiography is one such method which utilizes fluorescence and analyzes tissue perfusion. Multispectral reflectance imaging (MSRI) is an alternative technology which analyzes optical properties of oxygenated and deoxygenated hemoglobin to determine tissue viability. Because tissue in low perfusion states may still survive due to sufficient oxygenation, the authors hypothesized that compared to MSRI, ICG angiography overpredicts necrosis, potentially resulting in unnecessary resection of viable tissue. This study expands upon preliminary work to investigate this hypothesis.

Methods:

This was a prospective cohort of patients undergoing prepectoral direct implant reconstruction at a single institution. Each patient was examined intraoperatively with both ICG angiography and MSRI. Decisions to resect tissue were made in conjunction with MSRI and ICG images were collected purely for data analysis. Patients were followed postoperatively for at least two months for signs of postoperative necrosis.

Results:

53 cases were included. ICG angiography accurately predicted viability in 40/40 (100%) patients and incorrectly predicted necrosis in 11/13 (84.6%). Simultaneously, MSRI predicted necrosis in 0 patients and accurately predicted viability in 96.2% (51/53) of patients. There was no statistically significant difference in demographic data among patients predicted to experience necrosis via ICG angiography vs those predicted to have entirely viable tissue.

Conclusions:

This study suggests that ICG angiography is prone to overpredicting postoperative necrosis in comparison to MSRI.
“Fat Graft Retention: Adipose Tissue, Adipose-derived Stem Cells and Aging”
Authors: Trotzier Chloe , Sequeira Ines , Auxenfans Celine , Mojallal Ali A.
Published: February 2023

Over the past 30 years, there has been a dramatic increase in the use of autologous fat grafting for soft-tissue augmentation and to improve facial skin quality. Several studies have highlighted the impact of aging on adipose tissue, leading to a decrease of adipose tissue volume and preadipocytes proliferation and increase of fibrosis. Recently, there has been a rising interest in adipose tissue components, including Adipose-derived Stem/Stromal Cells (ASCs) due to their regenerative potential, including inflammation, fibrosis and vascularization modulation. Due to their differentiation potential and paracrine function, ASC has been largely used for fat grafting procedures as they are described to be a key component in fat graft survival. However, many parameters as surgical procedures of adipose tissue biology could change clinical outcomes. Variation on fat grafting methods lead to numerous inconsistent clinical outcomes. Donor-to-donor variation could also be imputed to ASCs, tissue inflammatory state or tissue origin. In this review, we aim to analyze (1) the parameters involved on the graft survival, and (2) the effect of aging on adipose tissue components, especially ASCs, that could lead to a decrease of skin regeneration and fat graft retention.
Arthroscopic versus open distal hemi-trapeziectomy without interposition in CMC thumb joint osteoarthritis 2-year results of a randomized controlled trial
Authors: van Laarhoven Cecile M.C.A. , Baas Martijn , Qi Hongchao , Coert J.Henk , Zuidam J. Michiel , Koch A. Richard
Published: February 2023

Background:

Distal hemi-trapeziectomy is suggested as alternative for total trapeziectomy for carpometacarpal (CMC) thumb joint osteoarthritis, when the scaphotrapeziotrapezoidal (STT) joint is unaffected. This can be performed as arthroscopic or open procedure, with suggested advantages for the less invasive arthroscopic technique. To determine which technique has better outcome on subjective and objective measures, we performed a prospective randomized controlled trial.

Methods:

We randomized 90 thumbs in the open (45) and arthroscopic (45) group and evaluated results at pre-operative, 3, 12 and 24 months follow up. The primary outcome was the Patient Rated Wrist and Hand Evaluation (PRWHE) to assess pain and function. Also, we evaluated pinch, grip and range of motion, together with return to work, satisfaction and complications.

Results:

Full follow up was obtained in 62 thumbs (32 open group, 30 arthroscopic group). For both groups, the PRWHE improved from pre-operative to 12 and 24 months follow up. Also, grip power, key- and tip-pinch improved at final follow up for both groups. Between groups, there were no clinical important differences between PRWHE, power of grip or pinch and range of motion. Operation time was shorter for the open group, also return to work was slightly shorter after open surgery. Satisfaction was comparable between groups.

Conclusions:

This study shows good functional improvement and pain reduction obtained with a hemi-trapeziectomy. No arthroscopic benefits could be substantiated in the results. Because of shorter operation time for the open procedure, with further equal outcomes compared to the arthroscopic technique, we prefer open hemi-trapeziectomy.
Measuring success in headache surgery: A comparison of different outcomes measures.
Authors: Albano Nicholas J. , Israel Jacqueline S. , Carbullido Mary K. , Stilp Emmaline K. , Leverson Glen , Voils Corrine I. , Afifi Ahmed M.
Published: February 2023

BACKGROUND:

Studies of migraine surgery have relied on quantitative, patient-reported measures like the Migraine Headache Index (MHI) and validated surveys to study the outcomes and impact of headache surgery. It is unclear whether a single metric or a combination of outcomes assessments is best suited to do so.

