Involutional lower eyelid entropion is a common age-related eyelid malposition associated with ocular surface irritation. Surgical correction has typically focused upon anatomical alignment, whereas functional recovery of the ocular surface has been reported less frequently. This retrospective study included 24 patients (24 eyelids) who underwent a modified transconjunctival procedure. The technique involved excision of the palpebral conjunctiva and lower eyelid retractor, followed by fixation to the inferior tarsal border with a buried running suture. Ocular surface parameters-conjunctivochalasis (CCh), superficial punctate keratopathy (SPK), and tear film break-up time (TBUT)-were evaluated preoperatively and at 6 months postoperatively in collaboration with ophthalmologists. The mean operative time was 17.3 min, with a low recurrence rate of 8.3%. CCh grade improved from 2.0 ± 0.7 to 1.0 ± 0.9 (p < 0.001), and SPK resolved in 13 eyelids, with the mean SPK score improving from 2.8 to 0.7 (p < 0.001). TBUT increased from 3.1 ± 1.8 to 5.2 ± 3.2 s (p < 0.001). Neither CCh nor TBUT changes independently predicted SPK resolution. This modified transconjunctival technique provided stable anatomical correction with a low recurrence rate and was associated with improvement in ocular surface parameters. It may represent a simple and time-efficient option, particularly for patients with predominant vertical laxity. LEVEL OF EVIDENCE: IV.
OBJECTIVE:Secondary nasolabial deformities are common after primary cleft lip repair, yet objective preliminary quantitative indication criteria for Abbe flap repair remain lacking. This study aimed to establish preliminary quantitative indication thresholds for Abbe flap repair, evaluate its clinical efficacy, and explore preoperative predictors for optimal postoperative outcomes. METHODS:This STROBE-compliant retrospective cohort study enrolled 102 patients with secondary cleft lip deformities (21 in Abbe flap group, 81 in non-Abbe flap group) and 36 healthy controls. Standardized anthropometric measurements, phenotypic stratification via cluster analysis, and ROC curve analysis for diagnostic efficacy were conducted. RESULTS:The Abbe flap group showed significant postoperative improvements in all core morphological parameters (all P < 0.05), while conventional non-Abbe repair yielded minimal improvement in patients with significant upper lip tissue deficiency. The optimal preliminary cut-off values for Abbe flap indication were upper-to-lower lip projection ratio (ULR) ≤0.700 (sensitivity 100%, specificity 97.26%) and nasolabial angle (NLA) ≥108° (sensitivity 95.24%, specificity 93.15%). Stratified analysis confirmed the therapeutic superiority of Abbe flap was independent of initial cleft type, and preoperative lip height index (LHI) and intercanthal width to medial upper lip height ratio (IMWH) were independent predictors for optimal postoperative outcomes. CONCLUSION:Preoperative ULR ≤0.700 and NLA ≥108° can be used as preliminary objective quantitative reference criteria for Abbe flap selection in secondary cleft lip deformity patients, with prospective multi-center validation required for further clinical generalization. The Abbe flap can achieve significant correction of morphological abnormalities caused by upper lip tissue deficiency, and preoperative LHI and IMWH can assist in prognostic evaluation for surgical candidates.
