Eplasty [JOURNAL]
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200 papers
Cultural Beliefs Regarding Breast Reconstruction in a Minority Group.
Li A, Luaces MA, De Souza M
Eplasty · 2023 · PMID 37664817
BACKGROUND: The diagnosis and treatment of breast cancer can significantly affect a woman's health and well-being. Several studies have identified factors contributing to disparities in breast reconstruction among ethnic...
BACKGROUND: The diagnosis and treatment of breast cancer can significantly affect a woman's health and well-being. Several studies have identified factors contributing to disparities in breast reconstruction among ethnic groups, but few have examined the experience of Hispanic women. METHODS: Hispanic women who had undergone breast reconstruction were interviewed in retrospective focus groups. Data were collected to identify themes that affected decision-making regarding the type and timing of reconstruction. RESULTS: Most participants chose to undergo reconstruction to regain normalcy and maintain their previous "feminine" appearance. Most (75%) received silicone breast implants, and 25% received autologous reconstruction. Safety was the most important consideration when choosing the type of reconstruction. All but 1 participant relied on a spouse or other family member for support during recovery. Although most found the experience overwhelming, they felt their community was supportive and encouraging throughout the process. CONCLUSIONS: Several themes underlying the decision to undergo reconstruction were identified, including maintaining femininity and choosing the safest procedure. Overall, participants described the experience as overwhelming but found support from community and family. These findings, which could be applied broadly to women regardless of ethnicity, can be used to improve communication between surgeon and patient throughout the reconstruction process.
Human Factors Approach to Assess Physician Workload in Elective Plastic Surgery Breast Procedures.
Mohan AT, Linden AR, Lowndes BR … +6 more , Blocker RC, Harless CA, Martinez-Jorge J, Hallbeck MS, Nguyen MT, Law KE
Eplasty · 2023 · PMID 37664816
BACKGROUND: Human factors research involves the study of work system interactions, physician workload, cognitive effort, and performance. This pilot study incorporated a human factor approach and other surgery-based metr...
BACKGROUND: Human factors research involves the study of work system interactions, physician workload, cognitive effort, and performance. This pilot study incorporated a human factor approach and other surgery-based metrics to assess cognitive workload among plastic surgeons during elective plastic surgery breast procedures. METHODS: In this prospective study of plastic surgery breast procedures over a 3-month period, surgeon and patient demographics and procedural details were collected. The lead surgeon assessed each procedure using a validated workload questionnaire (National Aeronautics and Space Administration Task Load Index [NASA-TLX]) that included 6 subscales (ie, mental, physical, temporal demand, performance, effort, and frustration), a question on distraction, and their expectation of procedural difficulty. RESULTS: Fifty-seven cases were included in this study. Surgical duration had a positive correlation with increased mental demand ( < .001), physical demand ( < .001), and degree of distractions ( < .001). Free flap reconstruction, breast reduction, and transgender mastectomy had the highest average mental, physical demands, and perceived effort. Bilateral cases had significantly higher workload than unilateral ones ( = .002). NASA-TLX scores between immediate and delayed reconstructions were comparable, but delayed cases had higher degree of distractions ( = .04). There was a strong correlation between degree of distractions and increased mental workload 0.68; < .001), increased physical demand ( = 0.61; < .001), and increased temporal demand ( 0.78; < .001). More difficult procedures were associated with greater procedural duration than those rated as difficult as expected or less difficult than expected ( = .02). CONCLUSIONS: These preliminary data demonstrated multiple factors that may influence and govern perceived physician workload and may provide insight for targeted quality improvement to plan procedures safely and effectively.
Vascular Mapping for Abdominal-Based Breast Reconstruction: A Comprehensive Review of Current and Upcoming Imaging Modalities.
Ibelli TJ, Chennareddy S, Mandelbaum M … +1 more , Henderson PW
Eplasty · 2023 · PMID 37664815
BACKGROUND: Preoperative vascular imaging is a very common element of surgical planning for abdominal-based breast reconstruction (ABBR). Surgeons must tailor which flap is best suited for each respective patient based o...
