Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006202
Joseph Banuelos, M. Sabbagh, Si-Gyun Roh, M. Nguyen, V. Lemaine, N. Tran, S. Jacobson, J. Boughey, J. Jakub, T. Hieken, A. Degnim, J. Mandrekar, E. Berbari, Basel Sharaf
BACKGROUND Surgical-site infection after implant-based breast reconstruction adversely affects surgical outcomes and increases health care costs. This 11-year case-control study examines risk factors specific for surgical-site infection after immediate tissue expander/implant-based breast reconstruction. METHODS The authors performed a retrospective review to identify all consecutive patients with breast implant infections between 2006 and 2016. Patients who developed surgical-site infection after immediate tissue expander/implant-based breast reconstruction were included. Surgical-site infection was defined using the Centers for Disease Control and Prevention criteria; specifically, infections requiring hospital admission, intravenous antibiotics, or surgical intervention were included. The authors matched a control patient to each infection case by patient age and date of surgery. Patient demographics, medical comorbidities, and perioperative surgical variables were examined. Univariate and multivariable conditional logistic regression models were constructed. RESULTS A total of 270 breasts in 252 patients were evaluated. On multivariate analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95 percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95 percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95 percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95 percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with surgical-site infection. CONCLUSIONS Women with obesity, women with hypertension, and those treated with neoadjuvant chemotherapy are at increased risk of surgical-site infection. Further risks are also associated with postoperative seroma and wound complications. This may help patient selection and counseling, adjusted based on risk factors regarding complications of immediate implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
{"title":"Infections following Immediate Implant-Based Breast Reconstruction: A Case-Control Study over 11 Years.","authors":"Joseph Banuelos, M. Sabbagh, Si-Gyun Roh, M. Nguyen, V. Lemaine, N. Tran, S. Jacobson, J. Boughey, J. Jakub, T. Hieken, A. Degnim, J. Mandrekar, E. Berbari, Basel Sharaf","doi":"10.1097/PRS.0000000000006202","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006202","url":null,"abstract":"BACKGROUND\u0000Surgical-site infection after implant-based breast reconstruction adversely affects surgical outcomes and increases health care costs. This 11-year case-control study examines risk factors specific for surgical-site infection after immediate tissue expander/implant-based breast reconstruction.\u0000\u0000\u0000METHODS\u0000The authors performed a retrospective review to identify all consecutive patients with breast implant infections between 2006 and 2016. Patients who developed surgical-site infection after immediate tissue expander/implant-based breast reconstruction were included. Surgical-site infection was defined using the Centers for Disease Control and Prevention criteria; specifically, infections requiring hospital admission, intravenous antibiotics, or surgical intervention were included. The authors matched a control patient to each infection case by patient age and date of surgery. Patient demographics, medical comorbidities, and perioperative surgical variables were examined. Univariate and multivariable conditional logistic regression models were constructed.\u0000\u0000\u0000RESULTS\u0000A total of 270 breasts in 252 patients were evaluated. On multivariate analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95 percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95 percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95 percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95 percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with surgical-site infection.\u0000\u0000\u0000CONCLUSIONS\u0000Women with obesity, women with hypertension, and those treated with neoadjuvant chemotherapy are at increased risk of surgical-site infection. Further risks are also associated with postoperative seroma and wound complications. This may help patient selection and counseling, adjusted based on risk factors regarding complications of immediate implant-based breast reconstruction.\u0000\u0000\u0000CLINICAL QUESTION/LEVEL OF EVIDENCE\u0000Risk, III.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81988951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006265
F. Franchignoni, A. Giordano, S. Vercelli, Elisabetta Bravini, Valeria Stissi, G. Ferriero
BACKGROUND The Patient and Observer Scar Assessment Scale (POSAS) v2.0 is a widely used instrument to evaluate postsurgical scars. Its two subscales respectively investigate the patient's and clinician's opinion on the scar quality. However, psychometric studies of the POSAS have indicated that its metric performance is suboptimal, and structural adjustments may be appropriate. The authors aimed to verify through Rasch analysis the measurement properties of the POSAS v2.0, and propose eventual structural refinements for an easier and more confident use of the scale in clinical practice and research. METHODS Consecutive patients admitted to two rehabilitation centers for postsurgery rehabilitation over a 2-year period underwent scar assessments with the POSAS v2.0. We performed Rasch analysis to examine the scale's dimensionality, rating categories, item fit, reliability indices, local item independence, and differential item functioning. RESULTS The study population consisted of 115 patients. The 10 response options of the POSAS showed malfunctioning, and thus were collapsed, forming a parsimonious five-level rating scale, which helped to improve the measurement accuracy. After that, unidimensionality of both subscales was confirmed. Then, internal construct validity of the POSAS v2.0 was demonstrated (through item fit to the Rasch model). Reliability indices were high (≥0.80). No significant differential item functioning was detected concerning age or sex. CONCLUSION This study demonstrates the good psychometric properties of a simplified Rasch-based version of the Patient and Observer Scar Assessment Scale with five response options (POSAS v2.1) in patients with postsurgical linear scars, and provides insights for future refinement of the tool.