BACKGROUND:Tear trough deformity (TTD) is a common esthetic concern characterized by a concave infraorbital groove. Recent anatomical studies have identified the tear trough ligament and its lateral continuation, the orbicularis retaining ligament, as key contributors. OBJECTIVES:To evaluate the esthetic outcomes of surgical release of the tear trough ligament in patients with varying grades of TTD. METHODS:This prospective case series included patients with clinically evident TTD treated via a sub-ciliary approach. The procedure involved release of the tear trough ligament, with additional release of the orbicularis retaining ligament when indicated, allowing spontaneous repositioning of the sub-orbicularis oculi fat and conservative lower eyelid skin excision. Outcomes were assessed using standardized photographs evaluated by independent surgeons according to Barton's grading system. Patient satisfaction was measured using patient-reported outcome measures (PROMs). Statistical analysis was performed using chi-square testing. RESULTS:Seventy-three patients were included with a mean follow-up of 10 months. Excellent outcomes were achieved in 19/21 Grade I, 29/33 Grade II, and 14/19 Grade III cases; no poor outcomes were observed. PROMs demonstrated high satisfaction across all grades, with a trend toward lower satisfaction in more severe deformities. No major complications, including ectropion or lower eyelid malposition, occurred. Differences between the grades were not statistically significant (p > 0.05). CONCLUSIONS:Tear trough ligament release provides consistent esthetic improvement across all deformity grades by addressing the underlying anatomical tethering. This technique may represent a simplified alternative to volume augmentation or septal manipulation. Further controlled studies are warranted. LEVEL OF EVIDENCE:Level IV, therapeutic study.
BACKGROUND:Autologous fat grafting is widely used in plastic surgery, but graft survival remains unpredictable, particularly under compromised conditions such as cigarette smoking. Smoking impairs microcirculation and tissue oxygenation, adversely affecting graft viability. Platelet-rich plasma (PRP) has been proposed as a biological adjunct that enhances angiogenesis and tissue regeneration. Plasma gel (PG), similarly derived from PRP and retaining various growth factors, as a fibrin-based volumizing scaffold. This study aimed to evaluate whether PRP or PG can mitigate cigarette smoke-induced impairment of fat graft survival and to compare their respective effects. METHODS:Thirty male Sprague-Dawley rats were assigned to control (n = 10) and smoke-exposed groups (n = 20). Smoke-exposed animals were divided into PRP (n = 10) and PG (n = 10) groups. After six weeks of smoke exposure, autologous fat grafts were implanted bilaterally, with the right side receiving treatment and the left side serving as an internal control. After six weeks, graft retention and histological parameters were evaluated. RESULTS:Smoke exposure reduced graft retention and increased fibrosis and necrosis. PRP improved graft retention (64.9% vs 36.5%, p = 0.004), reduced necrosis, and increased viable adipose tissue. PG did not improve graft retention (p = 0.084) and was associated with higher fibrosis (p = 0.015). PRP-treated grafts showed greater retention than both the Control and PG groups (p < 0.001). CONCLUSION:PRP improves fat graft survival under cigarette smoke exposure, whereas PG does not. PRP may be a useful adjunct in recipients with compromised conditions.
BACKGROUND:Facial feminization surgery (FFS) has been shown to improve mental health-related quality-of-life measures among transgender and nonbinary (TGNB) individuals. However, there is a lack of validated tools to evaluate long-term satisfaction and psychosocial well-being after FFS. This study aimed to address this gap using the FACE-Q patient-reported outcomes measure (PROM) in a TGNB cohort. METHODS:Patients seeking FFS over a 4-year period within an integrated healthcare system were enrolled prospectively. Facial satisfaction and psychosocial well-being were assessed before or after FFS using FACE-Q. Iterative survey occurred preoperatively and at 3, 6, and 12 months postoperatively. The minimal important difference (MID) was calculated to interpret the clinically meaningful change in PROM over time. Two-tailed paired t-tests allowed an outcome comparison before or after FFS. RESULTS:The final analysis included 65 patients. Satisfaction with overall facial appearance increased from 34.3±12.4 preoperatively to 83.0±15.7 at 3 months, 83.1±16.2 at 6 months, and 92.2±11.9 at 12 months postoperatively (p<0.001). Average scores increased by at least 33 points for lips (p<0.001), 34 points for lower face (p<0.001), and 23 points for aging appearance (p<0.001). Social and psychological function increased by at least 35 and 39 points, respectively (p<0.001). The mean MID estimate was 3 for facial appearance and 4 for psychosocial function and outcome satisfaction. CONCLUSION:FFS can have a large impact on patient-reported outcomes. Using a validated PROM, this study demonstrated significant improvements in facial esthetics satisfaction and psychosocial functioning while maintaining low adverse effects. To the authors' knowledge, this study is one of the first to incorporate the MID into gender-affirming surgery PROM.
