Kashish Malhotra, Sophie Bondje, Alexandros Sklavounos, Hatan Mortada, Ankur Khajuria
Introduction When repairing facial wounds, it is crucial to possess a thorough understanding of suitable suture materials and their evidence base. The absence of high-quality and comprehensive systematic reviews poses challenges in making informed decisions. In this study, we conducted a review of the existing literature and assessed the quality of the current evidence pertaining to the clinical, aesthetic, and patient-reported outcomes associated with absorbable and non-absorbable sutures for facial skin closure. Methods The study was registered on PROSPERO. We conducted searches on EMBASE, OVID, and PUBMED/MEDLINE databases. Only randomized controlled trials (RCTs) were eligible for inclusion in this study. Additionally, the risk of bias in the randomized studies was assessed using Cochrane's Risk of Bias Tool. Results The study included a total of nine RCTs involving 804 participants with facial injuries. Among these injuries, absorbable sutures were utilized in 50.2% (403 injuries), while non-absorbable sutures were employed in 49.8% (401 injuries). The analysis of cosmesis scales revealed no statistically significant difference between absorbable and non-absorbable sutures regarding infections (p = 0.72), visual analog scale (p = 0.69), wound dehiscence (p = 0.08), and scarring (p = 0.46). The quality of the included studies was determined to have a low risk of bias. Conclusion Absorbable sutures can be considered a suitable alternative to non-absorbable sutures, as they demonstrate comparable aesthetic and clinical outcomes. Future high-quality studies with a level I evidence design and cost-effectiveness analysis are necessary to enhance clinician-patient shared decision-making and optimize the selection of suture materials.
{"title":"Absorbable Versus Non-Absorbable Sutures for Facial Skin Closure: A Systematic Review and Meta-Analysis of Clinical and Aesthetic Outcomes","authors":"Kashish Malhotra, Sophie Bondje, Alexandros Sklavounos, Hatan Mortada, Ankur Khajuria","doi":"10.1055/a-2318-1287","DOIUrl":"https://doi.org/10.1055/a-2318-1287","url":null,"abstract":"Introduction\u0000When repairing facial wounds, it is crucial to possess a thorough understanding of suitable suture materials and their evidence base. The absence of high-quality and comprehensive systematic reviews poses challenges in making informed decisions. In this study, we conducted a review of the existing literature and assessed the quality of the current evidence pertaining to the clinical, aesthetic, and patient-reported outcomes associated with absorbable and non-absorbable sutures for facial skin closure.\u0000Methods\u0000The study was registered on PROSPERO. We conducted searches on EMBASE, OVID, and PUBMED/MEDLINE databases. Only randomized controlled trials (RCTs) were eligible for inclusion in this study. Additionally, the risk of bias in the randomized studies was assessed using Cochrane's Risk of Bias Tool. \u0000Results\u0000The study included a total of nine RCTs involving 804 participants with facial injuries. Among these injuries, absorbable sutures were utilized in 50.2% (403 injuries), while non-absorbable sutures were employed in 49.8% (401 injuries). The analysis of cosmesis scales revealed no statistically significant difference between absorbable and non-absorbable sutures regarding infections (p = 0.72), visual analog scale (p = 0.69), wound dehiscence (p = 0.08), and scarring (p = 0.46). The quality of the included studies was determined to have a low risk of bias.\u0000Conclusion\u0000Absorbable sutures can be considered a suitable alternative to non-absorbable sutures, as they demonstrate comparable aesthetic and clinical outcomes. Future high-quality studies with a level I evidence design and cost-effectiveness analysis are necessary to enhance clinician-patient shared decision-making and optimize the selection of suture materials.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141023166","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}
Abdullah Bin Faisal, Fatima Shahid, Laiba Khalid, Mohammad Fazlur Rahman
Breast cancer ranks as the most diagnosed cancer globally and the leading cause of cancer mortality in women, with Pakistan exhibiting a particularly high incidence. However, breast reconstruction surgery, a critical intervention post-mastectomy, remains underutilized in Pakistan due to various barriers. Recent studies shed light on patient perspectives and outcomes regarding immediate breast reconstruction (IBR), indicating its positive impact on psychosocial well-being. Despite these insights, significant literature gaps persist, including the need for comprehensive national data, addressing cultural and awareness barriers, improving access and education, and prioritizing patient-centered care. This short communication underscores the urgency of addressing these gaps to advance breast reconstruction surgery in Pakistan. By conducting comprehensive studies, tackling cultural barriers, and prioritizing patient-centered care, we can ensure improved care and quality of life for Pakistani breast cancer patients. This call to action aims to transform the landscape of breast reconstruction surgery in Pakistan, offering hope for a brighter future for patients.