METHODS:

All patients who underwent headache surgery had an MHI calculated and completed the Headache Impact Test (HIT-6TM), Migraine Disability Assessment Test (MIDAS), Migraine Specific Quality of Life Questionnaire (MSQ) and an institutional ad hoc survey pre- and postoperatively.

RESULTS:

Seventy-nine percent of patients (n=27) experienced greater than or equal to 50% MHI reduction. MHI decreased significantly from a median of 210 preoperatively to 12.5 postoperatively (85%, p <0.0001). HIT-6TM scores improved from 67 to 61 (14%, p < 0.0001). MIDAS scores improved from 57 to 20 (67%, p = 0.0022). The MSQ demonstrated improvement in quality of life scores within all three of its domains (p <0.0001). Our ad hoc survey demonstrated that participants “strongly agreed” that, (1) surgery helped their symptoms, (2) they would choose surgery again, and (3) they would recommend headache surgery to others.

CONCLUSION:

Regardless of how one measures it, headache surgery is effective. We demonstrate that surgery significantly improves patients’ quality of life and decreases the effect of headaches on patients’ functioning, but headaches can still be present to a substantial degree. The extent of improvement in migraine burden and quality of life in these patients may exceed the amount of improvement demonstrated by current measures.
Umbilical Complications Following DIEP Flap Breast Reconstruction: Demonstrating the Added Benefit of Preoperative Imaging
Authors: Huang Hao , Jung Wooram F. , Otterburn David M.
Published: February 2023

Background:

Despite the umbilicus being an essential aesthetic unit, current literature in umbilical outcomes following abdominally based breast reconstruction is limited. In this study, we aim to elucidate the incidence and predictors of umbilical complications following DIEP flaps, with a particular emphasis on past abdominal surgery by type and measures that can be easily obtained from preoperative imaging.

Methods:

An IRB-approved retrospective review of 258 patients who underwent DIEP flap reconstruction from 2011 to 2020 was performed. Patient demographics, preoperative labs, and intraoperative factors were appraised. Preoperative CTA or MRA was used to measure umbilical stalk height, abdominal wall thickness, and total fascial diastasis. Patients with and without perfusion-related umbilical complications were compared.

Results:

Forty patients (15.5%) developed umbilical complications, including 20 patients with epidermolysis/scab, 12 with dehiscence, and 14 with partial necrosis. Patients with complications had a significantly higher rate of hypertension, prior abdominal midline incision, more lateral perforators per flap, longer umbilical stalk, and larger stalk height to abdominal wall thickness ratio (p<0.05). Logistic regressions revealed that stalk height (p=0.006) and stalk height to abdominal wall thickness ratio (p<0.001) were the only significant predictors, with the latter having a greater area under the receiver operating characteristic curve (AUC=0.79, p<0.001).

Conclusions:

Radiographic measurements of umbilical stalk height and stalk height to abdominal wall thickness ratio reliably predict the occurrence of umbilical complications, with the ratio having a more robust predictive ability. We propose the use of routine preoperative imaging to identify high-risk patients who may benefit from prophylactic measures.
The effect of Free Versus Local Flaps on Time to Union in Open Tibia Fractures
Authors: Zelenski Nicole A. , Archual Anthony , Tangtiphaiboontana Jennifer , Kuruoglu Doga , Yan Maria , Bustos-Hemer Samyd , Moran Steven L.
Published: February 2023

Background:

Early soft tissue reconstruction of open fractures has been shown to decrease infection rates and improve rates of bony union. The purpose of this study was to compare the rates and time to union of open tibia fractures that underwent soft tissue coverage.

METHODS:

A retrospective chart review of 118 patients with open tibia fractures requiring soft tissue reconstruction treated at a single level 1 trauma center was performed. Demographic data as well as flap type were collected. Union status was determined using radiographic union scale in tibia fractures (modified RUST) score >11.

RESULTS:

Limb salvage was achieved in 90% of patients. The overall rate of nonunion was 33%. Flap type significantly affected time to union with local fasciocutaneous and keystone flaps having significantly longer time to union (202 SD 120.3 days) than all other flap groups (p=0.01). Free flaps had significantly shorter time to union than local flaps (115 SD 49.6 vs. 149 SD 75.4 days p=0.02). Muscle flaps had significantly shorter time to union than fasciocutaneous flaps (123 days SD 52.4 vs. 165 SD 104.1 days, p=0.04). This remained true after controlling for fracture location, age of patient, need for second flap and fixation method (p=0.037). Patients who underwent an initial soft tissue reconstruction with a local muscle flap were more likely to require a second flap to achieve wound closure (OR=3.7, p=0.008) and needing a second flap significantly increased time to union (162 SD95.9 vs. 122 SD 51.9 days p=0.03).