Hematoma prevention in outpatient plastic surgery is crucial for patient safety and procedural success. This study evaluates hematoma rates over three decades of outpatient cosmetic procedures and outlines a structured multimodal prevention protocol. We conducted a single-center, retrospective review of 44,133 consecutive cosmetic procedures performed by board-certified plastic surgeons between 1995 and 2024 at an accredited outpatient surgical facility with postoperative nursing observation capabilities. A structured 5-Step Hematoma Prevention Protocol, incorporating tranexamic acid (TXA), was implemented. Hematoma was defined as a postoperative blood collection requiring reoperation within 30 days. Overall, 203 hematomas occurred, yielding a rate of 0.46%. Following adoption of the protocol, the hematoma rate declined to 0.2% during 2017-2024. In facial procedures, TXA use was associated with a 91% reduction in hematoma rates (0.74% vs. 0.06%; p<0.0001). To our knowledge, this represents the largest single-center analysis of outpatient hematoma prevention, spanning three decades and over 44,000 cases. This analysis supports the role of a structured multimodal protocol-with TXA as a key component-in minimizing hematoma risk. Broader adoption of standardized strategies may enhance patient safety and optimize outcomes in aesthetic surgery.
PURPOSE:Breast augmentation after massive weight loss (MWL) is surgically challenging owing to altered anatomy and tissue quality. Previous case series suggest higher revision rates, but controlled, population-based evidence is lacking. We aimed to evaluate long-term outcomes, including reoperation frequency and indications, after primary augmentation in MWL patients compared with matched controls. METHODS:We performed a nationwide, population-based case-control study using prospectively collected registry data (SOReg and BRIMP). The cohort comprised 817 MWL patients undergoing 1634 primary augmentations and 3512 matched controls with 7023 procedures (2004-2022). Follow-up averaged 5.4 (SD 2.9) and 5.6 (SD 2.8) years, respectively. Revision procedures, indications for re-operations, and intraoperative findings were analyzed. Statistical comparisons employed the Mann-Whitney U and Fisher's exact tests with Bonferroni-Holm correction. RESULTS:Reoperation was more frequent in MWL patients (9.4% vs. 7.1%, p<0.001), with shorter time to first revision (1.5 (SD 1.8) vs. 2.3 (SD 2.4) years, p<0.001). Implant malposition (20% vs. 11%, p=0.004), rotation (9.5% vs. 3.1%, p=0.002), and seroma (6.9% vs. 1.7%, p=0.002) were more common in MWL revisions. Indications were similar, most often patient-driven changes. CONCLUSION:Breast augmentation after MWL carries a higher and earlier risk of reoperation compared with the controls, though absolute complication rates remain low. These findings provide population-based evidence to guide patient counseling and surgical planning in this complex group.
Blood transfusion is common during pediatric craniosynostosis surgery; however, transfusion volumes and use of cell salvage systems can vary considerably. To support preoperative transfusion planning in patients undergoing craniectomy for craniosynostosis, we developed and internally validated machine learning (ML) models to predict perioperative transfusion risks and transfusion volumes in this patient population. Data from eligible patients ≤36 months of age from the NSQIP® Pediatric dataset were included for modeling. A classifier pipeline was developed to predict probabilities associated with transfusion risk, and a probabilistic/quantile regression pipeline was developed to predict the median transfusion volume (in mL/kg) with interquartile range. Performance of the modeling pipelines was evaluated using nested cross-validation with 5-fold outer loops. In total, 8045 patients were included with 4091 (50.9%) receiving perioperative transfusion. For the classification pipeline, the optimal model configuration was a LightGBM classifier. The modeling pipeline achieved a mean area under the receiver operating characteristic curve (AUC-ROC) of 0.77 (95% confidence interval [CI] 0.75-0.78) and mean Brier score of 0.20 (95% CI 0.19-0.20) across nested cross-validation. For the regression stage, the optimal model configuration was a probabilistic NGBoost regressor. The modeling pipeline achieved an average median absolute error of 6.86 mL/kg (95% CI 6.61-7.11), with a mean IQR coverage of 53% (95% CI 52-53%). These models may support individualized blood product preparation and selective use of cell salvage systems. External validation and further real-world testing are needed prior to the clinical implementation of this tool.