BACKGROUND: Preoperative vascular imaging is a very common element of surgical planning for abdominal-based breast reconstruction (ABBR). Surgeons must tailor which flap is best suited for each respective patient based on the patient's health and vascular anatomy. The goal of this review is to give surgeons practical tools for choosing which imaging technology best suits their patient's needs for successful breast reconstruction. METHODS: A review of literature was undertaken on Google scholar to assess preoperative imaging modalities used for ABBR. Search terms included and Articles were included based on relevance and significance to ABBR. Advantages and disadvantages of each imaging modality were then classified according to clinically relevant utility. RESULTS: Overall, imaging technologies that produce 3-dimensional images were found to have greater resolution for identifying perforators and the pedicle network than 2- dimensional images. CONCLUSIONS: This paper addresses the strengths and weaknesses of the currently used imaging modalities described and also discusses new technologies that may be helpful in the future for planning of ABBR.
Nasal Soft Tissue Triangle Large Composite Graft Take With Postoperative Hyperbaric Oxygen Therapy: A Case Report.
Askinas CA, Burko I, Heffern J … +2 more , Puyana S, Jansen DA
Eplasty · 2023 · PMID 37664814
BACKGROUND: Auricular composite grafts hold great potential for reconstructing the nasal soft tissue triangle with desired aesthetic results because there is ample tissue available for sufficient nasal ala projection and...
BACKGROUND: Auricular composite grafts hold great potential for reconstructing the nasal soft tissue triangle with desired aesthetic results because there is ample tissue available for sufficient nasal ala projection and the natural curvature of the helical rim matches that of the alar rim. The use of auricular composite grafts also results in positive functional outcomes because of the cartilaginous airway support provided to widen the external nasal valve. Composite graft survival is highly dependent on graft size, as larger sized grafts have a higher metabolic demand.To improve graft viability and reliability, hyperbaric oxygen therapy can be employed to accommodate the increased metabolic demand seen with larger composite grafts. CONCLUSIONS: This report presents the survival of a large skin and cartilage composite graft for nasal soft tissue triangle reconstruction in conjunction with hyperbaric oxygen therapy to improve graft viability.
Outcomes of Tracheostomy on Burn Inhalation Injury.
Ruiz S, Puyana S, McKenney M … +2 more , Hai S, Mir H
Eplasty · 2023 · PMID 37664813
BACKGROUND: Tracheostomy has been proposed for patients with expected prolonged intubation. This study aims to determine the outcomes of tracheostomy on patients with burn inhalation injuries requiring mechanical ventila...
BACKGROUND: Tracheostomy has been proposed for patients with expected prolonged intubation. This study aims to determine the outcomes of tracheostomy on patients with burn inhalation injuries requiring mechanical ventilation. METHODS: This study is a retrospective review from 2011 to 2019. Inclusion criteria were recording of inhalation injury, ventilator support (at least 24 hours), and total body surface area of <15%. The patients were stratified into 2 groups: tracheostomy (group 1) versus no tracheostomy (group 2). The outcome measures were in-hospital mortality rate, hospital length of stay, intensive care unit length of stay, ventilator days, and ventilator- associated pneumonia (VAP). RESULTS: A total of 33 burn patients met our inclusion criteria. Group 1 consisted of 10 patients and group 2 of 23 patients. There was no statistically significant difference in terms of percent total body surface area. There was a higher intensive care unit length of stay at 23.8 days in group 1 compared with 3.16 days in group 2, a higher hospital length of stay at 28.4 days in group 1 compared with 5.26 days in group 2, and higher ventilator days in group 1 with 20.8 days compared with 2.5 days in group 2. There was no statistically significant difference between the 2 groups in terms of mortality. The incidence of VAP was also significantly higher in group 1 than in group 2. CONCLUSIONS: The ideal timing and implementation of tracheostomy with inhalation injury has yet to be determined. In this study, tracheostomy was associated with much longer lengths of stay and pneumonia. The impact of the underlying lung injury versus the tracheostomy itself on these observations is unclear. The challenge of characterizing the severity of an inhalation injury based on early visual inspection remains.