{"title":"Advancing Immediate Breast Reconstruction Surgery in Pakistan: Bridging Literature Gaps and Meeting Patient Needs","authors":"Abdullah Bin Faisal, Fatima Shahid, Laiba Khalid, Mohammad Fazlur Rahman","doi":"10.1055/a-2312-8945","DOIUrl":"https://doi.org/10.1055/a-2312-8945","url":null,"abstract":"Breast cancer ranks as the most diagnosed cancer globally and the leading cause of cancer mortality in women, with Pakistan exhibiting a particularly high incidence. However, breast reconstruction surgery, a critical intervention post-mastectomy, remains underutilized in Pakistan due to various barriers. Recent studies shed light on patient perspectives and outcomes regarding immediate breast reconstruction (IBR), indicating its positive impact on psychosocial well-being. Despite these insights, significant literature gaps persist, including the need for comprehensive national data, addressing cultural and awareness barriers, improving access and education, and prioritizing patient-centered care. This short communication underscores the urgency of addressing these gaps to advance breast reconstruction surgery in Pakistan. By conducting comprehensive studies, tackling cultural barriers, and prioritizing patient-centered care, we can ensure improved care and quality of life for Pakistani breast cancer patients. This call to action aims to transform the landscape of breast reconstruction surgery in Pakistan, offering hope for a brighter future for patients.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665786","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}
Linh Le Diep, Lam Vu Ngoc, Duc Nguyen Quang, Tien Nguyen Phuong, Lan Luu Phuong, Manh Nguyen Quoc
Skin efects of the total nasal columella can significantly impact both nasal respiratory function and aesthetics. The reconstruction of total columella is a complex process and represents a significant challenge for plastic surgeons. Various factors can cause the loss of the columella. Numerous columella reconstruction procedures have been proposed, each with their own set of advantages and disadvantages. The main issues to address include the need for regional flaps from the forehead or nasofacial sulcus, a long pedicle to reach the columella, and the double angular folding that causes a risk of malnutrition or venous congestion. Additionally, using horizontal nasolabial flaps may lead to deformation of the upper lip. In this study, we present a new procedure to reconstruct the nasal columella using “Domino flaps” with two flaps (the horizontal upper lip island flap and nasocheek island flap). This new procedure ensures adequate skin for reconstruction of nasal columella and partial tip, minimizes rotation angle, reduces the angular folding of the pedicle, furthermore limits deformation of the upper lip. “Domino flaps” are a valuable option for surgeons when reconstructing the total nasal columella. However, it's important to consider whether the patient has a beard at the donor sites.