{"title":"Rasch Analysis of the Patient and Observer Scar Assessment Scale in Linear Scars: Suggestions for a Patient and Observer Scar Assessment Scale v2.1.","authors":"F. Franchignoni, A. Giordano, S. Vercelli, Elisabetta Bravini, Valeria Stissi, G. Ferriero","doi":"10.1097/PRS.0000000000006265","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006265","url":null,"abstract":"BACKGROUND\u0000The Patient and Observer Scar Assessment Scale (POSAS) v2.0 is a widely used instrument to evaluate postsurgical scars. Its two subscales respectively investigate the patient's and clinician's opinion on the scar quality. However, psychometric studies of the POSAS have indicated that its metric performance is suboptimal, and structural adjustments may be appropriate. The authors aimed to verify through Rasch analysis the measurement properties of the POSAS v2.0, and propose eventual structural refinements for an easier and more confident use of the scale in clinical practice and research.\u0000\u0000\u0000METHODS\u0000Consecutive patients admitted to two rehabilitation centers for postsurgery rehabilitation over a 2-year period underwent scar assessments with the POSAS v2.0. We performed Rasch analysis to examine the scale's dimensionality, rating categories, item fit, reliability indices, local item independence, and differential item functioning.\u0000\u0000\u0000RESULTS\u0000The study population consisted of 115 patients. The 10 response options of the POSAS showed malfunctioning, and thus were collapsed, forming a parsimonious five-level rating scale, which helped to improve the measurement accuracy. After that, unidimensionality of both subscales was confirmed. Then, internal construct validity of the POSAS v2.0 was demonstrated (through item fit to the Rasch model). Reliability indices were high (≥0.80). No significant differential item functioning was detected concerning age or sex.\u0000\u0000\u0000CONCLUSION\u0000This study demonstrates the good psychometric properties of a simplified Rasch-based version of the Patient and Observer Scar Assessment Scale with five response options (POSAS v2.1) in patients with postsurgical linear scars, and provides insights for future refinement of the tool.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87473488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006227
M. Danino, A. El Khatib, O. Doucet, Lan Dao, J. Efanov, J. Bou-Merhi, M. Iliescu-nelea
Acellular dermal matrices have become a mandatory tool in reconstructive breast surgery. Since their introduction, they have been considered to be nonreactive and nonimmunogenic scaffolds. However, some patients who undergo implant-based breast reconstruction with acellular dermal matrices develop postoperative cutaneous erythema overlying their matrices, a condition commonly referred to as red breast syndrome. The aim of this study was to gain a better understanding of this phenomenon. An analysis was conducted on consecutive patients who underwent acellular dermal matrix- and implant-based breast reconstructions and developed red breast syndrome that was treated surgically between April of 2017 and June of 2018 at the authors' institution. During surgery, 1-cm specimens of acellular dermal matrix were sampled and analyzed by scanning electron microscopy. Observations were charted to score and record the presence and thickness of biofilm, and for identification of bacteria. These measurements were performed using Adobe Photoshop CS6 Extended software. Six postmastectomy breast reconstruction patients were included, all with AlloDerm Ready-to-Use-based reconstructions. All specimens were colonized by various bacteria ranging from Gram-negative bacilli to Gram-positive microorganisms. Biofilm was present in all studied specimens. The cause of skin erythema overlying acellular dermal matrix grafts, and the so-called red breast syndrome, may be related to contamination with various bacteria. Although contamination was omnipresent in analyzed samples, its clinical significance is variable. Even if acellular dermal matrix-based reconstructions are salvaged, this could come at the price of chronic local inflammation.
