Pub Date : 2024-11-01Epub Date: 2024-01-08DOI: 10.1097/PRS.0000000000011285
Alice Yau, Marina A Lentskevich, Irene Yau, Iulianna Taritsa, Kaleem S Ahmed, Teeba Marlowe, Arun K Gosain
Summary: Although 100% of congressional legislators vote on health care policy, only a minority have a background in health care. A review of the participation of health care professionals (HCPs) in Congress, highlighting participation by surgeons, is critical to the future policy-making endeavors in health care. This article seeks to better understand the characteristics of HCPs who engage in advocacy and describe the trends in their representation in Congress, with commentary on participation by surgeons and its impact on current health advocacy efforts.A search of Congress.gov and the Biographical Directory of the United States Congress was performed to identify professional health care history for each congressperson, followed by review of official campaign websites for health advocacy work. Statistical analysis was performed using IBM SPSS Statistics Software for changes in representation of HCPs, physicians, and surgeons in Congress over time. Although there has been increasing representation of HCPs in Congress in the past 25 years, surgeons have the lowest increase in congressional membership. For health care reform to optimally address high costs, variable insurance coverage and reimbursement rates, and equal access to care, more physicians must make health care advocacy efforts an integral part of their careers. Incorporation of education in areas of health care advocacy and/or reform into undergraduate and graduate medical education curricula may help address deficiencies in knowledge of current health care-related events to further encourage involvement in health care legislation.
{"title":"A 50-Year Review of Congressional Membership by Health Care Professionals: Is Surgical Representation Adequate?","authors":"Alice Yau, Marina A Lentskevich, Irene Yau, Iulianna Taritsa, Kaleem S Ahmed, Teeba Marlowe, Arun K Gosain","doi":"10.1097/PRS.0000000000011285","DOIUrl":"10.1097/PRS.0000000000011285","url":null,"abstract":"<p><strong>Summary: </strong>Although 100% of congressional legislators vote on health care policy, only a minority have a background in health care. A review of the participation of health care professionals (HCPs) in Congress, highlighting participation by surgeons, is critical to the future policy-making endeavors in health care. This article seeks to better understand the characteristics of HCPs who engage in advocacy and describe the trends in their representation in Congress, with commentary on participation by surgeons and its impact on current health advocacy efforts.A search of Congress.gov and the Biographical Directory of the United States Congress was performed to identify professional health care history for each congressperson, followed by review of official campaign websites for health advocacy work. Statistical analysis was performed using IBM SPSS Statistics Software for changes in representation of HCPs, physicians, and surgeons in Congress over time. Although there has been increasing representation of HCPs in Congress in the past 25 years, surgeons have the lowest increase in congressional membership. For health care reform to optimally address high costs, variable insurance coverage and reimbursement rates, and equal access to care, more physicians must make health care advocacy efforts an integral part of their careers. Incorporation of education in areas of health care advocacy and/or reform into undergraduate and graduate medical education curricula may help address deficiencies in knowledge of current health care-related events to further encourage involvement in health care legislation.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1133-1140"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-26DOI: 10.1097/PRS.0000000000011548
Zachary M Borab, Rod J Rohrich
{"title":"Discussion: The Rhinoplasty Rosetta Stone: Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale.","authors":"Zachary M Borab, Rod J Rohrich","doi":"10.1097/PRS.0000000000011548","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011548","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 5","pages":"964-965"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-26DOI: 10.1097/PRS.0000000000011555
Christine S Wang, Kevin C Chung
{"title":"Artistry in Scientific Writing.","authors":"Christine S Wang, Kevin C Chung","doi":"10.1097/PRS.0000000000011555","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011555","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 5","pages":"915-918"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2023-07-25DOI: 10.1097/PRS.0000000000010947
Junhu Shi, Zhaochuan Liu, Yadi Li, Lihua Song, Yan Li, Jianwei Yang, Runhui Pang, Hongbin Zhang, Li Xiao, Ping Bai
Background: Conjoint fascial sheath (CFS) suspension has been gradually recognized and accepted for the treatment of congenital severe blepharoptosis in recent years. To address the problem of postoperative upper eyelid position regression of only CFS suspension, the authors designed and implemented a CFS combined levator muscle (LM) complex flap, and analyzed the surgical efficacy of CFS with LM (CFS+LM) compared with frontalis myofascial flap (FMF) suspension surgery.