Poly-4-hydroxybutyrate Mesh for Ventral Hernia Repairs: A Single-Surgeon Experience.
Fowler CC, Klifto KM, Wietlisbach LE … +4 more , Othman S, Weiss ES, Braslow B, Kovach SJ
Eplasty · 2023 · PMID 37664812
BACKGROUND: Poly-4-hydroxybutyrate (P4HB) (Phasix) biosynthetic mesh was recently introduced as an alternative to synthetic and biologic meshes for ventral hernia repair (VHR). However, outcomes data are limited. This st...
BACKGROUND: Poly-4-hydroxybutyrate (P4HB) (Phasix) biosynthetic mesh was recently introduced as an alternative to synthetic and biologic meshes for ventral hernia repair (VHR). However, outcomes data are limited. This study aims to analyze outcomes of VHR with P4HB mesh and identify predictors of postoperative outcomes. METHODS: We performed a retrospective study of adults who underwent open VHR with P4HB by the senior author from 2014 to 2020 with >12 months' follow-up. Subgroup comparisons and multivariate logistic regression were performed. RESULTS: Inclusion criteria were met by 169 patients with a median of 15 months of follow-up. Overall, 21.9% had surgical site occurrences, 17.8% required reoperation, and 4.7% had recurrences. Patients with prior VHR (47.9%) experienced similar outcomes to those without. Patients with prior mesh infection (18.3%) had higher rates of postoperative mesh infection (6.5% vs 0.7%; = .029) but did not have higher rates of reoperation. Retrorectus repairs (45.5%) had similar outcomes to onlay repairs (54.5%). Recurrence risk was increased by hypertension (odds ratio [OR] = 13.64; = .046), immunosuppression (OR = 42.57; = .004), and history of prior VHR (OR = 20.20; = .014). CONCLUSIONS: This study aimed to analyze outcomes of VHR augmented with P4HB mesh through retrospective review. VHR with P4HB mesh produces acceptable recurrence rates with favorable complication risks compared with biologic and synthetic meshes. Predictors of recurrence include a history of prior hernia repair, hypertension, and immunosuppression. A history of prior mesh infection seems to place patients at risk for developing subsequent infection but did not increase need for reoperation.
How to Select an Extracellular Matrix for Wound Repair: A Comprehensive Review.
Stetkevich S, Gupta M, Simman R … +1 more , Jackson SE
Eplasty · 2023 · PMID 37664811
BACKGROUND: An extracellular matrix (ECM) is a network of proteins and other molecules that provide support and structure to cells and tissues in the body. Since its discovery in 1930, researchers have reproduced the ECM...
BACKGROUND: An extracellular matrix (ECM) is a network of proteins and other molecules that provide support and structure to cells and tissues in the body. Since its discovery in 1930, researchers have reproduced the ECM through an array of evolving technologies, developing products that accelerate healing times, minimize scarring, and reduce pain. When selecting which ECM product to use, physicians rely on personal experience while considering wound location, type of tissue lost, exposed structures, chronicity, and even the patient's religious preferences. While comparison trials between a few different types of ECMs exist, there lacks a thorough investigation that assesses a majority of ECMs against each other. METHODS: Herein, we conducted a literature review using the PubMed database and utilized 71 articles to identify the best ECM for wound healing and positive patient outcomes. The primary search terms included and We did not exclude any specific type of research, but predominantly reviewed clinical trials, case series, and other review articles. We focused on the most popular and commonly used ECMs and constructed our results into the . RESULTS: We compared the indications, advantages, and disadvantages of each ECM and concisely illustrated these findings to provide a guide on how to select an ECM Allografts, whether they are glycerol or cryopreserved, suffice as a treatment choice and are superior to exposure healing. However, they do not produce healing at the same rate or quality as bioengineered matrices, porcine and bovine xenografts, or acellularized fish skin (AFS). Bioengineered matrices and porcine and bovine xenografts offer antimicrobial properties, low immunogenicity, cost effectiveness, and availability. The compromise with these ECMs is with healing times and cosmesis. Acellularized fish skin (AFS) provides diverse utility, antimicrobial activity, low immunogenicity, faster healing times, and cosmetic superiority. However, AFS yields a potential cost burden and is not plentiful or easily accessible in some parts of the world. CONCLUSIONS: Our findings assist in removing the subjectivity component of selecting an ECM and suggest further comparison or head-to-head trials would yield a more algorithmic approach to wound healing. We suggest to consider implementing the Disabilities of the Arm, Shoulder, and Hand (DASH) score as an additional objective comparison method in these future trials.