CONCLUSIONS:

Flap type affects time to union but not nonunion rate in open tibia fractures.
The use of recanalized vessels for diabetic foot reconstruction: Pushing the boundaries of reconstruction in vasculopathic lower extremity:
Authors: Suh Hyunsuk P , Kedar Daniel J , Lee Yeon Hoon , Lee Pil Hyung , Lee Seung-Whan , Hong Joon Pio
Published: February 2023

Background:

Free flap after lower extremity revascularization may enable limb salvage in defects following critical limb ischemia. This study examined the outcomes of reconstruction of ischemic diabetic foot according to the severity of the vessel occlusion and assessed whether recanalized vessels may serve as a reliable recipient vessel.

Methods:

Total of 62 patients who underwent diabetic foot reconstruction with free flaps after successful percutaneous transluminal angioplasty (PTA) from February 2010 to February 2016 were identified and divided into three groups; Group 1: used non-occluded vessels as recipient (n=11), Group 2: used recanalized artery after PTA for partially occluded artery (n=30), Group 3: used recanalized artery after PTA for completely occluded artery (n=21).

Results:

Flap survival was statistically higher for Group 2 (90%) compared to Group 3 (67%) (P<0.05). Subsequent major amputation was significantly lower in Groups 1 and 2 (0/7, 0% and 1/30, 3.3%) compared to Group 3 (5/21, 23.8%) (P<0.05). The patient survival and limb salvage rate was 90.9% at one and three years in Group 1, 89.8% at one year and 86.3% at three and five years in Group 2, and 76.2% at one, three, and five years in Group 3. This difference was not statistically significant (p = 0.485)

Conclusions:

The use of recanalized vessels after PTA can be safe for partially occluded arteries but require caution for complete occluded arteries. Nevertheless, one can push the limit of using completely occluded vessels after PTA when other options are not available and achieve a 76% chance of limb salvage.
“Disparities in Telemedicine Literacy and Access in the United States”
Authors: Harris Andrew , Jain Amit , Dhanjani Suraj A. , Wu Catherine A. , Helliwell Lydia , Mesfin Addisu , Menga Emmanuel , Aggarwal Shruti , Pusic Andrea , Ranganathan Kavitha
Published: February 2023

Background:

Due to the expansion of telehealth services through the 2020 CARES Act, telemedicine’s potential in plastic surgery has gained visibility. This study aims to identify populations who may suffer from limited access to telemedicine.

Methods:

We created a telemedicine literacy index (TLI), using a multivariate regression model and data from United States Census and Pew Research Institute survey. A multivariate regression model was created using backwards elimination, with TLI as the dependent variable and demographics as independent variables. The resulting regression coefficients were applied to data from the 2018 United States Census at the county level to create a county-specific Technological Literacy Index (cTLI). Significance was set at p<0.05.

Results:

On multivariable analysis, the following factors were found to be significantly associated with telemedicine literacy: age, gender, race, employment status, income level, marital status, educational attainment, and urban/rural classification. Counties in the lowest tertile had significantly lower median annual income levels ($43,613 vs. $60,418, p<0.001) and lower proportion of the population with at least a bachelor’s degree (16.7% vs. 26%, p<0.001). Rural areas were approximately 3 times more likely to be in the lowest cTLI compared to urban areas (p<0.001). Additional associations with low cTLI were black or African-American race (p=0.045), widowed marital status (p<0.001), less than high school education (p=0.005), and presence of a disability (p=0.01).

Conclusions:

These results highlight disadvantaged groups at-risk of being underserved with telehealth. Using these findings, key stakeholders may be able to target these communities for interventions to increase telemedicine literacy and access.
Revision Incidence after Immediate Direct-To-Implant Versus Two-Stage Implant-Based Breast Reconstruction: Results from a Nationwide Breast Implant Registry.
Authors: Becherer Babette E. , Heeg Erik , Young-Afat Danny A. , Vrancken Peeters Marie-Jeanne T.F.D. , Rakhorst Hinne A. , Mureau Marc A.M. ,   Dutch Breast Implant Registry (DBIR) group
Published: February 2023

Background.

In immediate implant-based breast reconstruction (IBBR), large variation is observed in current practices between a direct-to-implant and a two-stage approach (insertion of a breast implant after a tissue expander). This population-based study aimed to compare unplanned short- and long-term revision incidence between direct-to-implant and two-stage IBBR in the Netherlands.

Methods.