BACKGROUND:Free nipple grafting (FNG) is commonly performed during gender-affirming mastectomy (GAM) to reposition and resize the nipple-areola complex (NAC). Although postoperative NAC hypopigmentation is well-recognized, its longitudinal trajectory in transgender patients remains poorly characterized. METHODS:A retrospective cohort study was performed by including patients who underwent GAM with FNG at a single academic center. Inclusion required standardized preoperative, early postoperative (0-6 months), and mid postoperative (6-12 months) photographs, with a subset having late photographs (>12 months). NAC hypopigmentation was quantified using the ImageJ software by blinded reviewers. Longitudinal changes were assessed using paired t-tests, and subgroup analyses were performed using the ANOVA and unpaired t-tests. RESULTS:A total of 104 patients met the inclusion criteria. At the early postoperative follow-up, 68 patients (65%) demonstrated measurable NAC hypopigmentation. Mean hypopigmentation decreased from 13.4% at early follow-up to 7.4% at mid follow-up (p < 0.0001) and remained stable at late follow-up (7.2%, p = 0.216 for mid vs. late follow-up). Patients demonstrated heterogeneous pigmentation trajectories, including repigmentation, no change, and depigmentation. Early postoperative hypopigmentation differed by race (p < 0.0001), with more hypopigmentation observed in Black patients compared to White and Asian patients. Longitudinal improvement between early and mid-follow-up was observed among Black and Asian patients but not among White patients. CONCLUSIONS:NAC hypopigmentation after FNG in GAM is common in the early postoperative period, and frequently improves within the first postoperative year and stabilizes thereafter. These findings provide objective data to inform patient counseling regarding the expected time course of pigmentation changes and potential secondary interventions.
BACKGROUND:Procedural therapies, including chemodenervation and nerve-targeted surgery, are increasingly used for refractory migraine. However, nonclinical factors associated with escalation to procedural care remain incompletely understood. METHODS:A retrospective cohort study was conducted using data from the National Institutes of Health All of Us (NIH AoU) Research Program Registered Tier dataset (version 8). Adults with a documented diagnosis of migraine were identified and classified based on receipt of procedural migraine treatment within 1 year of diagnosis. Patient-reported measures were derived from NIH AoU The Basics and Social Determinants of Health (SDOH) surveys, focusing on psychosocial stress, emotional well-being, and patient-provider interactions. Multivariable logistic regression was performed to estimate the adjusted odds ratios (ORs) for receipt of procedural migraine treatment, controlling for age, sex, and race. RESULTS:Among 23,163 adult patients, 458 (2.0%) received procedural migraine treatment within 1 year of diagnosis. In adjusted analyses, higher perceived psychosocial stress (OR, 1.48; 95% confidence interval [95% CI], 1.21-1.82), frequent emotional withdrawal (OR, 1.47; 95% CI, 1.10-1.95), and patient-reported negative patient-provider interactions (OR, 1.35; 95% CI, 1.09-1.69) were significantly associated with receipt of procedural migraine treatment. Demographic factors, including age, sex, and race, were not significantly associated with treatment utilization after adjustment. CONCLUSION:Psychosocial distress and patient-provider interactions are associated with receipt of procedural migraine treatment, likely reflecting disease burden and care complexity rather than differential access. Leveraging the granularity of patient-reported survey data within the NIH AoU Research Program highlights the potential of next-generation datasets to advance patient-centered research in plastic and reconstructive surgery.