{"title":"Preliminary Results Supporting the Bacterial Hypothesis in Red Breast Syndrome following Postmastectomy Acellular Dermal Matrix- and Implant-Based Reconstructions.","authors":"M. Danino, A. El Khatib, O. Doucet, Lan Dao, J. Efanov, J. Bou-Merhi, M. Iliescu-nelea","doi":"10.1097/PRS.0000000000006227","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006227","url":null,"abstract":"Acellular dermal matrices have become a mandatory tool in reconstructive breast surgery. Since their introduction, they have been considered to be nonreactive and nonimmunogenic scaffolds. However, some patients who undergo implant-based breast reconstruction with acellular dermal matrices develop postoperative cutaneous erythema overlying their matrices, a condition commonly referred to as red breast syndrome. The aim of this study was to gain a better understanding of this phenomenon. An analysis was conducted on consecutive patients who underwent acellular dermal matrix- and implant-based breast reconstructions and developed red breast syndrome that was treated surgically between April of 2017 and June of 2018 at the authors' institution. During surgery, 1-cm specimens of acellular dermal matrix were sampled and analyzed by scanning electron microscopy. Observations were charted to score and record the presence and thickness of biofilm, and for identification of bacteria. These measurements were performed using Adobe Photoshop CS6 Extended software. Six postmastectomy breast reconstruction patients were included, all with AlloDerm Ready-to-Use-based reconstructions. All specimens were colonized by various bacteria ranging from Gram-negative bacilli to Gram-positive microorganisms. Biofilm was present in all studied specimens. The cause of skin erythema overlying acellular dermal matrix grafts, and the so-called red breast syndrome, may be related to contamination with various bacteria. Although contamination was omnipresent in analyzed samples, its clinical significance is variable. Even if acellular dermal matrix-based reconstructions are salvaged, this could come at the price of chronic local inflammation.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"402 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76620154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006251
Miao Chen, Xiucun Li, Zhenmin Jiang, Xu Gong
BACKGROUND Surgical delay can improve flap viability, leading to vasodilation, neovascularization, and vessel reorganization. Experiments suggest similar positive effect of botulinum toxin A (BTX-A) on pedicled flaps' viability. However, whether it may convert the choke anastomoses into the true anastomoses and how to identify the optimal timing for flap transfer remains unclear. METHODS One hundred and fifty-four Sprague-Dawley rats were divided into a control group, three saline injection groups, and three BTX-A injection groups defined by time of injection (2, 3, 4 weeks before flap harvest). A pedicled flap of 11×3 cm was marked on the unilateral dorsum of rat. Before flap harvest, the flap donors were assessed by the infrared thermal imaging, postmortem arteriography, immunohistochemical staining of CD 31 and ELISA. Flap survival areas percentage was measured on postoperative day 7. RESULTS In the control group and saline groups, the infrared thermography showed three independent white hotspots interspaced by red zones over flaps, whereas it presented a continuous white band in the BTX-A groups. There was a significant increase in the flap survival area, flap surface temperatures, the numbers of identifiable vessels in the choke zones, microvascular density and vascular endothelial growth factor concentration in the BTX-A groups. CONCLUSIONS BTX-A can convert the choke anastomoses into the true anastomoses and its preconditioning effect cannot increase over time; it is appropriate to choose the timing point when the infrared thermal images show a continuous white band existing over flaps for flap transfer.