Radiation-Induced Morphea of the Breast Treated With Wide Local Excision and Abdominal Free Flap Breast Reconstruction.
Titan A, Mohan AT, Tokuyama M … +3 more , Mirbegian J, Bean GR, Lee GK
Eplasty · 2023 · PMID 37664810
Radiation-induced morphea (RIM) associated with breast cancer treatment is a rare and underdiagnosed skin complication of radiotherapy that can lead to severe and painful contractures, resulting in disfigurement, failure...
Radiation-induced morphea (RIM) associated with breast cancer treatment is a rare and underdiagnosed skin complication of radiotherapy that can lead to severe and painful contractures, resulting in disfigurement, failure of reconstruction, and poor quality of life in patients. The condition may present on a spectrum of local or more generalized forms involving skin over the breast and anterior chest wall. This diagnosis must be differentiated from post-radiation fibrosis, infection, cancer recurrence, inflammatory breast cancer, and other inflammatory conditions as the clinical course and treatment approaches differ. Various noninvasive and topical agents have been used; however, many cases are refractory to treatment. Surgery has been less commonly described in the management of generalized RIM. This report describes a case of RIM in a patient with breast cancer who experienced simultaneous resolution of symptoms as well as successful breast reconstruction using autologous free-tissue transfer.
Outcomes of Sciatic Nerve Injury Repairs: A Systematic Review.
Turkman A, Thanaraaj V, Soleimani-Nouri P … +2 more , Harb E, Thakkar M
Eplasty · 2023 · PMID 37664809
BACKGROUND: The objective of this study was to investigate the surgical repair techniques and the outcomes of sciatic nerve injuries in traumatic wounds. METHODS: A literature search was conducted using the following key...
BACKGROUND: The objective of this study was to investigate the surgical repair techniques and the outcomes of sciatic nerve injuries in traumatic wounds. METHODS: A literature search was conducted using the following keywords: and RESULTS: In total, 715 studies were retrieved. After abstract review, 13 articles fit the criteria. A total of 2627 repairs were carried out, including nerve grafts (n = 953), suture (n = 482), and neurolysis (n = 1192). Six studies reported good motor outcome, and good sensory outcome was reported across 2 studies. The thigh region accounted for 81.5% of lesions. Sciatic, peroneal, and tibial nerves were all equally affected. Gunshot wounds were the most common mechanism of injury (22.6%). CONCLUSIONS: The cumulative evidence demonstrates sciatic nerve injury repair has poor motor and sensory outcomes. This study shows there is a lack of standardized outcome measures, making comparisons very difficult. Graft lengths of <4 cm within the intermediate region yielded more successful outcomes. Further higher quality studies of nerve transfers in the lower limbs are needed to determine the optimal repair to restore sciatic nerve function.
Intramedullary Free Gracilis for Dead-Space Obliteration and Stump Resurfacing in a Transfemoral Amputee With Recurrent Osteomyelitis.
Laub P, Vandevender J, Yang M … +2 more , Summers H, Vandevender D
Eplasty · 2023 · PMID 37664808
BACKGROUND: A 72-year-old man with a history of delayed presentation for severe right lower extremity burns underwent through-knee amputation complicated by periprosthetic distal femur osteomyelitis. Subsequent transfemo...