INTRODUCTION:Internal mammary lymph nodes (IMLNs) are the second most common site of nodal metastasis in breast cancer, however, they are infrequently sampled in contemporary practice. We report a series of positive IMLNs identified during autologous breast reconstruction and contextualize these findings within the current literature. METHODS:A retrospective case series was conducted of patients with positive IMLN(s) during autologous breast reconstruction between 2015 and 2024. Primary outcome measures included stage migration and modifications to therapy. A concurrent PubMed and MEDLINE literature review was performed. RESULTS:Six patients were included in the study (mean age 50±8.92 years). All patients had invasive carcinoma, including 5 invasive ductal and 1 invasive lobular carcinoma. Two patients had isolated IMLN metastases, and 4 had concomitant axillary nodal involvement. Preoperative imaging visualized a suspicious IMLN in 1 patient (16.7%). Pathologic stage migration occurred in 1 patient (16.7%); however, IMLN assessment influenced oncologic management in all 6 cases. There were no biopsy-related complications. Across 20 published studies and 4887 patients, 152 had positive IMLNs. Twelve studies used selective sampling, and 8 studies employed routine sampling. There was a mean positive IMLN detection of 5.7% per study. Three studies re--ed sampling only suspicious nodes, whereas 17 (85.0%) advocated for routine sampling of all IMLNs encountered during vessel dissection. CONCLUSIONS:Opportunistic IMLN biopsy during autologous breast reconstruction often alters staging and treatment. Given the safety and feasibility of this practice, routine sampling during internal mammary vessel preparation should be considered to better inform multidisciplinary breast cancer management decisions.
Advancements in breast reconstruction, including prepectoral implant-based breast reconstruction, are increasingly being incorporated into same-day discharge protocols within enhanced recovery after surgery pathways. However, data evaluating patient-centered outcomes within these care models remain limited. This exploratory mixed methods study assessed satisfaction, safety perceptions, and implementation considerations among women undergoing same-day discharge after post-mastectomy prepectoral implant-based breast reconstruction post-COVID. Twenty participants completed semi-structured interviews with quantitative data from the Surgical Satisfaction Questionnaire and same-day discharge-specific items, and qualitative data that were subjected to content analysis. All participants reported satisfaction with postoperative pain control, and nearly all felt safe and satisfied with same-day discharge. Most were satisfied with return to daily and social activities, although fewer were satisfied with return to exercise. Qualitative findings identified factors supporting pathway success, including effective pain management and clear communication, as well as modifiable challenges related to preparation, early recovery vulnerability, and adjustment to longer-term changes. These findings highlight the patients' favorable views of same-day discharge and identify actionable targets to improve surgical care pathways, discharge protocols, and multidisciplinary follow-up in post-mastectomy pre-pectoral implant-based breast reconstruction.
BACKGROUND:Nasal alar retraction poses a considerable clinical challenge. Conventional correction often relies on open rhinoplasty with cartilage grafting, which carries inherent surgical risks. For mild to moderate cases, hyaluronic acid (HA) fillers represent a promising and minimally invasive alternative. OBJECTIVES:We aimed to evaluate the clinical outcomes of HA injection for correcting nasal alar retraction by integrating objective photographic measurements, patient-reported outcomes, and finite element analysis (FEA). METHODS:A retrospective, single-center study was conducted on patients who received HA injections for alar retraction between June 2023 and July 2025. Outcomes were assessed through pre- and postoperative photographic measurements and a patient self-assessment questionnaire. FEA was employed to simulate rim displacement and von Mises stress distribution. RESULTS:All 44 patients who completed the study (mean follow-up: 11.2 months) showed significant morphological improvement in the alar rim (P < 0.001), consistent across lateral, central, and medial subtypes. Patient satisfaction scores increased markedly from a mean of 3.18 to 8.16 (P < 0.001). FEA demonstrated a linear, dose-dependent relationship between the clinical effect and deformation/stress. CONCLUSIONS:Hyaluronic acid injection provides predictable esthetic improvement and high patient satisfaction for mild to moderate alar retraction, with a linear, dose-dependent effect facilitating precise correction.