{"title":"Visualizing the pharmacological preconditioning effect of botulinum toxin A by the infrared thermography in a rat pedicled perforator island flap model.","authors":"Miao Chen, Xiucun Li, Zhenmin Jiang, Xu Gong","doi":"10.1097/PRS.0000000000006251","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006251","url":null,"abstract":"BACKGROUND\u0000Surgical delay can improve flap viability, leading to vasodilation, neovascularization, and vessel reorganization. Experiments suggest similar positive effect of botulinum toxin A (BTX-A) on pedicled flaps' viability. However, whether it may convert the choke anastomoses into the true anastomoses and how to identify the optimal timing for flap transfer remains unclear.\u0000\u0000\u0000METHODS\u0000One hundred and fifty-four Sprague-Dawley rats were divided into a control group, three saline injection groups, and three BTX-A injection groups defined by time of injection (2, 3, 4 weeks before flap harvest). A pedicled flap of 11×3 cm was marked on the unilateral dorsum of rat. Before flap harvest, the flap donors were assessed by the infrared thermal imaging, postmortem arteriography, immunohistochemical staining of CD 31 and ELISA. Flap survival areas percentage was measured on postoperative day 7.\u0000\u0000\u0000RESULTS\u0000In the control group and saline groups, the infrared thermography showed three independent white hotspots interspaced by red zones over flaps, whereas it presented a continuous white band in the BTX-A groups. There was a significant increase in the flap survival area, flap surface temperatures, the numbers of identifiable vessels in the choke zones, microvascular density and vascular endothelial growth factor concentration in the BTX-A groups.\u0000\u0000\u0000CONCLUSIONS\u0000BTX-A can convert the choke anastomoses into the true anastomoses and its preconditioning effect cannot increase over time; it is appropriate to choose the timing point when the infrared thermal images show a continuous white band existing over flaps for flap transfer.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73504738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006293
M. Nahabedian
www.PRSJournal.com 1267 I this study, the authors used eye-tracking technology to assess the gazing patterns of 100 laypersons that included 50 men and 50 women as they looked at digital images of eight different female breasts that included frontal, lateral, and oblique views.1 Each breast image was divided into several areas of interest that included the nippleareola complex, breast quadrants, neck, clavicular region, sternal region, and inframammary fold. The observers were told to assess breast aesthetics and symmetry on a scale ranging from 1 to 10. Eye-tracking technology was used for each participant; however, the true purpose of the eye tracking was not revealed until after the study was completed. The observers assessed each image for 30 seconds before going on to the next image. During this time interval, visual gaze data were accrued and included the duration of gaze and the number of times their gaze was directed at a particular area of interest. Findings included no difference in the mean duration of gaze for each image between the men and women, with a range of 21.21 to 22.08 seconds. The remainder of the 30 seconds was spent on blinking and saccadic eye movements. The authors found that, for both groups, the longest fixation duration and the highest fixation number were recorded for lower breast regions and the nipple-areola complex. I believe that this is a fascinating study for several reasons. First, it demonstrates that eye tracking can provide useful information during object analysis. Previous work has validated eye tracking based on oculomotor metrics including fixation frequency and duration, saccade variation, eye blink, and pupil diameter.2 Second, it demonstrates that men and women tend to focus on the same areas of the breast without gender disparity. It is not surprising that the nipple-areola complex had the highest gaze duration, as this is the focal point of the breast and usually the reference point for symmetry. Third, I applaud the authors for including the lay public as the principal subjects because this established a true baseline without inherent bias. Had the observers been plastic surgeons, the gaze patterns may have been different because of inherent bias as to the parameters that constitute an ideal breast. Finally, I believe that this study will be extremely useful moving forward as we try to better understand patient expectations in the preoperative setting. It is this point that I will further elaborate on. One of the most frustrating aspects of aesthetic and reconstructive breast surgery is performing an operation in which the plastic surgeon is happy with the result, but the patient is not. We all appreciate that “setting” patient expectations preoperatively is important; however, truly “understanding” patient expectations is critical. How a plastic surgeon sees the breast may be completely different than how a patient sees her breast. Having knowledge of this disparity preoperatively may serve as va