BACKGROUND: A 72-year-old man with a history of delayed presentation for severe right lower extremity burns underwent through-knee amputation complicated by periprosthetic distal femur osteomyelitis. Subsequent transfemoral amputation was complicated by Stage IVB Cierny-Mader osteomyelitis despite appropriate medical and surgical treatment. METHODS: Due to the presence of threatened proximal femur intramedullary nail from prior intertrochanteric femur fracture, inability to further shorten femur, and lack of local soft-tissue options, we performed soft tissue reconstruction with free gracilis flap. The free gracilis flap was pulled proximally through the femoral canal to obliterate intramedullary dead space and provide distal femoral stump coverage. RESULTS: The stump was fully healed upon 6-month follow-up with computerized tomography demonstrating continued presence of gracilis flap within the femoral canal and no evidence of osteomyelitis. At 1-year follow-up, the patient was ambulatory using a prosthetic without recurrence of osteomyelitis. CONCLUSIONS: Previous descriptions of intramedullary free muscle flaps for the treatment of osteomyelitis are limited in number, with its function being limited to dead-space obliteration. This report presents intramedullary free gracilis flap to be a viable option in above-knee amputees for combined dead space obliteration and stump resurfacing in the context of recurrent osteomyelitis.
Skin Anatomy.
Milner SM
Eplasty · 2023 · PMID 37519927
Abstract loading — click title to view on PubMed.
Comparison of Treatment Options for Chronic Scapholunate Interosseous Ligament (SLIL): A Systematic Literature Review and Meta-Analysis.
Amer KM, Thomson JE, Elsamna ST … +5 more , Congiusta DV, Gantz O, DalCortivo RL, Vosbikian MM, Ahmed IH
Eplasty · 2023 · PMID 37465482
BACKGROUND: The scapholunate interosseous ligament (SLIL) is an important contributor to wrist stability and functionality. SLIL injury is debilitating and therefore many surgical techniques have been proposed, but the o...
BACKGROUND: The scapholunate interosseous ligament (SLIL) is an important contributor to wrist stability and functionality. SLIL injury is debilitating and therefore many surgical techniques have been proposed, but the optimal treatment modality remains debated.This meta-analysis reviews the available literature comparing surgical techniques used in the treatment of chronic SLIL to determine the best approach. METHODS: An electronic search of the literature was conducted to identify all randomized controlled trials and cohort studies published before January 2019 that evaluated clinical outcomes of capsulodesis reconstruction, the modified Brunelli technique, and the reduction and association of the scaphoid and lunate (RASL) procedure for treatment of chronic SLIL. A chi-square analysis was performed to identify possible differences between each technique for several outcome measures. RESULTS: A total 20 studies encompassing 409 patients met inclusion criteria. Average age among patients was 36.7 years, and 68.2% of patients were male. Reductions in visual analog scale pain scale; Disabilities of Arm, Shoulder, and Hand (DASH) scores; and increases in grip strength and range of motion were observed for all techniques. Capsulodesis was superior to the modified Brunelli technique regarding preserved range of motion. CONCLUSIONS: No significant differences were observed among any of the techniques for pain, DASH score, and grip strength outcomes. Capsulodesis, modified Brunelli, and RASL surgical techniques for the treatment of chronic SLIL injuries may all be seen as reliable methods of treatment of chronic SLIL injuries. While future trials directly comparing these methods are needed, this study suggests there is no superiority of one technique over another.
Case Report of Complete Second Branchial Fistula.
Yauchi K, Ueda M, Omori M
Eplasty · 2023 · PMID 37465481
BACKGROUND: Branchial fistulas are anomalies of embryonic development of the branchial apparatus, with the most common being second branchial fistulas. However, complete fistulas are infrequent and may relapse. Furthermo...
BACKGROUND: Branchial fistulas are anomalies of embryonic development of the branchial apparatus, with the most common being second branchial fistulas. However, complete fistulas are infrequent and may relapse. Furthermore, they are difficult to manage without adequate treatment. METHODS: This article presents the case of a complete second branchial fistula in a 1-year-old female patient who had a sinus on the right side of the neck since birth. Excision of the fistula tract was performed without preoperative fistulography. The tract was then ligated and dissected immediately below the mucosa. RESULTS: The postoperative course was uneventful, and there was no evidence of recurrence. CONCLUSIONS: Previous case reports have also demonstrated good outcomes without excision of the internal opening or tonsillectomy.