BACKGROUND:A keystone island perforator advancement flap can be relatively pain free, esthetic pleasing, and have minimal vascular complications, with all this achieved efficiently. Although considered as a reliable reconstructive option virtually throughout the body, current evidence that would confirm its validity when used solely for nasal soft tissue restoration is sparse. METHODS:Over the past 5 years, keystone flaps were used in 25 patients to close defects following nasal skin cancer excision or scar revision. Demographic data for this retrospective chart review included etiology, defect dimensions, nasal subunit involvement, and complications when so employed. RESULTS:A total of 26 keystone flaps were used to close 25 defects encompassing all nasal subunits except the soft triangle and columella. Additionally, no nasal rim nor alar base repairs were attempted. Only relatively narrow defects (10.9 + 3.4 mm) were closed; and to achieve reach, especially within the lower lateral or alar subunits, 14 (53.8%) flaps included the underlying nasalis muscle to preserve circulation. Complications were unusual, with the most common being retraction of the alar rim in 5 (20%) patients, which typically receded significantly and required no secondary procedures. CONCLUSION:A keystone flap is a local flap option using adjacent nasal tissues to match nasal color and texture, and can be quickly completed in a single operative stage. Scars can be well hidden in crevices or along subunit boundaries that will be esthetically acceptable. Limitations may be major contour deformity sequalae and moderate or larger sized defects cannot be so closed.
BACKGROUND:Large palatal fistulae (> 2 cm) following primary palatoplasty represent an increasingly challenging subtype, causing substantial morbidity, including oronasal regurgitation, hypernasality, and reduced quality of life. Local and regional flap reconstruction remains the mainstay of surgical management for these defects across the majority of cleft centers worldwide. This study reports outcomes of local and regional flap techniques for large palatal fistulae, with a focus on recurrence, speech outcomes, and technique selection. METHODS:We performed a retrospective cohort study at CLAPP Hospital, Lahore, Pakistan, from January 2022 to December 2024. Patients with large palatal fistulae (>2 cm) managed exclusively with local or regional flaps were included. Fistulae were classified using the Pakistan Comprehensive Fistula Classification. Univariate and multivariate logistic regression analyses were used to identify factors associated with recurrence. RESULTS:A total of 129 patients were included; mean age was 10.04±7.85 years. Bardach redo-palatoplasty was used in 53.5%, buccinator myomucosal flap in 22.5%, tongue flap in 12.4%, and buccal sulcus myomucosal flap in 11.6% of cases. Overall recurrence occurred in 20 patients (15.5%). Combined local flap procedures were independently associated with lower recurrence on multivariate analysis (aOR 0.20, p=0.04). Postoperatively, 86.1% of assessed patients achieved normal or mild resonance (G0/G1), with the mean composite speech score improving from 15.2 to 6.4. CONCLUSION:Local and regional flap reconstruction achieves encouraging outcomes in large palatal fistula repair and should be regarded as the primary reconstructive strategy for large palatal fistulae.