{"title":"Discussion: Analysis of the Visual Perception of Female Breast Aesthetics and Symmetry: An Eye-Tracking Study.","authors":"M. Nahabedian","doi":"10.1097/PRS.0000000000006293","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006293","url":null,"abstract":"www.PRSJournal.com 1267 I this study, the authors used eye-tracking technology to assess the gazing patterns of 100 laypersons that included 50 men and 50 women as they looked at digital images of eight different female breasts that included frontal, lateral, and oblique views.1 Each breast image was divided into several areas of interest that included the nippleareola complex, breast quadrants, neck, clavicular region, sternal region, and inframammary fold. The observers were told to assess breast aesthetics and symmetry on a scale ranging from 1 to 10. Eye-tracking technology was used for each participant; however, the true purpose of the eye tracking was not revealed until after the study was completed. The observers assessed each image for 30 seconds before going on to the next image. During this time interval, visual gaze data were accrued and included the duration of gaze and the number of times their gaze was directed at a particular area of interest. Findings included no difference in the mean duration of gaze for each image between the men and women, with a range of 21.21 to 22.08 seconds. The remainder of the 30 seconds was spent on blinking and saccadic eye movements. The authors found that, for both groups, the longest fixation duration and the highest fixation number were recorded for lower breast regions and the nipple-areola complex. I believe that this is a fascinating study for several reasons. First, it demonstrates that eye tracking can provide useful information during object analysis. Previous work has validated eye tracking based on oculomotor metrics including fixation frequency and duration, saccade variation, eye blink, and pupil diameter.2 Second, it demonstrates that men and women tend to focus on the same areas of the breast without gender disparity. It is not surprising that the nipple-areola complex had the highest gaze duration, as this is the focal point of the breast and usually the reference point for symmetry. Third, I applaud the authors for including the lay public as the principal subjects because this established a true baseline without inherent bias. Had the observers been plastic surgeons, the gaze patterns may have been different because of inherent bias as to the parameters that constitute an ideal breast. Finally, I believe that this study will be extremely useful moving forward as we try to better understand patient expectations in the preoperative setting. It is this point that I will further elaborate on. One of the most frustrating aspects of aesthetic and reconstructive breast surgery is performing an operation in which the plastic surgeon is happy with the result, but the patient is not. We all appreciate that “setting” patient expectations preoperatively is important; however, truly “understanding” patient expectations is critical. How a plastic surgeon sees the breast may be completely different than how a patient sees her breast. Having knowledge of this disparity preoperatively may serve as va","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91516671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006248
T. Lee, Sanghoon Park
The occlusal plane angle is an important factor in lateral facial aesthetics. Low occlusal plane facial profiles appear planar and long-faced, whereas high occlusal plane facial profiles are considered more attractive, especially in Asian regions. Clockwise rotation of the occlusal plane for truly aesthetic purposes can be accomplished with double jaw surgery, without need for orthodontic treatments. Patients with normal occlusion who desired to improve their lateral facial aesthetics were included in this study. A conventional Le Fort I osteotomy was followed by a sagittal split ramus osteotomy under general anesthesia. The movement of the maxillomandibular complex was determined in accord with a preoperative analysis. From 2015 to 2017, 43 patients with normal occlusion underwent double jaw surgery without orthodontic treatment. Whereas all patients were subjectively satisfied with the surgery, two underwent orthodontic treatment to correct mild occlusal discrepancies noticed after surgery. There were no delayed occlusal problems or relapses reported during the study. For patients who desired to improve their lateral facial aesthetics but had normal occlusion, orthognathic surgery without orthodontic treatment can be effective. Clockwise rotation of the occlusal plane by double jaw surgery without orthodontic treatment resulted in satisfactory aesthetic outcomes with stable and reliable long-term results. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