Tissue Is the Issue: Use of 2 Bipedicled "Bucket-Handle" Local Advancement Flaps to Close a Nonhealing Wound.
Kumar T, Holmes C, Burko I … +1 more , Chaffin AE
Eplasty · 2023 · PMID 37465480
INTRODUCTION: Soft tissue loss following total knee arthroplasty can result in catastrophic complications. Defects can be covered using various flaps and grafts, including fasciocutaneous flaps. Here, we discuss one case...
INTRODUCTION: Soft tissue loss following total knee arthroplasty can result in catastrophic complications. Defects can be covered using various flaps and grafts, including fasciocutaneous flaps. Here, we discuss one case of double bipedicled "bucket-handle" local advancement flaps used for a nonhealing midline knee dehiscence wound following total knee arthroplasty. METHODS: Flaps were planned using perforators identified with forward-looking infrared (FLIR) thermal imaging. Two bucket-handle bipedicled flaps were used for repair. Autologous split-thickness skin grafts were used for the donor sites. RESULTS: FLIR imaging was used for flap monitoring. Apart from one site of superficial epidermolysis that healed with local wound care, there were no postoperative complications. DISCUSSION: This case demonstrates the successful use of double bipedicled local advancement flaps to reconstruct a defect following a total knee arthroplasty. These flaps minimize donor site morbidity, provide adequate coverage, allow for tension-free closures, and have reliable vascular supplies. FLIR thermal imaging is an accessible and useful tool in designing and monitoring flaps.
The Double Donut: A Safe and Simple Option for Immediate Nipple Areolar Complex Reconstruction in Skin-Sparing Mastectomy Patients With Contraindications to Nipple-Sparing Mastectomy.
Westrick E, Mostovych A, MacDavid J … +2 more , Simpson A, Wilhelmi BJ
Eplasty · 2023 · PMID 37465479
BACKGROUND: Restoration of the nipple areolar complex (NAC) has been shown to improve quality of life (QoL) in post-mastectomy patients. Despite expansion of nipplesparing mastectomy inclusion criteria, many patients rem...
BACKGROUND: Restoration of the nipple areolar complex (NAC) has been shown to improve quality of life (QoL) in post-mastectomy patients. Despite expansion of nipplesparing mastectomy inclusion criteria, many patients remain ineligible and are relegated to bilateral skin-sparing mastectomy. In this study, we evaluated immediate NAC reconstruction with the double donut areolar graft and split nipple composite graft reconstruction (DDSNS). METHODS: A single-center prospective study was performed for patients undergoing immediate post-mastectomy reconstruction with the DDSNS technique. Demographics and post-reconstruction endpoints were collected, focusing on aesthetic and functional outcomes. RESULTS: A total of 31 patients and 62 breasts underwent immediate reconstruction with the DDSNS technique. Four of 62 (6.4%) nipple composite grafts and 1 of 62 (1.6%) areolar grafts experienced partial graft loss. All incidents of initial loss healed to a satisfactory result. All patients were able to proceed with adjuvant therapy, if indicated, without delay. CONCLUSIONS: The DDSNS technique can be successfully applied to achieve cosmetically satisfactory results in the post-mastectomy patient. This technique has shown reliable outcomes with respect to graft success and patient satisfaction with their NAC reconstruction.
Subdermal Plexus Density as It Relates to Obesity and Wound Complications in Patients Undergoing Reduction Mammaplasty.
Brown KW, McCandless MG, Nannapaneni H … +3 more , Adams K, Songcharoen SJ, Arnold PB
Eplasty · 2023 · PMID 37465478
BACKGROUND: Reduction mammaplasty is one of the most common reconstructive procedures performed in plastic surgery. Multiple comorbidities play a role in postoperative wound healing complications; however, there are insu...