All patients with immediate IBBR following a mastectomy between 2015 and 2019 were selected from the nationwide Dutch Breast Implant Registry (DBIR). Short- and long-term unplanned revision incidences were studied per immediate IBBR, including revision indications and the total number of additional operations. Confounding by indication was limited using propensity score matching.

Results.

A total of 4512 breast implants (3948 women) were included, of which 2100 (47 percent) for direct-to-implant IBBR and 2412 (53 percent) for two-stage IBBR. Median (IQR) follow-up was 29 (16-45) months and 33 (21-47) months, respectively. Short-term revision incidence was 4.0 percent and 11.7 percent, respectively (conditional OR 0.31, 95 percent CI 0.23-0.42). Long-term revision incidence was 10.6 percent (95 percent CI 9.2-12.1) and 16.4 percent (95 percent CI 14.8-17.9), respectively. In the propensity score matched cohort, similar results were found. In the direct-to-implant group, more breasts were reconstructed within the planned number of operations than in the two-stage group.

Conclusion.

Unplanned revision surgery occurred less often after direct-to-implant IBBR, and more breasts were reconstructed within the planned number of operations compared to two-stage IBBR. These results, based on real-world data, are important for improving patient counseling and shared decision-making.
Paravertebral Blocks in Tissue Expander Breast Reconstruction: A Propensity-Matched Analysis of Perioperative Opioid Consumption and Patient-Reported Outcomes
Authors: Shamsunder Meghana G. , Chu Jacqueline J. , Taylor Erin , Polanco Thais O. , Allen Robert J. , Moo Tracy-Ann , Disa Joseph J. , Mehrara Babak J. , Tokita Hanae K. , Nelson Jonas A.
Published: February 2023

Background:

The paravertebral block (PVB) is an adjunctive perioperative pain control method for breast reconstruction patients that may improve perioperative pain control and reduce narcotic use. This study determined the efficacy of preoperative PVBs for perioperative pain management in tissue expander breast reconstruction patients.

Methods:

A retrospective review was performed of patients who underwent tissue expander breast reconstruction from December 2017 to September 2019. Two PVB patients were matched using propensity scoring to one no-block patient. Perioperative analgesic use, pain severity scores on days 2-10 after discharge, and BREAST-Q Physical Wellbeing scores before surgery and at 2 weeks, 6 weeks, and 3 months after surgery were compared between the two groups.

Results:

The propensity-matched cohort consisted of 471 patients (314 PVB and 157 no-block). The PVB group used significantly fewer morphine milligram equivalents than the no-block group (53.7 vs. 69.8; p < 0.001). Average daily postoperative pain severity scores were comparable, with a maximum difference of 0.3 points on a 0-4 scale. BREAST-Q Physical Wellbeing scores were significantly higher for the PVB group than the no-block group at 6 weeks after surgery (60.6 vs. 51.0, p = 0.015), but did not differ significantly at 2 weeks or 3 months after surgery.

Conclusions:

PVBs may help reducing peri-operative opioid requirements but did not reduce pain scores after discharge when used as part of an expander-based reconstruction perioperative pain management protocol. Continued research should examine additional or alternative regional block procedures, as well as financial cost and potential long-term impact of PVBs.
“Alpha Defensin-1 Biomarker Outperforms Culture in Diagnosing Breast Implant-Related Infection: Results from a Multicenter Prospective Study.”
Authors: Basta Marten N. , White-Dzuro Colin G. , Rao Vinay , Liu Paul Y. , Kwan Daniel , Breuing Karl H. , Sullivan Rachel , Mermel Leonard A. , Drolet Brian C. , Schmidt Scott
Published: February 2023

BACKGROUND:

Prompt diagnosis of breast implant infection is critical to reducing morbidity. High incidence of false-negative microbial culture mandate superior testing modalities. Alpha defensin-1 (AD-1), an infection biomarker, has outperformed culture in diagnosing periprosthetic joint infection with sensitivity/specificity of 97%. After previously demonstrating its feasibility in breast implant-related infection (BIRI), this case-control study compares AD-1’s accuracy to microbial culture in suspected BIRI.

METHODS:

An IRB-approved, prospective multicenter study was conducted of adults with prior breast implant reconstruction undergoing surgery for suspected infection (cases-BIRI) or prosthetic exchange/revision (controls). Demographics, perioperative characteristics, antibiotic exposure, and implant pocket fluid was collected. Fluid samples underwent microbial culture, AD-1 assay, and adjunctive markers (CRP, lactate, cell differential); diagnostic performance was assessed via sensitivity, specificity, and accuracy from receiver operator curve (ROC) analysis with p<0.05 considered significant.