咬合面角是影响侧脸美观的重要因素。低咬合面面部轮廓显得平面和长脸，而高咬合面面部轮廓被认为更具吸引力，特别是在亚洲地区。顺时针旋转的咬合平面真正美观的目的可以完成双颌手术，而不需要正畸治疗。希望改善侧面面部美观的正常咬合患者被纳入本研究。常规Le Fort I型截骨术后在全身麻醉下行矢状分叉支截骨术。上颌下颌复合体的运动与术前分析一致。2015年至2017年，43例正常咬合患者在未进行正畸治疗的情况下接受了双颌手术。所有患者主观上都对手术满意，其中2例接受了正畸治疗，以纠正术后发现的轻度咬合差异。在研究期间，没有迟发性咬合问题或复发报告。对于希望改善侧面面部美观但咬合正常的患者，不进行正畸治疗的正颌手术是有效的。双颌手术在不进行正畸治疗的情况下顺时针旋转咬合平面，获得了满意的美学效果，长期效果稳定可靠。临床问题/证据水平:治疗性，IV。
{"title":"Clockwise Rotation of the Occlusal Plane for Aesthetic Purposes by Double Jaw Surgery without Orthodontic Treatment.","authors":"T. Lee, Sanghoon Park","doi":"10.1097/PRS.0000000000006248","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006248","url":null,"abstract":"The occlusal plane angle is an important factor in lateral facial aesthetics. Low occlusal plane facial profiles appear planar and long-faced, whereas high occlusal plane facial profiles are considered more attractive, especially in Asian regions. Clockwise rotation of the occlusal plane for truly aesthetic purposes can be accomplished with double jaw surgery, without need for orthodontic treatments. Patients with normal occlusion who desired to improve their lateral facial aesthetics were included in this study. A conventional Le Fort I osteotomy was followed by a sagittal split ramus osteotomy under general anesthesia. The movement of the maxillomandibular complex was determined in accord with a preoperative analysis. From 2015 to 2017, 43 patients with normal occlusion underwent double jaw surgery without orthodontic treatment. Whereas all patients were subjectively satisfied with the surgery, two underwent orthodontic treatment to correct mild occlusal discrepancies noticed after surgery. There were no delayed occlusal problems or relapses reported during the study. For patients who desired to improve their lateral facial aesthetics but had normal occlusion, orthognathic surgery without orthodontic treatment can be effective. Clockwise rotation of the occlusal plane by double jaw surgery without orthodontic treatment resulted in satisfactory aesthetic outcomes with stable and reliable long-term results. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88217443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006281
Yijun Xia, Jun Zhao, Juan Xie, Yang Lv, Dongsheng Cao
BACKGROUND Several randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds have been published. Previous articles have revealed that the role of platelet-rich plasma in promoting chronic wound healing is uncertain. This quantitative meta-analysis was conducted to evaluate whether superior outcomes can be obtained by using platelet-rich plasma in nonhealing ulcers compared with traditional wound care. METHODS The PubMed, EMBASE, EBSCO (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases were searched through November of 2018 for randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds. For binary outcome measures, we calculated the risk ratio. The continuous outcomes were expressed as the mean differences. Subgroup analyses were also performed according to the type of chronic ulcer. RESULTS Overall, 630 adult patients in 15 randomized controlled trials from 2000 to 2018 were included. The number of ulcers healed in the platelet-rich plasma group was higher than in the control group, and the difference was statistically significant (risk ratio, 1.26; 95 percent CI, 1.11 to 1.42; p = 0.0003). During the fourth week of follow-up, the number of ulcers healed in the platelet-rich plasma group was significantly greater than in the control group (risk ratio, 3.50; 95 percent CI, 1.80 to 6.81; p = 0.0002). CONCLUSIONS Platelet-rich plasma is a valuable and safe treatment dressing for chronic nonhealing ulcers; it is simple to prepare and has remarkable effects. Further high-quality prospective studies are necessary to validate these results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
{"title":"The Efficacy of Platelet-Rich Plasma Dressing for Chronic Nonhealing Ulcers: A Meta-Analysis of 15 Randomized Controlled Trials.","authors":"Yijun Xia, Jun Zhao, Juan Xie, Yang Lv, Dongsheng Cao","doi":"10.1097/PRS.0000000000006281","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006281","url":null,"abstract":"BACKGROUND\u0000Several randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds have been published. Previous articles have revealed that the role of platelet-rich plasma in promoting chronic wound healing is uncertain. This quantitative meta-analysis was conducted to evaluate whether superior outcomes can be obtained by using platelet-rich plasma in nonhealing ulcers compared with traditional wound care.