{"title":"The reconstruction of the nasal columella defect using Domino flaps","authors":"Linh Le Diep, Lam Vu Ngoc, Duc Nguyen Quang, Tien Nguyen Phuong, Lan Luu Phuong, Manh Nguyen Quoc","doi":"10.1055/a-2309-1701","DOIUrl":"https://doi.org/10.1055/a-2309-1701","url":null,"abstract":"Skin efects of the total nasal columella can significantly impact both nasal respiratory function and aesthetics. The reconstruction of total columella is a complex process and represents a significant challenge for plastic surgeons. Various factors can cause the loss of the columella. Numerous columella reconstruction procedures have been proposed, each with their own set of advantages and disadvantages. The main issues to address include the need for regional flaps from the forehead or nasofacial sulcus, a long pedicle to reach the columella, and the double angular folding that causes a risk of malnutrition or venous congestion. Additionally, using horizontal nasolabial flaps may lead to deformation of the upper lip. \u0000In this study, we present a new procedure to reconstruct the nasal columella using “Domino flaps” with two flaps (the horizontal upper lip island flap and nasocheek island flap). This new procedure ensures adequate skin for reconstruction of nasal columella and partial tip, minimizes rotation angle, reduces the angular folding of the pedicle, furthermore limits deformation of the upper lip. “Domino flaps” are a valuable option for surgeons when reconstructing the total nasal columella. However, it's important to consider whether the patient has a beard at the donor sites.\u0000","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140686476","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}
Mao Yamamoto, Hiroki Mori, Masako Akiyama, Mutsumi Okazaki
Abstract Backgrounds The purpose of this study was to clarify fading, RGB change, and color reproducibility for Nipple-areola complex (NAC) tattoos. Methods NAC tattooing was performed on 60 sites in 59 Japanese patients prospectively. The evaluation was assessed using digital photo, Casmatch standardization and RGB and luminance values preoperatively, immediately after, 1 week, 1 month, 3 months, 6 months and 12 months after tattooing. RGB and luminance values changes over time, time-adjusted fading rate, and the rate of luminance at 12 months were calculated. In color reproducibility study (n=34), RGB values after 12 months were compared with the color sample about dark / reddish and light / less reddish pigments. Results RGB varied widely from immediately after to one month after tattooing. For RGB and luminance, significant differences were seen between pre-immediate after, 1-3 months, 3-6 months, and 6-12 months. In G values, Significant differences were seen between all neighboring points. The fading rate tended to decrease as time progresses, but was not significant, i.e., fading continued even between 6 -12 months. Luminance was 9% brighter than contralateral NAC at 12 months. Color reproducibility tended to be higher with dark / reddish pigments, despite no significant differences. Conclusions The fading rate of tattooed NACs tended to decrease as time progresses, but fading still occurs between 6 - 12 months. Luminance was 9% brighter than contralateral NAC at 12 months after.
{"title":"Fading and color reproducibility of nipple areola tattoos in Asian patients","authors":"Mao Yamamoto, Hiroki Mori, Masako Akiyama, Mutsumi Okazaki","doi":"10.1055/a-2309-2731","DOIUrl":"https://doi.org/10.1055/a-2309-2731","url":null,"abstract":"Abstract\u0000Backgrounds\u0000The purpose of this study was to clarify fading, RGB change, and color reproducibility for Nipple-areola complex (NAC) tattoos. \u0000Methods\u0000NAC tattooing was performed on 60 sites in 59 Japanese patients prospectively. The evaluation was assessed using digital photo, Casmatch standardization and RGB and luminance values preoperatively, immediately after, 1 week, 1 month, 3 months, 6 months and 12 months after tattooing. RGB and luminance values changes over time, time-adjusted fading rate, and the rate of luminance at 12 months were calculated. In color reproducibility study (n=34), RGB values after 12 months were compared with the color sample about dark / reddish and light / less reddish pigments. \u0000Results\u0000RGB varied widely from immediately after to one month after tattooing. For RGB and luminance, significant differences were seen between pre-immediate after, 1-3 months, 3-6 months, and 6-12 months. In G values, Significant differences were seen between all neighboring points. The fading rate tended to decrease as time progresses, but was not significant, i.e., fading continued even between 6 -12 months. Luminance was 9% brighter than contralateral NAC at 12 months. Color reproducibility tended to be higher with dark / reddish pigments, despite no significant differences.\u0000Conclusions\u0000The fading rate of tattooed NACs tended to decrease as time progresses, but fading still occurs between 6 - 12 months. Luminance was 9% brighter than contralateral NAC at 12 months after.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140689578","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}
F. Neamonitou, Konstantinos P Neamonitos, S. Stavrianos, Konstantinos P Neamonitos
Background: Angiofibromas are a common facial manifestation of Tuberous Sclerosis (TS). However, current treatments have proven ineffective due to high recurrence rates and non-compliance. To address this issue, we developed a new triple laser therapy protocol for more effective management of angiofibromas. We conducted tests to validate its efficacy. Methods: This is a prospective study of 10 patients with TS (4 women and 6 men, mean 26.3 years old {15-37 y/o}) with angiofibromata who received triple sequential laser therapy at our private dermatological clinic conducted from January 2000 to December 2022. We evaluated the outcome with the Facial Angiofibromata Severity Index (FASI) via clinical photography (0, 6 months, 1 year, 2 years) and Dermatology Life Quality Index (DLQI). Results: All patients had a successful recovery without any complications. Among these 10 patients, 4 experienced localised recurrences at their 6th-month follow-up. These recurrences were treated with a second single CO2 laser session. After 2 years of follow-up, we observed no recurring facial cutaneous manifestations. Furthermore, all patients experienced a decrease in their FASI score after treatment. According to the Visual Analogue Scale (VAS), patients reported 95% satisfaction, and DLQI indicated only a minor impact on their everyday lives. Conclusion: We believe that this protocol of 3-step Laser treatment is effective, safe, and compliable for patients with facial angiofibromata, providing a satisfactory outcome adaptable to the daily dermatological and plastic surgery practice.