RESULTS:

53 implant pocket samples were included (Cases-20, Controls-33). All 20 patients with suspected BIRI exhibited cellulitis, 65% had abnormal drainage, and 55% were febrile. All suspected BIRIs were AD-1 positive (sensitivity=100%). Microbial culture failed to grow any microorganisms in 4 BIRIs (sensitivity=80%, p=0.046); gram stain was least accurate (sensitivity=25%, p<0.001). All tests demonstrated 100% specificity. ROC analyses yielded the following area under the curve (AUCs): AD-1 AUC=1.0, Microbial culture AUC=0.90 (p=0.029), gram stain AUC=0.62 (p<0.001). Adjunctive markers were significantly higher among infections versus controls (p<0.001).

CONCLUSIONS:

Study findings confirm AD-1’s accuracy in diagnosing BIRI and indicate superiority to microbial culture. While further study is warranted, AD-1 may facilitate perioperative decision-making in BIRI management in a resource-efficient manner.
Comparing the benefits and risks of immediate breast cancer reconstruction with or without acellular dermal matrix (ADM) or synthetic mesh support– A Systematic Review and Network Meta-analysis.
Authors: Murphy Donal , O’Donnell John P , Ryan Éanna J. , Lane O’Neill Billy , Boland Michael R , Lowery Aoife J , Kerin Michael J , Mc Inerney Niall M
Published: February 2023

Introduction and Aims:

The use of acellular dermal matrices (ADM) and synthetic mesh as part of implant-based breast reconstruction (IBBR) has been widely adopted. Our aims were to investigate the clinical efficacy and safety of the use of human/allograft (HADM), xenograft (XADM) and synthetic mesh as part of IBBR in post-mastectomy patients as compared to previous standard implant reconstruction techniques using only a submuscular pocket for coverage.

Methods:

A systematic search for randomised control trials and observational studies was performed. A frequentist network meta-analysis was conducted using the R packages netmeta and Shiny.

Results:

A total of 31 studies of 2375 identified met the predefined inclusion criteria. Traditional submuscular placement (no ADM/mesh) had fewer overall complications compared to HADM (odds ratio [OR] 0.51; Credible interval [CrI]: 0.34 – 0.74), however there was no significant difference between no ADM/mesh and XADM (OR 0.63; CrI: 0.29-1.32) or synthetic mesh (OR 0.77; CrI: 0.44 – 1.30). No one treatment was superior with regards to implant loss. No ADM/mesh was associated with less infectious complications than HADM (OR 0.6; CrI 0.39 – 0.89). Both no ADM/mesh (OR 0.45; CrI 0.27 – 0.75) and XADM (OR 0.46; CrI 0.23 – 0.88) had reduced seroma compared with HADM.

Conclusion:

Selecting the appropriate IBBR should evaluate effectiveness, adverse events, and cost. While it is difficult to select a universal ideal IBBR, evaluation using this network analysis may help guide both physicians and patients in their choice of procedure, especially in the case of HADM, which in this study has shown to be significantly predisposed to complications of infection and seroma. Randomised data is required comparing XADM versus synthetic meshes given the similar risk profiles but significant cost discrepancy between the techniques.
High Definition Liposculpture's 18-year Evolution: Patient Safety and Aesthetic Outcomes
Authors: Hoyos Alfredo E. , Cala Laura C. , Perez Mauricio E. , Mogollon Ivan R. , Dominguez-Millan Rodrigo
Published: February 2023

BACKGROUND:

High definition liposculpture (HDL) emerged as an innovative surgical technique that allowed plastic surgeons around the world to achieve higher aesthetic results by a natural and athletic appearance through minimal incisions and imperceptible scarring. Its ultimate targets are: High Aesthetic Standards and Patient Safety.

PURPOSE:

This manuscript summarizes the evolution of High Definition Liposculpture by showing the upgrades to the original technique and comparing the complications rate among them.

METHODS:

We retrospectively reviewed our records from 4 private medical centers (Evolution Medical Center, Santa Barbara Medical Center, and Dhara Clinic in Bogota; and FOSCAL in Bucaramanga – Colombia), looking for patients who underwent High Definition Liposculptures performed by the senior author over an 18-year period (2002 to 2019). Patients were classified into three groups: Suction-assisted lipoplasty (Period I), VASER-assisted HD lipo (Period II), and Dynamic Definition liposculpture (Period III).

RESULTS:

We established a cohort of 5,052 patients (4,300 women and 752 men). 923 in period I, 1272 in period II and 2857 in period III. Most common complications included seroma, bruising, hematoma, acute anemia, hyperchromia, wrinkled skin, wound dehiscence and local infections.