BACKGROUND:Post-mastectomy lymphatic reconstruction is increasingly common, yet its frequency and outcomes remain underexplored. This study evaluates national trends and safety outcomes of prophylactic lymphovenous bypass (LVB) following axillary lymph node dissection (ALND) over a 10-year period, including the COVID-19 era. METHODS:A retrospective cohort study using the American College of Surgeons National Surgery Quality Improvement Program database from 2013-2022 analyzed 61,819 ALND cases, including 572 (0.93%) with concurrent LVB. LVB cases were identified via CPT codes (38999, 38308, 35206, 35236, 38305). Primary analysis evaluated temporal adoption trends. Secondary endpoints included 30-day postoperative complications [reoperation, deep vein thrombosis (DVT), wound dehiscence, surgical site infection (SSI), and sepsis]. RESULTS:LVB adoption increased steadily over the study period, demonstrating significant linear growth (0.24% annually; R²=0.88; p<0.001). Rates increased from 1.54 to 2.10% during the COVID-19 pandemic from 2019 to 2021. LVB patients had higher rates of any postoperative complication (9.3 vs. 7.0%; p=0.040), DVT (0.7 vs. 0.2%; p=0.032), and superficial SSI (4.5 vs. 2.7%; p=0.014). Rates of reoperation, wound dehiscence, and deep SSI were comparable. Among mastectomy patients without reconstruction, LVB patients had an increased rate of DVT (1.3 vs. 0.2%; p=0.042). Multivariate analysis trended toward decreased reoperation risk with LVB (OR 0.64; 95% CI 0.40-1.01; p=0.056). CONCLUSION:This decade-long analysis demonstrates a 14.6-fold rise in prophylactic LVB during ALND. Although LVB had increased complications and DVT in select subgroups, reoperation rates were comparable to ALND alone. The trend toward reduced reoperation risk and expanding national use indicates increasing integration of lymphatic microsurgery into breast cancer care.
BACKGROUND:Acellular dermal matrices (ADMs) are widely used in implant-based breast reconstruction to enhance esthetic outcomes and reduce capsular contracture. However, concerns persist regarding their performance in patients undergoing postmastectomy radiation therapy (PMRT). The impact of ADM processing method-aseptic versus sterile-on clinical outcomes and postirradiation tissue characteristics remains incompletely defined. OBJECTIVES:To compare clinical outcomes, patient-reported satisfaction, and histologic characteristics of aseptic and sterile ADMs in implant-based breast reconstruction followed by PMRT. METHODS:This study included 157 patients (100 aseptic and 57 sterile) who underwent two-stage implant-based reconstruction with PMRT between 2018 and 2022. Postoperative complications and patient-reported outcomes (BREAST-Q) were analyzed. Postirradiation biopsy specimens from 66 patients were evaluated for tissue thickness and fibrosis-related markers (α-smooth muscle actin [α-SMA] and vimentin). Scanning electron microscopy was performed to qualitatively evaluate collagen ultrastructure following irradiation. RESULTS:During a mean follow-up of 39.8 months, no significant differences were observed between the groups in postoperative infection, capsular contracture, or overall complication rates. BREAST-Q scores for satisfaction, psychosocial well-being, sexual well-being, and physical well-being were comparable. Histologic analysis demonstrated no significant differences in ADM thickness. Expression of α-SMA and vimentin did not differ between the groups, indicating similar myofibroblast and fibroblast activity. Qualitative SEM assessment demonstrated preservation of collagen architecture in sterile ADM after irradiation. CONCLUSION:Aseptic and sterile ADMs demonstrated comparable safety profiles, patient-reported outcomes, and histologic characteristics in implant-based breast reconstruction with PMRT. Both ADM processing methods appear to be safe and effective options in the setting of PMRT.