BACKGROUND: Reduction mammaplasty is one of the most common reconstructive procedures performed in plastic surgery. Multiple comorbidities play a role in postoperative wound healing complications; however, there are insufficient data on the subdermal plexus (SDP) as it relates to these comorbidities. The purpose of this study is to evaluate the relationship between body mass index (BMI) and SDP of the superficial breast tissues and examine the association between SDP and postoperative complications. METHODS: After Institutional Review Board approval, screening, and informed consent, patients undergoing reduction mammaplasty were selected. Tissue to be discarded was sent to pathology for analysis of immunohistochemistry directed against endothelial cells to determine the density of the SDP. Patients with BMI <35 and ≥35 kg/m were compared. Statistical analysis, including 2-tailed test and Pearson correlation, was conducted. RESULTS: A significant difference in SDP density (standard deviation) was identified between patients with a BMI ≥35 versus <35 kg/m (2.65 capillaries/mm ± 1.8 vs 1.56 capillaries/mm ± 1.2; = .033). Patients with no historical use of tobacco versus those who used tobacco showed a significantly increased SDP (2.11 capillaries/mm ± 1.6 vs 1.20 capillaries/mm ± 0.5; = .009). A significant relationship between postoperative infection (1.00 capillaries/mm ± 1.1; = .041) and hematoma/seroma (0.788 capillaries/mm ± 0.1; = .003) was identified. No significant relationship was found between SDP and delayed wound healing, nipple-areolar complex complications, fat/flap necrosis, or symptomatic scar occurrence. CONCLUSIONS: There is a statistically significant increase in SDP seen with increasing BMI, which does not explain the higher rate of wound healing complications after reduction mammaplasty typically seen in the higher BMI patient population. The association between BMI and complications after reduction mammaplasty remains unclear.
Use of Multimodal Long-Wave Infrared Thermography Devices in Clinical Practice.
Simman R, Gordon DM, Klomparens K … +1 more , Aviles F
Eplasty · 2023 · PMID 37465477
BACKGROUND: The current practice of assessing wounds is highly dependent on visual examination and clinical judgment; these methods are highly subjective and leave great room for error. Objective measures of wound severi...
BACKGROUND: The current practice of assessing wounds is highly dependent on visual examination and clinical judgment; these methods are highly subjective and leave great room for error. Objective measures of wound severity and healing are necessary tools that have been lacking in clinical practice. Long-wave infrared thermography (LWIT) has diverse applications that can be optimized to help detect and monitor wounds. METHODS: This work is a retrospective case series of pertinent patients encountered by the authors in clinical practice. RESULTS: Nine cases were ultimately selected to best represent the multitude of benefits that can be seen with the utilization of LWIT devices. CONCLUSIONS: Through this case series, we show the many advantages of LWIT devices. This technology is safe, noninvasive, and user friendly and, most importantly, gives objective, instant, and repeatable measurements.
The Utility of Telemedicine in Plastic and Reconstructive Surgery: Provider and Patient Perspectives.
Alba B, Arnold SH, Siotos C … +4 more , Hansdorfer M, Aminzada A, Dorafshar A, Hood K
Eplasty · 2023 · PMID 37465476
BACKGROUND: The use of telemedicine has become increasingly common, especially since the COVID-19 pandemic. Virtual visits can be beneficial for use in plastic surgery but are not without limitations. The purpose of this...
BACKGROUND: The use of telemedicine has become increasingly common, especially since the COVID-19 pandemic. Virtual visits can be beneficial for use in plastic surgery but are not without limitations. The purpose of this study was to better understand the utility of telemedicine in plastic surgery from both patient and provider perspectives. METHODS: A survey was distributed to all patients who had a telemedicine visit at the authors' institution from April to October 2020 as well as a representative cohort of providers via the American Society of Plastic Surgeons. The survey collected various demographic data and included a Likert scale questionnaire to assess the use and overall quality of telemedicine services. Data collected for the patient and provider groups were compared using tests, chi-square tests, and Mann-Whitney () tests. RESULTS: A total of 67 patients (N = 501; 13.4%) and 160 providers (N = 2701; 5.9%) responded to the survey. Patients were significantly younger than providers (45.8 ± 11.8 vs 55.0 ± 11.6 years; < .001). Patients responded significantly more favorably than providers in the domains of telemedicine usefulness, ease of use, interaction quality, and reliability. Patients were significantly more comfortable than providers in scheduling surgery without an in-person visit. Patients also rated higher comfort levels than providers with a virtual physical examination, including examination of sensitive body parts, such as breasts and genitals. CONCLUSIONS: Plastic surgery patients are generally comfortable and satisfied with the care provided by telemedicine. Telemedicine can provide high-quality health care and can be utilized by plastic surgeons to optimize care in their practice.