Methods: Patients diagnosed with congenital severe ptosis and LM function of 4 mm or less were enrolled. The patients were assigned to either the CFS+LM group or the FMF group, to compare and statistically analyze the postoperative effects of CFS+LM versus FMF suspension.
Results: Data from 182 patients (220 eyes) were collected in this study, including 89 patients (103 eyes) in the CFS+LM group and 93 patients (117 eyes) in the FMF group. The full correction rate, patient satisfaction, postoperative upper eyelid excursion, and lagophthalmos in the CFS+LM group were significantly better than those in the FMF group. The eyelid retraction rate was significantly higher in the FMF group than in the CFS+LM group. The complication rate in the CFS+LM group was significantly lower than that in the FMF group.
Conclusions: CFS+LM suspension had better outcomes than FMF suspension. Considering that the CFS tissue could be weak in patients younger than 5 years and have poor muscle elasticity in patients with LM function less than or equal to 1 mm, FMF suspension is recommended first. For patients older than 5 years with severe ptosis, CFS+LM suspension is recommended.
Clinical question/level of evidence: Therapeutic, III.
{"title":"Efficacy of Combined Conjoint Fascial Sheath and Levator Muscle Composite Flap Suspension for Congenital Severe Ptosis.","authors":"Junhu Shi, Zhaochuan Liu, Yadi Li, Lihua Song, Yan Li, Jianwei Yang, Runhui Pang, Hongbin Zhang, Li Xiao, Ping Bai","doi":"10.1097/PRS.0000000000010947","DOIUrl":"10.1097/PRS.0000000000010947","url":null,"abstract":"<p><strong>Background: </strong>Conjoint fascial sheath (CFS) suspension has been gradually recognized and accepted for the treatment of congenital severe blepharoptosis in recent years. To address the problem of postoperative upper eyelid position regression of only CFS suspension, the authors designed and implemented a CFS combined levator muscle (LM) complex flap, and analyzed the surgical efficacy of CFS with LM (CFS+LM) compared with frontalis myofascial flap (FMF) suspension surgery.</p><p><strong>Methods: </strong>Patients diagnosed with congenital severe ptosis and LM function of 4 mm or less were enrolled. The patients were assigned to either the CFS+LM group or the FMF group, to compare and statistically analyze the postoperative effects of CFS+LM versus FMF suspension.</p><p><strong>Results: </strong>Data from 182 patients (220 eyes) were collected in this study, including 89 patients (103 eyes) in the CFS+LM group and 93 patients (117 eyes) in the FMF group. The full correction rate, patient satisfaction, postoperative upper eyelid excursion, and lagophthalmos in the CFS+LM group were significantly better than those in the FMF group. The eyelid retraction rate was significantly higher in the FMF group than in the CFS+LM group. The complication rate in the CFS+LM group was significantly lower than that in the FMF group.</p><p><strong>Conclusions: </strong>CFS+LM suspension had better outcomes than FMF suspension. Considering that the CFS tissue could be weak in patients younger than 5 years and have poor muscle elasticity in patients with LM function less than or equal to 1 mm, FMF suspension is recommended first. For patients older than 5 years with severe ptosis, CFS+LM suspension is recommended.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"865e-873e"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10235701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-02-02DOI: 10.1097/PRS.0000000000011325
Lee H Kilmer, Jesse Chou, Christopher A Campbell, Brent R DeGeorge, John T Stranix
Background: Patients with gender dysphoria face significant health disparities and barriers to care. Transition-related care includes hormonal therapy, mental health care, and gender-affirming surgery. Studies have described favorable surgical outcomes and patient satisfaction; however, the degree to which these procedures affect mental health conditions is not fully understood. The purpose of this study was to evaluate the effect of gender-affirming plastic surgery on mental health and substance misuse in the transgender population.
