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The latest medical research on Plastic Surgery

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Gas and Bloat in Female Patients after Anti-Reflux Procedures: Analysis of 934 Cases.

Journal of the

Anti-reflux procedures (ARPs) are effective treatments for gastroesophageal reflux disease (GERD). However, variation in objective and patient reported outcomes persists. Limited evidence and anecdotal experience suggest that patient sex may play a role. The objective of this study was to compare outcomes after ARPs between male and female patients.

We performed a retrospective review of a prospectively maintained database at a single institution. All patients who underwent an ARP for GERD were included. Demographic, clinical, and patient reported outcomes data (GERD-Health Related Quality of Life, Reflux Symptom Index), as well as radiographic hernia recurrence were collected and stratified by sex. Uni- and multivariable logistic and mixed effects linear regression were used to control for confounding effects.

Between 2009 and 2022, 934 patients (291 males, 643 females) underwent an ARP. Reflux Symptom Index, GERD-HRQL, and gas/bloat scores improved uniformly for both sexes, though female patients were more likely to have higher gas/bloat scores one year post-procedure (mean ± SD 1.7 ± 1.4 vs 1.4 ± 1.3, p=0.03) and higher GERD-HRQL scores two years post-procedure (6.3 ± 8.1 vs 4.7 ± 6.8, p=0.04). Higher gas/bloat scores in females persisted on regression controlling for confounders. Hernia recurrence rates were low (85 patients, 9%) and were similar for both sexes. A final intraprocedural DI ≥3mm 2/mmHg was significantly associated with a 7 times higher rate of recurrence (95% CI 1.62-31.22, p=0.01).

While patients of either sex experience symptom improvement and low rates of recurrence after ARPs, females are more likely to endorse gas/bloat compared to males. Final distensibility ≥3mm 2/mmHg carries a high risk of recurrence. These results may augment how physicians prognosticate during consultations and tailor their treatments in patients with GERD.

Use of Intraoperative Template for the Reconstruction of Septal Replacement Graft.

Aesthetic Plastic Surgery

Anterior and caudal deviation of the septum can severely affect a patient's functional and cosmetic outcomes, especially seen in crooked noses. Hen...

Histological Changes of Porcine Animal Skin with Micro-focused Ultrasound.

Aesthetic Plastic Surgery

As a noninvasive alternative therapy, microfocused ultrasound (MFU) has become a research hotspot in recent years for its potential to enhance skin laxity. While several clinical studies have explored the effects of MFU on improving skin laxity, there is limited literature available on the histological changes resulting from MFU treatments. It has been established that the skin structure and composition of the Bama miniature pigs closely resembles that of humans, including collagen content, type I collagen distribution, and elastin distribution.

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Following the standard operating procedures provided by the manufacturer, different handles were used in different skin area of pigs. Biopsies were obtained immediately after treatment and 1 month after treatment. Significant histological changes were observed in the Bama miniature pigs skin, including collagen contraction and fragmentation, dilation and congestion of superficial dermal capillaries immediately after MFU treatment; dermal thickening, increased thickness and density of collagen fibers, elevated levels of elastin and type I collagen, as well as thickened fiber septa in the adipose layer 1 month later. These histological results corresponded to clinical findings in human, such as facial redness and swelling immediately after treatment, and improvement in facial relaxation after approximately 1 month after treatment.

Collectively, these histological findings provide valuable evidence supporting the clinical application of MFU for enhancing skin laxity.

Procedure Risk vs Frailty in Outcomes for Elderly Emergency General Surgery Patients: Results of a National Analysis.

Journal of the

The direct association between procedure risk and outcomes in elderly emergency general surgery (EGS) patients has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly EGS patients is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly EGS patients compared to frailty.

Elderly patients (age > 65) undergoing emergency general surgery operative procedures were identified in the NSQIP) database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5 Item Frailty Index (mFI-5; mFI 0 Non-Frail, mFI 1-2 Frail, and mFI ≥3 Severely Frail) and based on procedure risk. Multivariable regression models and Receiving Operative Curve (ROC) analysis were used to determine risk factors associated with outcomes.

A total of 59,633 elderly EGS patients were classified into non-frail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group.Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared to frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly EGS patients compared to frailty.

Assessing frailty in the elderly EGS patient population without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes.

Prospective Outpatient Follow-Up of Early Cognitive Impairment in Patients with Mild Traumatic Brain Injury and Intracranial Hemorrhage.

Journal of the

Mild traumatic brain injury (mTBI) encompasses a spectrum of disability including early cognitive impairment (ECI). The Brain Injury Guidelines (BIG) suggest mTBI patients can be safely discharged from the Emergency Department. Although half of mTBI patients with intracranial hemorrhage (ICH) have evidence of ECI, it is unclear what percentage of these patients' ECI persists after discharge. We hypothesize a significant proportion of trauma patients with mTBI and ECI at presentation have persistent ECI at 30-day follow-up.