\u0000\u0000\u0000METHODS\u0000The PubMed, EMBASE, EBSCO (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases were searched through November of 2018 for randomized controlled trials comparing platelet-rich plasma to standard wound care for chronic wounds. For binary outcome measures, we calculated the risk ratio. The continuous outcomes were expressed as the mean differences. Subgroup analyses were also performed according to the type of chronic ulcer.\u0000\u0000\u0000RESULTS\u0000Overall, 630 adult patients in 15 randomized controlled trials from 2000 to 2018 were included. The number of ulcers healed in the platelet-rich plasma group was higher than in the control group, and the difference was statistically significant (risk ratio, 1.26; 95 percent CI, 1.11 to 1.42; p = 0.0003). During the fourth week of follow-up, the number of ulcers healed in the platelet-rich plasma group was significantly greater than in the control group (risk ratio, 3.50; 95 percent CI, 1.80 to 6.81; p = 0.0002).\u0000\u0000\u0000CONCLUSIONS\u0000Platelet-rich plasma is a valuable and safe treatment dressing for chronic nonhealing ulcers; it is simple to prepare and has remarkable effects. Further high-quality prospective studies are necessary to validate these results.\u0000\u0000\u0000CLINICAL QUESTION/LEVEL OF EVIDENCE\u0000Therapeutic, II.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89569922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006270
Thijs Bink, L. Duraku, Ryan P. Ter Louw, J. Zuidam, I. Mathijssen, C. Driessen
BACKGROUND Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias. METHODS A systematic review was conducted to study the efficacy of decompression of extracranial sensory nerves as a treatment for neuralgia. Clinical studies were included that studied patients, aged 18 years or older, diagnosed with any definition of headache and were treated with extracranial nerve decompression surgery. Outcome parameters included intensity (on a 10-point scale), duration (in days), and frequency (of headaches per month). RESULTS Thirty-eight articles were found describing extracranial nerve decompression in patients with headaches. Postoperative decrease in headache intensity ranged from 2 to 8.2, reduction of duration ranged from 0.04 to 1.04 days, and reduction in frequency ranged between 4 and 14.8 headaches per month. Total elimination of symptoms was achieved in 8.3 to 83 percent of cases. A detailed summary of the outcome of single-site decompression is described. Statistical pooling and therefore meta-analysis was not possible, because of articles having the same surgeon and an overlapping patient database. CONCLUSIONS Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.
{"title":"The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache.","authors":"Thijs Bink, L. Duraku, Ryan P. Ter Louw, J. Zuidam, I. Mathijssen, C. Driessen","doi":"10.1097/PRS.0000000000006270","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006270","url":null,"abstract":"BACKGROUND\u0000Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias.\u0000\u0000\u0000METHODS\u0000A systematic review was conducted to study the efficacy of decompression of extracranial sensory nerves as a treatment for neuralgia. Clinical studies were included that studied patients, aged 18 years or older, diagnosed with any definition of headache and were treated with extracranial nerve decompression surgery. Outcome parameters included intensity (on a 10-point scale), duration (in days), and frequency (of headaches per month).\u0000\u0000\u0000RESULTS\u0000Thirty-eight articles were found describing extracranial nerve decompression in patients with headaches. Postoperative decrease in headache intensity ranged from 2 to 8.2, reduction of duration ranged from 0.04 to 1.04 days, and reduction in frequency ranged between 4 and 14.8 headaches per month. Total elimination of symptoms was achieved in 8.3 to 83 percent of cases. A detailed summary of the outcome of single-site decompression is described. Statistical pooling and therefore meta-analysis was not possible, because of articles having the same surgeon and an overlapping patient database.\u0000\u0000\u0000CONCLUSIONS\u0000Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"156 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90767591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006268
A. Murphy, S. Haykal, D. Lalonde, T. Zhong
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Describe the fundamental concepts of multimodal analgesia techniques and how they target pain pathophysiology. 2. Effectively educate patients on postoperative pain and safe opioid use. 3. Develop and implement a multimodal postoperative analgesia regimen. SUMMARY For many years, opioids were the cornerstone of postoperative pain control, contributing to what has become a significant public health concern. This article discusses contemporary approaches to multimodal, opioid-sparing postoperative pain management in the plastic surgical patient.