Methods: A national insurance claims-based database was used for data collection. Patients with a diagnosis of gender dysphoria were propensity score-matched for the likelihood of undergoing gender-affirming surgery (no surgery being the control cohort), based on comorbidities, age, and sex. Primary outcomes included postoperative antidepressant use and the prevalence of mental health conditions.
Results: A total of 3134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance misuse, and selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor use. There was an absolute decrease of 8.8% in selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor prescription after gender-affirming plastic surgery ( P < 0.001), and significant decreases were found in postoperative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol misuse (2.1%), and drug misuse (1.9%).
Conclusion: Gender-affirming surgery in appropriately selected patients with gender dysphoria is associated with decreased postoperative rates of SSRI or SNRI use and improved mental health.
Clinical question/level of evidence: Therapeutic, IV.
{"title":"Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria.","authors":"Lee H Kilmer, Jesse Chou, Christopher A Campbell, Brent R DeGeorge, John T Stranix","doi":"10.1097/PRS.0000000000011325","DOIUrl":"10.1097/PRS.0000000000011325","url":null,"abstract":"<p><strong>Background: </strong>Patients with gender dysphoria face significant health disparities and barriers to care. Transition-related care includes hormonal therapy, mental health care, and gender-affirming surgery. Studies have described favorable surgical outcomes and patient satisfaction; however, the degree to which these procedures affect mental health conditions is not fully understood. The purpose of this study was to evaluate the effect of gender-affirming plastic surgery on mental health and substance misuse in the transgender population.</p><p><strong>Methods: </strong>A national insurance claims-based database was used for data collection. Patients with a diagnosis of gender dysphoria were propensity score-matched for the likelihood of undergoing gender-affirming surgery (no surgery being the control cohort), based on comorbidities, age, and sex. Primary outcomes included postoperative antidepressant use and the prevalence of mental health conditions.</p><p><strong>Results: </strong>A total of 3134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance misuse, and selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor use. There was an absolute decrease of 8.8% in selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor prescription after gender-affirming plastic surgery ( P < 0.001), and significant decreases were found in postoperative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol misuse (2.1%), and drug misuse (1.9%).</p><p><strong>Conclusion: </strong>Gender-affirming surgery in appropriately selected patients with gender dysphoria is associated with decreased postoperative rates of SSRI or SNRI use and improved mental health.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1142-1149"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139692667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-26DOI: 10.1097/PRS.0000000000011498
Sumeet S Teotia, Nicholas T Haddock
{"title":"Reply: Abandoning the SIEA Flap for the Dual-Plane DIEP Reduces Fat Necrosis and Flap Failure.","authors":"Sumeet S Teotia, Nicholas T Haddock","doi":"10.1097/PRS.0000000000011498","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011498","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 5","pages":"1061e-1062e"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Microfat and nanofat are commonly used in various surgical procedures, from skin rejuvenation to scar correction, to contribute to tissue regeneration. Microfat contains mainly adipocytes and is well suited for tissue augmentation, and nanofat is rich in lipids, adipose-derived stem cells, microvascular fragments, and growth factors, making it attractive for aesthetic use. The authors have previously demonstrated that the mechanical processing of microfat into nanofat significantly changes its proteomic profile. Considering that mechanical fractionation leads to adipocyte disruption and lipid release, they aimed to analyze their lipidomic profiles for their regenerative properties.
Methods: Microfat and nanofat samples were isolated from 14 healthy patients. Lipidomic profiling was performed by liquid chromatography tandem mass spectrometry. The resulting data were compared against the Human Metabolome and LIPID MAPS Structure Database. MetaboAnalyst was used to analyze metabolic pathways and lipids of interest.
Results: From 2388 mass-to-charge ratio features, metabolic pathway enrichment analysis of microfat and nanofat samples revealed 109 pathways that were significantly enriched. Microfat samples revealed higher-intensity levels of sphingosines, different eicosanoids, and fat-soluble vitamins. Increased levels of coumaric acids and prostacyclin were found in nanofat.
Conclusions: This is the first study to analyze the lipidomic profiles of microfat and nanofat, providing evidence that mechanical emulsification of microfat into nanofat leads to changes in their lipid profiles. From 109 biological pathways, antiinflammatory, antifibrotic, and antimelanogenic lipid mediators were particularly enriched in nanofat samples when compared with microfat. Although further studies are necessary for a deeper understanding of the composition of these specific lipid mediators in nanofat samples, the authors propose that they might contribute to its regenerative effects on tissue.