A single-center prospective cohort study including adult trauma patients with ICH or skull fracture plus a Glasgow coma scale (GCS) of 13-15 on arrival was performed. Participants were screened for ECI using the Rancho Los Amigos Scale (RLA), and ECI was defined as a RLA < 8. We compared ECI and non-ECI groups for demographics, injury profile, computed tomography (CT) imaging (e.g., Rotterdam CT score) and outcomes with bivariate analysis. 30-day follow up phone calls were performed to re-evaluate RLA for persistent ECI and concussion symptoms.

From 62 patients with ICH or skull fracture and mTBI, 21 (33.9%) had ECI. Patients with ECI had a higher incidence of subarachnoid hemorrhage (85.7% versus 46.3%, p=0.003) and higher Rotterdam CT score (p=0.004) compared to those without ECI. On 30-day follow up, 6 of 21 patients (26.6%) had persistent ECI. In addition, 7 (33.3%) patients had continued concussion symptoms.

Over one-third of mTBI patients with ICH had ECI. At 30-day post-discharge follow-up over one-fourth of these patients had persistent ECI and 33% had concussion symptoms. This highlights the importance of identifying ECI prior to discharge as a significant portion may have ongoing difficulties reintegrating into work and society.

Global Outcomes Benchmarks in Laparoscopic Liver Surgery for Segments 7 and 8: International Multicenter Analysis.

Journal of the

In recent years, there has been growing interest in laparoscopic liver resection (LLR) and the audit of the results of surgical procedures. The aim of this study was to define reference values for LLR in segments 7 and 8.

Data on LLR in segments 7 and 8 between January 2000 and December 2020 were collected from 19 expert centers. Reference cases were defined as no prior hepatectomy, ASA <3, body mass index <35 kg/m2, no chronic kidney disease, no cirrhosis and portal hypertension, no chronic obstructive pulmonary disease (FEV1<80%), and no cardiac disease. Reference values were obtained from the 75th percentile of the medians of all reference centers.

Of 585 patients, 461 (78.8%) met the reference criteria. The overall complication rate was 27.5% (6% were Clavien-Dindo≥3a) with a mean CCI of 7.5 ± 16.5. At 90-day follow-up, the references values for overall complications were 31%, Clavien≥3a 7.4%, conversion 4.4%, hospital stay < 6 days, and readmission rate < 8.33%, respectively. Eastern centers patients categorized as low risk had a lower rate of overall complications (20.9% vs 31.2%, p=0.01) with similar Clavien-Dindo≥3a (5.5% and 4.8%, p=0.83) compared to Western centers, respectively.

This study shows the need to establish standards for the postoperative outcomes in LLR based on the complexity of the resection and the location of the lesions.

Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis.

Aesthetic Plastic Surgery

Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients. A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .

Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39-60), and median time since radiotherapy was 48 months (range 11.7-86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96-6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85-5.35, p-value 0.10) compared to the NIB, but not significant.

We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB.

Update on Total Auricular Construction.

Plastic and Reconstructive Surgery

After studying this article, the participant should be able to: 1. Understand principles of preoperative planning for microtia repair. 2. Understand key techniques for flap design, skin envelope dissection, framework creation, and donor-site reconstruction. 3. Describe important components of postoperative management.

Total auricular construction remains a challenge for reconstructive surgeons. This article describes current surgical strategies and advancements for microtia construction. The authors' focus is to describe the several keys for success that are useful for young surgeons who wish to train themselves to create satisfactory results.

Five-Year Outcomes from a Prospective Study on the Safety and Efficacy of Phasix-ST Mesh Use at the Hiatus During Paraesophageal Hernia Repair.

Journal of the

Laparoscopic paraesophageal hernia (PEH) repair has a high hernia recurrence rate. The aim of this study was to assess the 5-year hernia recurrence rate after PEH repair using a combination of bioresorbable mesh and advanced surgical techniques to address tension as needed in a prospective group of patients.

In 2016 a prospective database was established for 50 patients undergoing primary, elective PEH repair with a new bioresorbable mesh (Phasix-ST). Intra-operatively, tension was addressed with Collis gastroplasty and / or diaphragm relaxing incisions as needed. All 50 patients from the initial study were tracked and asked to return for objective follow-up. Recurrence was considered present for any hernia > 2 cm in size.

Objective follow-up was obtained in 27 of the original 50 patients (54%) at a median of 5.25 years after their PEH repair. Prior to the 5-year follow-up, 5 patients had a known recurrent hernia. Objective evaluation at 5 years identified an additional 3 recurrences, for a total recurrence rate of 25% (8/32 patients). The hernia recurrence rate in patients with a Collis gastroplasty was significantly lower compared to those without a Collis (7% vs 54%, p=0.008). Two patients underwent re-operation for hernia recurrence. No patient had a mesh infection or mesh erosion.