BACKGROUND:Healthcare contributes to approximately 4-5% of global greenhouse gas emissions. Burn surgery is particularly resource intensive; however, its environmental impact has not been quantified at the case level. We aimed to evaluate the carbon footprint of burn surgery and identify its key drivers. METHODS:A prospective observational study was conducted at a UK regional burns centre by including adult and paediatric burn procedures. Carbon emissions were calculated in kilograms of carbon dioxide equivalent (kg CO₂e) using published life-cycle assessment data and NHS emission factors. Linear and multivariable regression were used to assess the predictors of emissions. RESULTS:Fifty-two procedures were analysed (in 49 adults and 3 paediatric patients; burn size 0.2-85% TBSA). Mean intraoperative carbon footprint was 158 kg CO₂e per case (range 40-875 kg CO₂e). Emissions increased by 9 kg CO₂e per 1% increase in TBSA (R²=0.75, p<0.001). Consumables accounted for 67% of total emissions, followed by theatre energy (20%) and anaesthesia (13%). Use of advanced single-use adjuncts was associated with higher emissions on univariate analysis. On an average, a single burn operation generated emissions equivalent to approximately 800 miles of petrol vehicle travel. CONCLUSIONS:Burn surgery is associated with substantial intraoperative carbon emissions that scale primarily with burn size and consumable use. Although burn severity is non-modifiable, targeted measures-including adoption of reusable textiles, optimisation of theatre ventilation, rationalisation of consumables and preferential use of TIVA-offer practical opportunities to reduce environmental impact without compromising care. These data provide a quantitative benchmark for burn surgery and support integration of carbon metrics into routine audit to guide sustainable clinical practice.
Background Cheek biting is an underrecognized sequela of facial nerve paralysis that is not captured by conventional grading systems. Although this symptom can cause persistent mucosal irritation and discomfort during mastication, surgical strategies specifically targeting cheek biting remain poorly defined. Methods A repeated-measures analysis was conducted within an IRB-approved prospective cohort at a single institution. Seven patients with facial nerve paralysis who reported symptomatic cheek biting underwent surgical treatment. Cheek biting was treated using a periosteal fixation technique designed to elevate the buccal musculature, and to displace the lax buccal mucosa away from the occlusal plane. Symptom severity was assessed using patient-reported scores before surgery and at 1 year postoperatively. Results Seven patients were included (mean age 66.6 years; 4 males). The mean symptom score improved from 25.0 ± 18.9 preoperatively to 78.6 ± 20.8 postoperatively (p = 0.042). Intraoral photographs showed disappearance of buccal mucosal protrusion into the occlusal space after surgery. Postoperative photographs demonstrated elevation of the cheek soft tissue with a mild smiling appearance. Conclusion Buccinator elevation for cheek biting in patients with facial nerve paralysis was minimally invasive, technically straightforward, and associated with symptomatic improvement. This technique may represent a useful surgical option for selected patients with symptomatic cheek biting related to facial nerve paralysis.
BACKGROUND:Three-dimensional imaging systems are used in breast volume revision surgery. However, the utility of a three-dimensional imaging system for breast reduction after autologous breast reconstruction is yet to be reported. In this study, we retrospectively investigated the use of VECTRA® H1 (Canfield Scientific, Inc. NJ. USA.) three-dimensional image analysis to estimate the amount of tissue required for breast revision surgery after deep inferior epigastric artery perforator flap reconstruction. METHODS:This retrospective study included patients who underwent reconstructive breast volume reduction surgery after reconstruction with a deep inferior epigastric artery perforator flap. We took three-dimensional images before and 6 months after surgery, and analyzed the consistency between the volume difference (apparent difference) after surgery and weight of the actual reduced tissue. RESULTS:The intraclass correlation coefficient [ICC(2,1) and ICC(2,k)] were 0.654 and 0.791 (p < 0.0001), respectively. The Bland-Altman plot yielded a bias of 2.28, with limits of agreement ranging from -85.4 to 89.96. A significant positive correlation was found between these values in a simple regression analysis (y = 0.547x + 34.72, R2 = 0.43, p < 0.001). CONCLUSION:To our knowledge, this is the first study examining the accuracy of VECTRA® H1 for tissue reduction, including skin and fat. The difference in breast volume between the two sides assessed using VECTRA® H1 was consistent with the actual resection weights. Therefore, VECTRA® H1 could be a useful volumetric indicator for revision surgery after breast reconstruction using autologous tissue.