Clinical relevance statement: Profiling the unique lipid mediators in nanofat and microfat enhances our understanding of their different therapeutic effects and allows us to link these specific mediators to antiinflammatory, pro-regenerative, or healing properties. Ultimately, this insight can advance personalized therapeutic strategies, where a specific type of fat is selected based on its optimal therapeutic effect.
{"title":"Lipidomic Analysis of Microfat and Nanofat Reveals Different Lipid Mediator Compositions.","authors":"Lisanne Grünherz, Sedef Kollarik, Nadia Sanchez-Macedo, Michelle McLuckie, Nicole Lindenblatt","doi":"10.1097/PRS.0000000000011335","DOIUrl":"10.1097/PRS.0000000000011335","url":null,"abstract":"<p><strong>Background: </strong>Microfat and nanofat are commonly used in various surgical procedures, from skin rejuvenation to scar correction, to contribute to tissue regeneration. Microfat contains mainly adipocytes and is well suited for tissue augmentation, and nanofat is rich in lipids, adipose-derived stem cells, microvascular fragments, and growth factors, making it attractive for aesthetic use. The authors have previously demonstrated that the mechanical processing of microfat into nanofat significantly changes its proteomic profile. Considering that mechanical fractionation leads to adipocyte disruption and lipid release, they aimed to analyze their lipidomic profiles for their regenerative properties.</p><p><strong>Methods: </strong>Microfat and nanofat samples were isolated from 14 healthy patients. Lipidomic profiling was performed by liquid chromatography tandem mass spectrometry. The resulting data were compared against the Human Metabolome and LIPID MAPS Structure Database. MetaboAnalyst was used to analyze metabolic pathways and lipids of interest.</p><p><strong>Results: </strong>From 2388 mass-to-charge ratio features, metabolic pathway enrichment analysis of microfat and nanofat samples revealed 109 pathways that were significantly enriched. Microfat samples revealed higher-intensity levels of sphingosines, different eicosanoids, and fat-soluble vitamins. Increased levels of coumaric acids and prostacyclin were found in nanofat.</p><p><strong>Conclusions: </strong>This is the first study to analyze the lipidomic profiles of microfat and nanofat, providing evidence that mechanical emulsification of microfat into nanofat leads to changes in their lipid profiles. From 109 biological pathways, antiinflammatory, antifibrotic, and antimelanogenic lipid mediators were particularly enriched in nanofat samples when compared with microfat. Although further studies are necessary for a deeper understanding of the composition of these specific lipid mediators in nanofat samples, the authors propose that they might contribute to its regenerative effects on tissue.</p><p><strong>Clinical relevance statement: </strong>Profiling the unique lipid mediators in nanofat and microfat enhances our understanding of their different therapeutic effects and allows us to link these specific mediators to antiinflammatory, pro-regenerative, or healing properties. Ultimately, this insight can advance personalized therapeutic strategies, where a specific type of fat is selected based on its optimal therapeutic effect.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 5","pages":"895e-905e"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1097/PRS.0000000000011831
Elsa M Ronde, Guido A de Jong, Jitske W Nolte, Marloes E L Nienhuijs, Neil W Bulstrode, Thomas J J Maal, Alfred G Becking, Corstiaan C Breugem
Introduction: Craniofacial microsomia (CFM) is classified using the subjective Orbit, Mandible, Ear, Nerve and Soft tissue (OMENS) tool. Digital stereophotogrammetry (i.e. three-dimensional [3D] photography) can be used to capture facial shape objectively. This case-control study assessed the applicability of 3D photography in distinguishing between patients with CFM and individuals without craniofacial conditions, as well as classifying the severity of facial involvement.
Methods: 3D photographs of patients with CFM and/or microtia from the Amsterdam UMC, Radboudumc and the Great Ormond Street Hospital and of individuals without craniofacial conditions were assessed. Differences between patients and controls were explored through asymmetry index (ASI) and facial signature (FS) scores, as well as a principal components (PC) analysis of FS scores and logistic regression. Correlations between OMENS scores and ASI, FS and PC scores were evaluated.