CONCLUSIONS:

High Definition and Dynamic Definition liposculpture procedures are safe and reproducible techniques in order to achieve not only an athletic and but also a natural body contour. Complication rates, especially those related to bleeding, did decrease as the technique evolved. These procedures have always been framed towards patient safety so as to provide them with higher aesthetic outcomes using extensive medical, anatomical, artistic, and technological knowledge.
“Preservation rhinoplasty for the twisted nose: management with unilateral or asymmetric wedge resection, the Modified “Push-Down & Let-Down” technique.
Authors: Jasso-Ramírez Elizabeth , Burgos-Páez Alan , Sánchezy Béjar Fernando , Friedman Oren , Kern Eugene , López-Ulloa Fausto
Published: February 2023

Background:

We present a retrospective, comparative, and analytical cohort study, which aimed to prove the utility of unilateral or asymmetrical bony wedge resection to straighten the twisted nose as applied in the “Let-Down” / “Push- Down” methods. The study involved objective angle measurements preoperatively and postoperatively on frontal view photographs.

Patients and methods:

Preoperative and postoperative angle measurements were made on frontal view photographs of 78 patients with twisted noses classified as Type- C and Type –I. Angles of deviation were obtained using Scion Image software, measured in degrees. Statistical analysis was performed using Excel v15.13.3.

Results:

42 patients had twisted nose Type- C and 28 patients had twisted nose Type –I. The mean age was 19 years old. There was 81% improvement ratio for twisted nose Type-C and 79% for twisted nose Type-I, and the angle correction for each type of nasal deformity was statistically significant (p< 0.01). The majority of postoperative results were classified as “excellent to good” except for four cases with “bad” outcomes, including 2 patients with Type-C and 2 with Type-I deviations.

Conclusion:

Unilateral or asymmetrical bony wedge resection is a modification of the “Let-Down” rhinoplasty technique. This study demonstrates statistically significant improvements in straightening twisted noses among patients with or without preoperative hump, while preserving the nasal dorsum. We found this modification better suited for Type- C deviations.
“Comparison of Picosecond Nd: YAG 1,064nm Laser and Nanosecond Q-Switched Nd: YAG 1,064nm Laser in the Treatment of Melasma: A Prospective, Split-face, Randomized, Clinical Trial”
Authors: Feng Jiayi , Huang Lvping
Published: February 2023

Melasma is a refractory pigmentary disorder. The picosecond Nd: YAG 1,064nm laser (PSNY) has cast an optimistic outlook to become a better treatment for melasma with less side effects and favorable therapeutic efficacy. This article evaluated the efficacy and safety of the picosecond Nd: YAG 1,064nm laser and the nanosecond Q-switched Nd: YAG 1,064nm laser in patients with melasma. Eighteen patients were recruited in this study to receive two types of laser treatments on spilt faces respectively. The modified Melasma area severity index (mMASI) was assessed at baseline and the 3-month follow-up visit. The recurrence rate and the patients’ self-satisfaction assessment would be evaluated as well. Two treated sides showed statistically significant decrease in mMASI after treatment at follow-up compared to the baseline(p＜0.001), though there was no statistically significant difference between two modalities(p=0.873), which was consistent with the patients’ self-satisfaction assessment (p=0.287). The visual analogue scale (VAS) pain assessment showed that the Q-switched laser was painful than the picosecond counterpart (p=0.007). But the recurrence rate was the same for two treated sides (12.5%). The picosecond Nd: YAG 1,064nm laser would be a better choice with less treatment pain and post-procedure erythema as well as lower potential risk of exacerbation on melasma.
Negative Pressure Wound Therapy Induces Lymphangiogenesis in Murine Diabetic Wound Healing
Authors: Wu Mengfan , Liu Qinxin , Yu Zhen , Karvar Mehran , Aoki Shimpo , Hamaguchi Ryoko , Ma Chenhao , Orgill Dennis P. , Panayi Adriana C.
Published: February 2023

Background

Decreased lymphangiogenesis contributes to impaired diabetic wound healing. Although Negative Pressure Wound Therapy (NPWT) has been shown to be effective in the treatment of recalcitrant wounds, its impact on lymphangiogenesis remains to be elucidated. Here, we investigate the mechanisms of lymphangiogenesis following NPWT treatment of diabetic murine wound healing.

Methods

1×1 cm2 full thickness dorsal skin wounds were excised on 30 db/db mice. The mice were either treated with occlusive covering (Control, n=15), or received a 7-day treatment of continuous NPWT at -125 mmHg (NPWT, n=15). The wounds were photographed on days 0, 7, 10, 14, 21 and 28. Wound tissue was harvested on day 10, 14, 21 and 28 for quantitative analysis. Functional analysis of lymphatic drainage was performed on day 14 and 28 with Evans Blue dye tracing.