{"title":"A Triple Laser Combination Treatment for Facial Angiofibromata Management in Tuberous Sclerosis and Literature Review","authors":"F. Neamonitou, Konstantinos P Neamonitos, S. Stavrianos, Konstantinos P Neamonitos","doi":"10.1055/a-2306-0962","DOIUrl":"https://doi.org/10.1055/a-2306-0962","url":null,"abstract":"Background: Angiofibromas are a common facial manifestation of Tuberous Sclerosis (TS). However, current treatments have proven ineffective due to high recurrence rates and non-compliance. To address this issue, we developed a new triple laser therapy protocol for more effective management of angiofibromas. We conducted tests to validate its efficacy. Methods: This is a prospective study of 10 patients with TS (4 women and 6 men, mean 26.3 years old {15-37 y/o}) with angiofibromata who received triple sequential laser therapy at our private dermatological clinic conducted from January 2000 to December 2022. We evaluated the outcome with the Facial Angiofibromata Severity Index (FASI) via clinical photography (0, 6 months, 1 year, 2 years) and Dermatology Life Quality Index (DLQI).\u0000Results: All patients had a successful recovery without any complications. Among these 10 patients, 4 experienced localised recurrences at their 6th-month follow-up. These recurrences were treated with a second single CO2 laser session. After 2 years of follow-up, we observed no recurring facial cutaneous manifestations. Furthermore, all patients experienced a decrease in their FASI score after treatment. According to the Visual Analogue Scale (VAS), patients reported 95% satisfaction, and DLQI indicated only a minor impact on their everyday lives.\u0000Conclusion: We believe that this protocol of 3-step Laser treatment is effective, safe, and compliable for patients with facial angiofibromata, providing a satisfactory outcome adaptable to the daily dermatological and plastic surgery practice.\u0000","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702028","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}
The clinical application of Polydioxanone (PDO) threads, conventionally associated with tissue lifting, for volumizing effects in midface rejuvenation. The novel approach involves utilizing PDO volumizing threads to achieve physical augmentation, serving as a "solid filler." The study introduces a more convenient insertion method for PDO volumizing threads, emphasizing ease and efficiency. Clinical cases showcase the effectiveness of volumizing threads in addressing midface concerns, including nasolabial folds and midcheek grooves. The integration of volumizing threads for sagging area support, is explored for natural-looking enhancements. While emphasizing positive outcomes, potential side effects like thread protrusion are discussed, along with solutions for their mitigation. The volumizing thread is presented as a satisfactory procedure for patients averse to fillers or seeking subtle enhancements, with the recommendation of combining it with cog threads for those desiring distinct changes in facial shape. Overall, volumizing thread offers a minimal side-effect alternative for midface rejuvenation.