Results: A total of 179 patients and 210 controls were analyzed. ASI and FS scores differed significantly between patients and controls (p<0.001), and were correlated with several OMENS subscales. The logistic regression model distinguishing between patients and controls showed increasing asymmetry of the mandible and orbits with increasing Pruzansky-Kaban score. Patients with isolated microtia deviated from controls in the midface.
Conclusion: Clinically significant differences in the facial morphology of patients with CFM and microtia were found compared to controls, suggesting that 3D photography can be used to assess the severity of facial involvement in a novel, objective and safe way in these patients.
{"title":"Three-dimensional facial morphology in patients with craniofacial microsomia and microtia.","authors":"Elsa M Ronde, Guido A de Jong, Jitske W Nolte, Marloes E L Nienhuijs, Neil W Bulstrode, Thomas J J Maal, Alfred G Becking, Corstiaan C Breugem","doi":"10.1097/PRS.0000000000011831","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011831","url":null,"abstract":"<p><strong>Introduction: </strong>Craniofacial microsomia (CFM) is classified using the subjective Orbit, Mandible, Ear, Nerve and Soft tissue (OMENS) tool. Digital stereophotogrammetry (i.e. three-dimensional [3D] photography) can be used to capture facial shape objectively. This case-control study assessed the applicability of 3D photography in distinguishing between patients with CFM and individuals without craniofacial conditions, as well as classifying the severity of facial involvement.</p><p><strong>Methods: </strong>3D photographs of patients with CFM and/or microtia from the Amsterdam UMC, Radboudumc and the Great Ormond Street Hospital and of individuals without craniofacial conditions were assessed. Differences between patients and controls were explored through asymmetry index (ASI) and facial signature (FS) scores, as well as a principal components (PC) analysis of FS scores and logistic regression. Correlations between OMENS scores and ASI, FS and PC scores were evaluated.</p><p><strong>Results: </strong>A total of 179 patients and 210 controls were analyzed. ASI and FS scores differed significantly between patients and controls (p<0.001), and were correlated with several OMENS subscales. The logistic regression model distinguishing between patients and controls showed increasing asymmetry of the mandible and orbits with increasing Pruzansky-Kaban score. Patients with isolated microtia deviated from controls in the midface.</p><p><strong>Conclusion: </strong>Clinically significant differences in the facial morphology of patients with CFM and microtia were found compared to controls, suggesting that 3D photography can be used to assess the severity of facial involvement in a novel, objective and safe way in these patients.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/PRS.0000000000011844
Meagan Wu, Benjamin B Massenburg, Dillan F Villavisanis, Ashley E Chang, Dominic J Romeo, Jinggang J Ng, Joseph A Napoli, Scott P Bartlett, Jordan W Swanson, Jesse A Taylor
Introduction: This study compares the long-term aesthetic outcomes of patients with unicoronal synostosis (UCS) who underwent fronto-orbital distraction osteogenesis (FODO) versus traditional fronto-orbital advancement and remodeling (FOAR).
Methods: Patients treated for nonsyndromic UCS from 2009 to 2023 were retrospectively reviewed. Perioperative and complication characteristics were compared between all patients who underwent FOAR, open FODO, and endoscopic-assisted FODO ("endo-FODO"). Aesthetic outcomes at greater than five years postoperatively were compared between patients who underwent FODO and a contemporaneous cohort of age-matched controls who underwent FOAR. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, orbital dystopia angle (ODA), and frontal bossing angle were calculated, with positive differences representing postoperative improvement.
Results: Forty-one patients were treated at a median age of 9.7, 5.4, and 5.4 months in the FOAR, open FODO, and endo-FODO groups, respectively. Among 28 patients photographed at a median of 6.3 years postoperatively, the FODO cohort demonstrated greater margin-to-reflex distance 1 symmetry (6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5], p=0.010) and canthal tilt symmetry (0.9° [0.2°, 2.9°] vs. 3.3° [2.3°, 5.3°], p=0.004) postoperatively as well as ODA correction (5.4° [4.0°, 7.5°] vs. 3.0° [2.5°, 4.4°], p=0.027) compared to the FOAR cohort. Fewer patients in the FODO cohort exhibited temporal hollowing postoperatively compared to the FOAR cohort (14% vs. 71%, p=0.002).