Results

Lymphatic density and diameter, as visualized through podoplanin (PDPN)-probing, was significantly higher in the NPWT group compared to the Control group (p<0.001). NPWT up-regulated the expression of lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1) at the protein level (p=0.04) and significant differences were noted in lymphatic density as assessed by LYVE-1 staining (p=0.001). Leucocyte infiltration was significantly higher in the NPWT group (p=0.01). A higher speed of wound closure (p<0.0001) and greater wound bed thickness (p<0.0001) were noted in the NPWT group compared to the Control group.

Conclusion

NPWT increased the lymphatic vessel density and diameter with LYVE-1 upregulation. NPWT therefore plays a positive role in lymphangiogenesis in diabetic wound healing.
Long-term Outcomes Following Free Vascularized Fibula Physeal Transfer for Proximal Humerus Oncologic Reconstruction in Children: An International Multi-Institutional Study
Authors: Azoury Saïd C. , Shammas Ronnie L. , Othman Sammy , Sergesketter Amanda , Brigman Brian E. , Nguyen Jie C. , Arkader Alexandre , Weber Kristy L. , Erdmann Detlev , Levin L. Scott , Kovach Stephen J. , Innocenti Marco
Published: February 2023

BACKGROUND:

Vascularized fibula epiphyseal flap was first described in 1998 for proximal humeral reconstruction in children/infants. The authors aim to review their international, multi-institutional long-term outcomes.

METHODS:

An international, multi-institutional review (2004-2020) was conducted of patients <18 years of age undergoing free vascularized fibula epiphyseal transfer for proximal humeral reconstruction. Donor/recipient site complications, pain, and final ambulatory status were reviewed. Growth of the transferred bone was assessed under the guidance of a pediatric musculoskeletal radiologist.

RESULTS:

Twenty-seven patients were included with a median age of 7 years (range 2-13 years). Average follow-up was 120 ± 87.4 months. There were two flap failures (7.4%). Recipient site complications included fracture (n=11, 40.7%), avascular necrosis of the fibula head (n=1, 3.7%), fibular head avulsion (n=1, 3.7%), infection (n=1, 3.7%), hardware failure (n=1, 3.7%). Operative fixation was necessary in one patient with a fracture. The case of infection necessitated fibula explantation 2 years post-operatively, and ultimately prosthetic reconstruction. Sixteen patients suffered peroneal nerve palsy (59.3%): thirteen of these cases resolved within a year (81% recovery), and 3 were permanent (11.1%). One patient (3.7%) complained of upper extremity pain. Longitudinal growth was confirmed in all but 3 cases (n=24, 88.9%) at an average rate of 0.83 ± 0.25 cm/year.

CONCLUSIONS:

The vascularized fibula epiphysis for proximal humerus reconstruction in children preserves the potential for future growth and an articular surface for motion. Peroneal nerve palsy is common following harvest, although this is often transient. Future efforts should be geared towards reducing post-operative morbidity.
“Outcomes after Endoscopic-Assisted Strip Craniectomy and Orthotic Therapy for Syndromic Craniosynostosis.”
Authors: Chiang Sarah N , Skolnick Gary B , Naidoo Sybill D , Smyth Matthew D , Patel Kamlesh B
Published: February 2023

Background:

Endoscopic craniosynostosis repair has emerged as an effective alternative to open repair, but data are limited on treatment of the 15-24% of patients with syndromic diagnoses. Here, we examine postoperative outcomes after endoscopic repair in syndromic craniosynostosis.

Methods:

Retrospective review was performed of all consecutive patients undergoing endoscopic repair and all syndromic patients undergoing open repair from 2006-2021. Demographics, complications, and reoperations were compared between groups. Patient-reported measures of stigma and cognitive function were recorded at age 5 years and greater.

Results:

335 patients underwent endoscopic repair, of which 38 (11%) had syndromic craniosynostosis. Syndromic craniosynostosis was associated with bicoronal involvement (p<0.001) and female sex (p=0.003). Secondary procedures were significantly more common in the syndromic group (24% vs 2.4%, p<0.001), as were transfusions (18% vs 6.4%, p=0.018). Secondary procedures were performed at a mean 2.8 years of age (range 10 months to 8 years), and most commonly consisted of fronto-orbital advancement (7 in syndromic group, 3 in non-syndromic). Patient-reported stigma was higher in patients with syndromes (p=0.002), but cognitive function did not differ significantly (p=0.065). Incidence of reoperations after open repair was 13%, but baseline differences precluded direct comparison with the endoscopic group.

Conclusions:

Minimally invasive approaches in early infancy can alleviate the need for additional cranial procedures in the growing child. Syndromic craniosynostoses are a complex and heterogeneous group, and in more severe cases, endoscopic repair can be considered an adjunct technique to reduce the number of major craniofacial procedures.
Risk Factors of Isolated Microtia: A Systematic Review and Meta-Analysis
Authors: Huang Ying , Huang Ximeng , Li Kexuan , Yang Qinghua
Published: February 2023

Background:

Isolated microtia is a congenital facial anomaly and its etiology is unclear. This study systematically investigated related suspicious factors.