{"title":"Volumizing Threads (Jamber) in the Midface and Controlling Side Effects: Clinical Cases","authors":"Kyuho Yi, Soohyun Park","doi":"10.1055/a-2303-5156","DOIUrl":"https://doi.org/10.1055/a-2303-5156","url":null,"abstract":"The clinical application of Polydioxanone (PDO) threads, conventionally associated with tissue lifting, for volumizing effects in midface rejuvenation. The novel approach involves utilizing PDO volumizing threads to achieve physical augmentation, serving as a \"solid filler.\" The study introduces a more convenient insertion method for PDO volumizing threads, emphasizing ease and efficiency. Clinical cases showcase the effectiveness of volumizing threads in addressing midface concerns, including nasolabial folds and midcheek grooves. The integration of volumizing threads for sagging area support, is explored for natural-looking enhancements. While emphasizing positive outcomes, potential side effects like thread protrusion are discussed, along with solutions for their mitigation. The volumizing thread is presented as a satisfactory procedure for patients averse to fillers or seeking subtle enhancements, with the recommendation of combining it with cog threads for those desiring distinct changes in facial shape. Overall, volumizing thread offers a minimal side-effect alternative for midface rejuvenation.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716462","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}
Anchal Jain, Bilal A Rafique, Amer Durrani, Ahid Abood
Soft tissue sarcomas are one of the rarest forms of cancer. We describe a unique case of a 35-year-old patient who sustained an open lower limb fracture requiring an intra-medullary nail and free latissimus dorsi muscle flap reconstruction. He had a complex post-operative course including osteomyelitis, a re-fracture and chronic pain. Eleven years following the injury, he presented with pain and localized swelling around the flap. Histological analysis confirmed a rhabdomyosarcoma (RMS) within the LD muscle and he underwent a trans-femoral amputation. He is now in remission and walks on a prosthesis pain free.
{"title":"A Rare Case Of Primary Sarcoma Arising Within Free Muscle Transfer.","authors":"Anchal Jain, Bilal A Rafique, Amer Durrani, Ahid Abood","doi":"10.1055/a-2303-4940","DOIUrl":"https://doi.org/10.1055/a-2303-4940","url":null,"abstract":"Soft tissue sarcomas are one of the rarest forms of cancer. We describe a unique case of a 35-year-old patient who sustained an open lower limb fracture requiring an intra-medullary nail and free latissimus dorsi muscle flap reconstruction. He had a complex post-operative course including osteomyelitis, a re-fracture and chronic pain. Eleven years following the injury, he presented with pain and localized swelling around the flap. Histological analysis confirmed a rhabdomyosarcoma (RMS) within the LD muscle and he underwent a trans-femoral amputation. He is now in remission and walks on a prosthesis pain free.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140720240","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}
Maria Kamila Klimeczek Chrapusta, Marek Kachnic, Anna Chrapusta
Proteus syndrome is an exceptionally uncommon genetic disorder that has been documented in only about 250 cases in the literature spanning the past four decades. It is characterized by a disproportionate, asymmetric overgrowth of all types of tissues, provoked by a somatic activating mutation in serine/threonine protein kinase 1 (AKT1). We report a case of a Proteus syndrome in a two-year-old female patient with the following clinical features: unilateral overgrowth of connective tissue in the right buttock and a right foot, where multiple surgeries were performed to achieve a desirable aesthetic outcome and ensure psychological comfort of the young patient. The insights provided by this case underscore the pivotal role of obtaining pleasing aesthetic outcomes in the surgical management of untreatable genetic disorders, with the aim of nurturing psychological contentment in affected children.
{"title":"Proteus Syndrome: A Case Report and Updated Review of the Literature","authors":"Maria Kamila Klimeczek Chrapusta, Marek Kachnic, Anna Chrapusta","doi":"10.1055/a-2300-7002","DOIUrl":"https://doi.org/10.1055/a-2300-7002","url":null,"abstract":"Proteus syndrome is an exceptionally uncommon genetic disorder that has been documented in only about 250 cases in the literature spanning the past four decades. It is characterized by a disproportionate, asymmetric overgrowth of all types of tissues, provoked by a somatic activating mutation in serine/threonine protein kinase 1 (AKT1). We report a case of a Proteus syndrome in a two-year-old female patient with the following clinical features: unilateral overgrowth of connective tissue in the right buttock and a right foot, where multiple surgeries were performed to achieve a desirable aesthetic outcome and ensure psychological comfort of the young patient. The insights provided by this case underscore the pivotal role of obtaining pleasing aesthetic outcomes in the surgical management of untreatable genetic disorders, with the aim of nurturing psychological contentment in affected children.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140740390","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}
E. Shaffrey, Steven P. Moura, S. Jupitz, Trevor Seets, Tisha Kawahara, A. Uselmann, Christie Lin, S. Poore
Nipple–areolar complex (NAC) necrosis is a devastating complication in nipple-sparing mastectomies (NSMs) that significantly impacts patient's quality of life. The use of fluorescence angiography for intraoperative assessment of mastectomy skin flap perfusion in NSM has been successfully described and can be utilized to help guide surgical decision-making. Recently, a novel fluorescence-guided surgical imager was developed, OnLume Avata System (OnLume Surgical, Madison, WI), which provides intraoperative evaluation of vascular perfusion in ambient light. In this case report, we describe the use of OnLume fluorescence-guided surgery technology to help aid in clinical decision-making for two breast reconstruction cases with concern for intraoperative nipple hypoperfusion.