Conclusions: Compared to FOAR, FODO was associated with greater periorbital symmetry, greater orbital dystopia correction, and reduced temporal hollowing in the long-term. Follow-up to cranial maturity is needed to adequately compare the two techniques.
简介:本研究比较了接受眶前牵引成骨术(FODO)和传统眶前推进重塑术(FOAR)的单冠突合症(UCS)患者的长期美学效果:方法:对2009年至2023年期间接受非综合征UCS治疗的患者进行回顾性研究。比较了所有接受 FOAR、开放式 FODO 和内窥镜辅助 FODO("endo-FODO")的患者的围手术期和并发症特征。对接受 FODO 手术的患者和同时接受 FOAR 手术的年龄匹配对照组患者术后五年以上的美学效果进行了比较。计算了术前和术后眶周对称性比率、眼窝倾斜对称性、眶距角(ODA)和额颢角之间的差异,正差异代表术后改善:41名患者在中位年龄9.7、5.4和5.4个月时分别接受了FOAR组、开放式FODO组和内科FODO组的治疗。在术后中位 6.3 年拍照的 28 名患者中,FODO 组显示出更高的边缘到反射距离 1 对称性(6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5],P=0.与 FOAR 队列相比,FOD 患者术后的腱反射距离 1 对称性(6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5],p=0.010)和胼胝体倾斜对称性(0.9° [0.2°, 2.9°] vs. 3.3° [2.3°, 5.3°],p=0.004)以及 ODA 矫正(5.4° [4.0°, 7.5°] vs. 3.0° [2.5°, 4.4°],p=0.027)更高。与 FOAR 组相比,FODO 组术后出现颞部凹陷的患者较少(14% vs. 71%,p=0.002):结论:与FOAR相比,FODO与更大的眶周对称性、更大的眶内斜视矫正以及长期的颞部凹陷减少有关。要充分比较这两种技术,还需要对颅骨成熟度进行随访。
{"title":"The Evolution of Unicoronal Synostosis Correction: Long-Term Aesthetic Outcomes of Fronto-Orbital Distraction Versus Traditional Advancement.","authors":"Meagan Wu, Benjamin B Massenburg, Dillan F Villavisanis, Ashley E Chang, Dominic J Romeo, Jinggang J Ng, Joseph A Napoli, Scott P Bartlett, Jordan W Swanson, Jesse A Taylor","doi":"10.1097/PRS.0000000000011844","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011844","url":null,"abstract":"<p><strong>Introduction: </strong>This study compares the long-term aesthetic outcomes of patients with unicoronal synostosis (UCS) who underwent fronto-orbital distraction osteogenesis (FODO) versus traditional fronto-orbital advancement and remodeling (FOAR).</p><p><strong>Methods: </strong>Patients treated for nonsyndromic UCS from 2009 to 2023 were retrospectively reviewed. Perioperative and complication characteristics were compared between all patients who underwent FOAR, open FODO, and endoscopic-assisted FODO (\"endo-FODO\"). Aesthetic outcomes at greater than five years postoperatively were compared between patients who underwent FODO and a contemporaneous cohort of age-matched controls who underwent FOAR. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, orbital dystopia angle (ODA), and frontal bossing angle were calculated, with positive differences representing postoperative improvement.</p><p><strong>Results: </strong>Forty-one patients were treated at a median age of 9.7, 5.4, and 5.4 months in the FOAR, open FODO, and endo-FODO groups, respectively. Among 28 patients photographed at a median of 6.3 years postoperatively, the FODO cohort demonstrated greater margin-to-reflex distance 1 symmetry (6.5 [-9.3, 0.0] vs. -13.9 [-22.9, -11.5], p=0.010) and canthal tilt symmetry (0.9° [0.2°, 2.9°] vs. 3.3° [2.3°, 5.3°], p=0.004) postoperatively as well as ODA correction (5.4° [4.0°, 7.5°] vs. 3.0° [2.5°, 4.4°], p=0.027) compared to the FOAR cohort. Fewer patients in the FODO cohort exhibited temporal hollowing postoperatively compared to the FOAR cohort (14% vs. 71%, p=0.002).</p><p><strong>Conclusions: </strong>Compared to FOAR, FODO was associated with greater periorbital symmetry, greater orbital dystopia correction, and reduced temporal hollowing in the long-term. Follow-up to cranial maturity is needed to adequately compare the two techniques.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/PRS.0000000000011841
Mathias Ørholt, Tim K Weltz, Mathilde N Hemmingsen, Andreas Larsen, Erik E F Bak, Caroline B Norlin, Liv Hart, Jens Jørgen Elberg, Peter V Vester-Glowinski, Mikkel Herly
Background: Fat grafting is increasingly used for breast augmentation. However, long-term volume retention, time to reach steady state, and the effect of postoperative weight changes on these outcomes are not fully understood.