Methods:

A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Four databases were searched for eligible case-control and cohort studies. Odds Ratios and 95% confidence intervals were calculated for each exposure variable if data from at least two eligible studies were provided. If not, narrative syntheses were performed.

Results:

28 articles were included. Meta-analyses were conducted with 22 articles and 25 factors were identified to have significant association with isolated microtia. Moderate evidence showed that parental low education level, low birth weight (<2500g), parity≥2, family history of malformation (especially microtia), maternal intake of antibiotics, benzodiazepines, NSAIs, progesterone and traditional Chinese medicine, as well as maternal non-gestational diabetes, upper respiratory infection and radiation exposure increased the risk of microtia in offspring. Limited evidence showed that maternal Hispanic race, pesticides exposure, threaten abortion, history of spontaneous abortion, pet contact and male infant were associated with increased risk. Maternal race of Black, non-Hispanic and living in urban area were two protective factors found with moderate and limited evidence, respectively.

Conclusions:

This study has provided an initial investigation of potential factors associated with isolated microtia and evidence-based conclusion supporting prevention over modifiable factors.
The Comparative Benefits of Open Versus Closed Reduction of Condylar Fractures: A Systematic Review and Meta-Analysis
Authors: Jazayeri Hossein E. , Lopez Joseph , Khavanin Nima , Xun Helen , Lee Urie K. , Best David L. , Reategui Alvaro , Urata Mark M. , Dorafshar Amir H.
Published: February 2023

Purpose:

Many fractures of the mandibular condylar neck are amenable to both open reduction and internal fixation (ORIF) and closed treatment (CT). Clinical outcomes following these two modalities remains a topic of debate. This systematic review critically appraises the literature to compare them following these treatment options.

Methods:

A systematic review and meta-analysis was performed to test the null hypothesis of no difference in clinical outcomes in ORIF versus CT of mandibular condyle fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development, and Evaluation methodology.

Results:

Of 1507 screened articles, 14 met inclusion criteria. ORIF was favored significantly when evaluating temporomandibular joint pain (RR 0.3; 95% CI 0.1-0.7) (NNTp 3; 2-6), laterotrusive movements of the mandible (MD 2.3; 1.7-3.0) (SMD 0.9; 0.4-1.3), and malocclusion (RR 0.5; 0.4-0.7) (NNTp 19; 10-200). However, ORIF yielded higher incidence of postoperative infection (RR 3.6; 95% CI 0.9-13.8) and must be weighed against the understood risk of facial nerve injury.

Conclusion:

Meta-analysis of high-level evidence in randomized controlled trial suggests that ORIF significantly improves functional outcomes, decreases pain, and restores occlusion and jaw symmetry. These long-term benefits must be weighed against the increased risk of postoperative infection and exposure of the facial nerve to potential injury.
A Simple Scoring Model for Evaluation of Concomitant Vascular Injuries in Patients with Lower Extremity Open Fractures
Authors: Su Chun-Lin , Hsu Chung-Chen , Liao Chien-Hung , Hsieh Chi-Hsun , Cheng Chi-Tung , Fu Chih-Yuan
Published: February 2023

Background:

Timely diagnosis and management of concomitant vascular injuries is usually needed for the management of lower extremity open fractures. In the current study, a prediction model and simplified scoring system of vascular injuries were developed for the primary evaluation of patients with lower extremity open fractures.

Methods:

Patients with lower extremity open fractures were retrospectively reviewed from 2017 to 2020. Multivariate logistic regression analysis was used to evaluate independent risk factors for concomitant vascular injuries in these patients using data collected in 2017–2019, and a prediction scoring model was created accordingly. Model performance was validated with data from 2020.

Results:

In total, 949 lower extremity open fracture patients (development cohort, 705 patients, 2017–2019; validation cohort, 244 patients, 2020) were enrolled. Concomitant vascular injuries occurred in 44 patients in the development cohort (6.2%). Three clinical variables were identified for a prediction scoring model with weighted points, including hard/soft vascular signs (3 points), segmental fractures (2 points) and degloving soft tissue injury (1 point). The model showed good discrimination [area under the receiver operating characteristic curve (AUC)=0.928], calibration (Hosmer-Lemeshow Ĉtest, p=0.661) and precision (Brier score=0.041). Subsequent management regarding different aspects (observation only, further imaging study or direct surgical exploration) can thus be decided. The model also demonstrated good discrimination (AUC=0.949), good calibration (Hosmer-Lemeshow Ĉ-test, p=0.174) and good precision (Brier score=0.042) in the validation cohort.

Conclusions:

This model may guide the subsequent management of vascular injuries associated with lower extremity open fractures.