Use of an Autologous Heterogenous Skin Construct in the Treatment of Intractable Late-Effect Radiation Wounds: Case Series.
Burgueno-Vega D, Shahani D, Conlan W … +1 more , Blakely M
Eplasty · 2023 · PMID 37465475
BACKGROUND: Late-effect radiation-induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia, and wound chronicity all work to impair healing,...
BACKGROUND: Late-effect radiation-induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia, and wound chronicity all work to impair healing, and this becomes more pronounced when defects are large or when avascular structures such as bone are exposed. Effective treatment options for this type of wound are limited. Thorough excision of irradiated tissue followed by distal pedicled or free flap closure is the most successful; however, this often requires multiple-stage surgeries and prolonged hospitalization and is associated with significant donor site morbidity. This is complicated further when wounds are large or in difficult locations, when surgery is not appropriate, or when there is limited access to surgeons with the appropriate experience/skill to perform such procedures. METHODS: This case series describes the use of an autologous heterogenous skin construct (AHSC) made from a small full-thickness sample of the patient's healthy skin. Three patients with intractable late-effect radiation wounds were treated with AHSC. Case 1 describes an abdominal wound with tunneling of 7.5 cm to the pubic symphysis, which had been treated for known osteomyelitis, and a shallower full-thickness groin wound. Case 2 describes a right scapular wound with exposed bone, which had failed flap closure. Case 3 describes a right thigh wound in a patient who had been treated for sarcoma with extensive radiation therapy. This eventually resulted in an above-the-knee amputation, which failed to heal, and full exposure of the distal end of the resected femur. All wounds had been present for greater than 10 months. RESULTS: Mean percent volume reduction was 83% (±2.7) at 3 weeks and 92.9% (±4.7) at 4 weeks. The tunneled abdominal wound decreased in depth from 7.5 cm to 1.2 cm in 3 weeks. Complete closure was achieved at 11 weeks for the abdominal and groin wounds (patient 1) and at 16 weeks for the thigh wound (patient 3). The scapular wound volume of patient 2 had decreased by 91.8% at week 4 but was not fully restored until week 21. Mean time to closure was 16.1 (±4.7) weeks. CONCLUSIONS: AHSC was effective in covering exposed bone, improving wound bed vascularity, filling in significant wound depth, and achieving complete wound closure with one application in patients with intractable late-effect radiation wounds.
Does Size Really Matter? A Review on How to Determine the Optimal Umbilical Size During an Abdominoplasty.
Fell C, Kachare MD, Moore A … +1 more , Wilhelmi BJ
Eplasty · 2023 · PMID 37465474
BACKGROUND: The umbilicus has historical significance regarding health and beauty principles. The visually pleasing aesthetic of the umbilicus has become a vital standard for the perceived success of an abdominoplasty pr...
BACKGROUND: The umbilicus has historical significance regarding health and beauty principles. The visually pleasing aesthetic of the umbilicus has become a vital standard for the perceived success of an abdominoplasty procedure. While the ideal position and shape of the umbilicus have been studied extensively in literature, less is known about the optimal size. Herein, the authors provide a comprehensive literature review to help determine the ideal umbilical size. METHODS: A computerized search in the PubMed database was performed to identify articles that discussed ideal umbilical size. RESULTS: The review was performed in July 2022. A total of 21 articles were initially identified, only 6 of which discussed umbilical size. References from the included articles were also evaluated for relevance and resulted in 10 additional articles in the final review. Most of the articles indicated that a smaller umbilicus was found to be aesthetically pleasing, but a numerical range of values were not specified. CONCLUSIONS: Although the literature on the ideal umbilical size is sparse, the consensus is toward a smaller, vertically oriented umbilicus.
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