The combination of Phasix-ST mesh and tension reducing techniques during PEH repair led to a 25% hernia recurrence rate at 5 years. The addition of a Collis gastroplasty led to significantly fewer hernia recurrences and is indicative of the potential for esophageal shortening in many patients with a PEH. The long-term safety and efficacy of Phasix-ST mesh in combination with surgical technique for PEH repair is confirmed.

Clinical Application of Botulinum Toxin A on Nasal Reconstruction with Expanded Forehead Flap for Asian Patients.

Aesthetic Plastic Surgery

Because of its unique advantages, frontal expansion has become a common tool for Asian nasal reconstruction, but it has the limitations of prolonging the duration and pain in the expansion area. Based on the fact that the denervation effect of botulinum toxin type A (BTX-A) has been widely used in the reconstruction of superficial organs, we hypothesized that BTX-A would shorten the length of nasal reconstruction sequence and alleviate the discomfort of patients.

The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Thirty patients were enrolled in the study; 15 (50%) with and 15 (50%) without BTX-A pre-injection. Demographic data were homogeneous. The duration of the observation group (BTX-A pretreated) (133.87 ± 13.64 days) was significantly shortened versus the control group (164.27 ± 14.08 days, P<0.001). At the initial stage, no significant difference was found in the VAS scores (P=0.64). At the medium stage, the VAS score of the observation group (2.07 ± 0.80) was significantly lower than the control group (3.00 ± 0.53, P<0.01). At the terminal stage, the VAS score of the observation group (1.93 ± 0.59) was significantly lower than the control group (2.73 ± 0.70) but with a narrower disparity.

Pre-injection of BTX-A is effective in shortening the duration of the expansion phase, as well as relieving the pain associated with expansion.

A ropivacaine-eluting poly(lactide-co-caprolactone) wound dressing provided enhanced analgesia in partial-thickness porcine injuries.

Plastic and Reconstructive Surgery

Partial-thickness skin wounds are some of the most painful injuries due to large areas of exposed nerve endings. These injuries often require systemic opioid treatments to manage pain adequately. However, in 2021 alone, the CDC reported nearly 17,000 prescription opioid-related deaths in the USA, highlighting the ongoing need for non-opioid treatment strategies. In this manuscript, we developed a novel single-application ropivacaine-eluting primary wound dressing that could provide sustained ropivacaine delivery to partial-thickness wounds and assessed its in vivo feasibility for prolonged non-opioid analgesia.

Sustained release of ropivacaine from a poly(lactide-co-e-caprolactone) matrix was first optimized in vitro using dissolution testing and a Box Behnken design of experiments. The optimized dressing was then tested against a clinical control silicone dressing in a porcine partial-thickness wound study to assess analgesic effect, pharmacokinetics, and wound healing.

The ropivacaine-eluting dressing showed a moderate analgesic effect in vivo, where normalized single pinprick scores significantly improved pain over the testing period (4-168h) (control vs treatment: 232±25% vs 145±16%, p<0.0003). Ropivacaine blood plasma levels peaked at 8 hours post-treatment, with a maximum concentration of 246 ± 74 ng/mL. No significant differences in wound healing were found when compared to control.

The ropivacaine-loaded poly(lactide-co-e-caprolactone)-based wound dressing provided sustained delivery of ropivacaine to partial-thickness skin wounds and enhanced analgesic effect compared to a clinical standard control dressing.

Histopathological Evaluation of Bipolar and Microneedle Radiofrequency Energy on the Skin and Fat of the Abdominal Region of the Rat.

Plastic and Reconstructive Surgery

Radiofrequency (RF)-based devices are frequently used in plastic surgeries. In the current literature, no comparative experimental study has demonstrated the histological and immunological effects of these devices that are frequently used in the facial area. In this study, we investigated the histological and immunological effects of Bipolar RF (BodyTite) and Microneedle RF (Morpheus 8) devices in the rat abdominal region.

24 rats were used in this study. The rats were divided into four groups: group I: Control. In group II, BodyTite was applied to the abdominal region. Group III: Morpheus 8 was applied to the abdominal region. Group IV: Both Morpheus 8 and BodyTite were applied to the abdominal region. The histological and immunological features of the tissues in the groups were examined using light microscopy, and collagen formation and desmosome structures were examined using light microscopy.

Collagens in Group II were thinner than those in the other groups. In addition, there were fewer vessels in Group III. The collagen scores were as follows: Group II:1.5; Group III:2; and Group IV:3. The VEGF scores were II:2.5, group III:2, and IV:3, respectively. The collagen score in group II and VEGF score in group III were significantly lower than those in the other groups. In addition, the bonds between desmosomes in group III were found to be looser using electron microscopy. Collagen morphology in groups III and IV was found to be similar to that in group I.

The use of radiofrequency devices has increased in plastic surgery practice over the past two decades, particularly emerging as a unique alternative for non-surgical candidates. There is a lack of experimental studies concerning these commonly used devices in clinical practice.