{"title":"Predicting Nipple Necrosis with a “Lights-on” Indocyanine Green Imaging System: A Report of Two Patients","authors":"E. Shaffrey, Steven P. Moura, S. Jupitz, Trevor Seets, Tisha Kawahara, A. Uselmann, Christie Lin, S. Poore","doi":"10.1055/s-0043-1777068","DOIUrl":"https://doi.org/10.1055/s-0043-1777068","url":null,"abstract":"Nipple–areolar complex (NAC) necrosis is a devastating complication in nipple-sparing mastectomies (NSMs) that significantly impacts patient's quality of life. The use of fluorescence angiography for intraoperative assessment of mastectomy skin flap perfusion in NSM has been successfully described and can be utilized to help guide surgical decision-making. Recently, a novel fluorescence-guided surgical imager was developed, OnLume Avata System (OnLume Surgical, Madison, WI), which provides intraoperative evaluation of vascular perfusion in ambient light. In this case report, we describe the use of OnLume fluorescence-guided surgery technology to help aid in clinical decision-making for two breast reconstruction cases with concern for intraoperative nipple hypoperfusion.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744400","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}
E. Dimovska, Gordana Georgieva, Blagoja Srbov, B. Dzonov, Goran Stevanovski, Sofija Pejkova
Microsurgical reconstruction constitutes a fundamental part of plastic and reconstructive surgery. It demands high dexterity and intricate technical skills. Its steep learning curve benefits from thorough training throughout residency, where using realistic simulation models in the appropriate sequence of complexity progression is essential in ensuring patient safety prior to progressing to a clinical setting. Commencing training on microvascular-like small diameter vessels could prove unsuitable and ineffective for inexperienced surgeons, however, the larger diameter neurovascular structures in the porcine thigh can provide excellent anastomotic training without compromising the animal tissue training sought after by residents. We present the results from implementing the first vascular anastomotic course in our country, where reconstructive theory was combined with simulated anastomotic training on the porcine thigh. Junior plastic surgery residents described acquiring comprehensive knowledge of reconstructive techniques and could successfully complete anastomoses, despite none to minimal previous experience. Using the porcine thigh should be encouraged as a start-up vascular anastomotic training tool as it provides realistic conditions and tissue handling training, and could improve quality of further training on microvascular structures.
{"title":"Starting from Scratch: Experiences from Developing the First Vascular Anastomotic Training Program in North Macedonia Using the Porcine Thigh as a Simulation Model","authors":"E. Dimovska, Gordana Georgieva, Blagoja Srbov, B. Dzonov, Goran Stevanovski, Sofija Pejkova","doi":"10.1055/s-0044-1779474","DOIUrl":"https://doi.org/10.1055/s-0044-1779474","url":null,"abstract":"Microsurgical reconstruction constitutes a fundamental part of plastic and reconstructive surgery. It demands high dexterity and intricate technical skills. Its steep learning curve benefits from thorough training throughout residency, where using realistic simulation models in the appropriate sequence of complexity progression is essential in ensuring patient safety prior to progressing to a clinical setting. Commencing training on microvascular-like small diameter vessels could prove unsuitable and ineffective for inexperienced surgeons, however, the larger diameter neurovascular structures in the porcine thigh can provide excellent anastomotic training without compromising the animal tissue training sought after by residents. We present the results from implementing the first vascular anastomotic course in our country, where reconstructive theory was combined with simulated anastomotic training on the porcine thigh. Junior plastic surgery residents described acquiring comprehensive knowledge of reconstructive techniques and could successfully complete anastomoses, despite none to minimal previous experience. Using the porcine thigh should be encouraged as a start-up vascular anastomotic training tool as it provides realistic conditions and tissue handling training, and could improve quality of further training on microvascular structures.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741002","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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