{"title":"Contemporary Approaches to Postoperative Pain Management.","authors":"A. Murphy, S. Haykal, D. Lalonde, T. Zhong","doi":"10.1097/PRS.0000000000006268","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006268","url":null,"abstract":"LEARNING OBJECTIVES\u0000After reading this article, the participant should be able to: 1. Describe the fundamental concepts of multimodal analgesia techniques and how they target pain pathophysiology. 2. Effectively educate patients on postoperative pain and safe opioid use. 3. Develop and implement a multimodal postoperative analgesia regimen.\u0000\u0000\u0000SUMMARY\u0000For many years, opioids were the cornerstone of postoperative pain control, contributing to what has become a significant public health concern. This article discusses contemporary approaches to multimodal, opioid-sparing postoperative pain management in the plastic surgical patient.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90113806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/PRS.0000000000006254
Erin R. Wallace, C. Birgfeld, M. Speltz, J. Starr, B. Collett
BACKGROUND Surgical repair for craniosynostosis varies depending on the infant's age, location of suture fusion, and approach (e.g., open versus endoscopic). Existing data suggest possible racial and ethnic disparities in timely access to surgical care for craniosynostosis that may, in turn, be associated with surgical approach and perioperative outcomes. This study examined racial and ethnic variation in craniosynostosis operations by surgical approach and perioperative outcomes. METHODS Data were collected by the 2013 to 2015 Pediatric National Surgical Quality Improvement Program. Patients aged younger than 24 months with diagnoses and procedure codes consistent with surgery for craniosynostosis were identified. Periprocedural characteristics and surgical approach (open, endoscopic/minimally invasive, or both) were examined descriptively, overall, and separately by race and ethnicity. RESULTS The authors identified 1982 admissions. Mean age at surgery was 7.8 ± 4.7 months. Ninety-one percent of procedures were classified as open operations, 5.8 percent were endoscopic, and 3.4 percent were both open and endoscopic. Relative to white/non-Hispanic patients, Hispanic and nonwhite patients underwent surgery at older ages, experienced longer operative and anesthesia times, and were hospitalized longer. Hispanic patients had the highest rates of open operations. CONCLUSIONS These data suggest that Hispanic and nonwhite patients tend to undergo craniosynostosis repair at older ages and to have lengthier operations than white/non-Hispanic patients. Although we were unable to examine the root cause(s) of these differences, delayed diagnosis is one factor that might result in surgery at an older age and more complex operations requiring open surgery. Prospective studies examining racial/ethnic disparities are needed to inform a comparison of outcomes associated with surgical approach.
{"title":"Surgical Approach and Periprocedural Outcomes by Race and Ethnicity of Children Undergoing Craniosynostosis Surgery.","authors":"Erin R. Wallace, C. Birgfeld, M. Speltz, J. Starr, B. Collett","doi":"10.1097/PRS.0000000000006254","DOIUrl":"https://doi.org/10.1097/PRS.0000000000006254","url":null,"abstract":"BACKGROUND\u0000Surgical repair for craniosynostosis varies depending on the infant's age, location of suture fusion, and approach (e.g., open versus endoscopic). Existing data suggest possible racial and ethnic disparities in timely access to surgical care for craniosynostosis that may, in turn, be associated with surgical approach and perioperative outcomes. This study examined racial and ethnic variation in craniosynostosis operations by surgical approach and perioperative outcomes.\u0000\u0000\u0000METHODS\u0000Data were collected by the 2013 to 2015 Pediatric National Surgical Quality Improvement Program. Patients aged younger than 24 months with diagnoses and procedure codes consistent with surgery for craniosynostosis were identified. Periprocedural characteristics and surgical approach (open, endoscopic/minimally invasive, or both) were examined descriptively, overall, and separately by race and ethnicity.\u0000\u0000\u0000RESULTS\u0000The authors identified 1982 admissions. Mean age at surgery was 7.8 ± 4.7 months. Ninety-one percent of procedures were classified as open operations, 5.8 percent were endoscopic, and 3.4 percent were both open and endoscopic. Relative to white/non-Hispanic patients, Hispanic and nonwhite patients underwent surgery at older ages, experienced longer operative and anesthesia times, and were hospitalized longer. Hispanic patients had the highest rates of open operations.\u0000\u0000\u0000CONCLUSIONS\u0000These data suggest that Hispanic and nonwhite patients tend to undergo craniosynostosis repair at older ages and to have lengthier operations than white/non-Hispanic patients. Although we were unable to examine the root cause(s) of these differences, delayed diagnosis is one factor that might result in surgery at an older age and more complex operations requiring open surgery. Prospective studies examining racial/ethnic disparities are needed to inform a comparison of outcomes associated with surgical approach.","PeriodicalId":20168,"journal":{"name":"Plastic & Reconstructive Surgery","volume":"196 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79876911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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