Methods: In this prospective study, we included patients undergoing breast augmentation with fat grafting and examined them with MRI preoperatively and up to three years postoperatively. We modeled fat graft retention over time and calculated the time to volumetric steady state of the fat graft. Secondly, we used our model to assess the effect of postoperative weight changes on fat graft retention and to determine the association between the graft/recipient volume ratio and the percentage breast augmentation at steady state. Finally, we assessed patient satisfaction using the BREAST-Q questionnaire.
Results: The study included 28 patients (46 breasts). The time to steady state was 253 days (95%CI 185-283) postoperatively, with a volume retention of 46% (95%CI 35-58). Patients with a weight loss of one BMI point after surgery had a volume retention of 22% (95%CI 4.7-38) while those increasing one and two BMI points had retention rates of 57% (95%CI 45-69) and 85% (95%CI 72-98), respectively. Increasing graft/recipient volume ratio was associated with higher percentage augmentation with no plateau in this relationship even up to ratios of 2:1. Postoperative satisfaction with breasts and sexual well-being increased substantially.
Conclusions: Breast augmentation with fat grafting reached volumetric steady state after 8 months with a volume retention of 46%. Weight loss following fat grafting leads to significantly lower volume retention.
{"title":"Long-term volume retention of breast augmentation with fat grafting depends on weight changes: a three-year prospective MRI study.","authors":"Mathias Ørholt, Tim K Weltz, Mathilde N Hemmingsen, Andreas Larsen, Erik E F Bak, Caroline B Norlin, Liv Hart, Jens Jørgen Elberg, Peter V Vester-Glowinski, Mikkel Herly","doi":"10.1097/PRS.0000000000011841","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011841","url":null,"abstract":"<p><strong>Background: </strong>Fat grafting is increasingly used for breast augmentation. However, long-term volume retention, time to reach steady state, and the effect of postoperative weight changes on these outcomes are not fully understood.</p><p><strong>Methods: </strong>In this prospective study, we included patients undergoing breast augmentation with fat grafting and examined them with MRI preoperatively and up to three years postoperatively. We modeled fat graft retention over time and calculated the time to volumetric steady state of the fat graft. Secondly, we used our model to assess the effect of postoperative weight changes on fat graft retention and to determine the association between the graft/recipient volume ratio and the percentage breast augmentation at steady state. Finally, we assessed patient satisfaction using the BREAST-Q questionnaire.</p><p><strong>Results: </strong>The study included 28 patients (46 breasts). The time to steady state was 253 days (95%CI 185-283) postoperatively, with a volume retention of 46% (95%CI 35-58). Patients with a weight loss of one BMI point after surgery had a volume retention of 22% (95%CI 4.7-38) while those increasing one and two BMI points had retention rates of 57% (95%CI 45-69) and 85% (95%CI 72-98), respectively. Increasing graft/recipient volume ratio was associated with higher percentage augmentation with no plateau in this relationship even up to ratios of 2:1. Postoperative satisfaction with breasts and sexual well-being increased substantially.</p><p><strong>Conclusions: </strong>Breast augmentation with fat grafting reached volumetric steady state after 8 months with a volume retention of 46%. Weight loss following fat grafting leads to significantly lower volume retention.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}