Summary An individual’s face undergoes numerous changes throughout life. Since mid-face aesthetic units are key areas for rejuvenation procedures, their comprehensive assessment is essential for the ...development of any aesthetic management plan. Despite the availability of many evaluation criteria for treatment of mid-face ageing, there are discrepancies existing in both assessment and management approaches. The goal of this study was to determine if there are any identifiable profiles of clinical judgements and approaches related to the level of surgeon’s experience. Forty seven standardised non-digital and not altered natural size photographic images of patients’ faces (front and profile) were presented to eight senior board certified plastic surgeons, eight junior non-board certified plastic surgeons and eight plastic surgery residents from an independent program. Surveyed physicians were ‘blinded’ from each other and asked to assess five different major features characterising ageing mid-face. An interclass correlation data analysis was performed and the Cronbach coefficient alpha values were computed for each category. Responses obtained from senior plastic surgeons were consistently characterised by higher Cronbach coefficient alpha values indicating higher concordance. The highest agreement levels were obtained for the assessment of rhytids and jowls across all groups and the lowest agreement levels were obtained for the assessment and recommendation of upper lip management. This study illustrated that discrepancies in clinical assessments and surgical management exist among surgeons involved in the aesthetic surgery of the mid-face ageing. It appears that the level of surgeon’s experience significantly impacts the inter-rater reliability and consensus in assessment and treatment of mid-face ageing. The most senior plastic surgeons’ assessment and recommendations had the highest level of concordance while the junior non-board certified plastic surgeons and the residents group produced variations with less consistency.
Abstract The overview of current diagnostic and therapeutic advances and controversies in the management of breast cancer is presented. Specific topics and their impact on breast reconstruction ...surgeons practicing in culturally different areas and with variable access to breast education and health care are discussed. The following approaches to the most common types of problems are presented: prophylactic mastectomy for women at high risk of breast cancer, size and location of the primary tumor and feasibility of breast conserving surgery and oncoplastic approach, management of the axilla, post-mastectomy radiation and chemotherapy, emerging breast reconstructive techniques (fat transfer, stem cells) and cancer risk, oncological follow up and imaging of the reconstructed breast, including illustrative cases. This material should help oncological and plastic surgeon specialists to understand each other's considerations for the best possible outcome of the breast cancer treatment.
The purpose of this article is to examine how plastic surgeons learn to use novel technology in their practices. In addition, a critical evaluation of current teaching methods as they relate to ...surgeon competence in these new technologies is discussed.
The aim of the study was to investigate the relationship between the static thermography figure of merit Δ
T (the difference in mean values of skin area temperature for the burn wound area and the ...unaffected reference skin area) and a means of burn classification which would be most suitable for the choice of treatment. The work was an in vivo animal experiment. Statistical analysis showed a high correlation between the Δ
T parameter and histopathological assessment. With regard to the choice of treatment, the most useful correlation was found to be that between Δ
T and the classification of burn wounds into those healed in 3 weeks and those unhealed. The results of this study have revealed a quantitative criterion Δ
T for burn classification. The study suggests that particular burn centres using static thermography use a Δ
T parameter based on their own values for burn classification so as to group burn wounds into those that healed in 3 weeks and those that did not heal. This criterion should be independent of and replace other classification systems. A criterion for the proper choice of burn treatment would then be made more readily available.
Endoscopic forehead lift is a well-established procedure in aesthetic plastic surgery. Many agree that currently available video-endoscopic equipment is bulky, multipieced and sometimes cumbersome in ...the operating theater. A novel system, the Universal Serial Bus Endoscope (USBE) was designed to simplify and reduce the number of necessary equipment pieces in the endoscopic setup. The USBE is attached by a single cable to a Universal Serial Bus (USB) port of a laptop computer. A built-in miniaturized cold light source provides illumination. A built-in digital camera chip enables procedure recording. The real-time images and movies obtained with USBE are displayed on the computer's screen and recorded on the laptop's hard disk drive. In this study, 25 patients underwent endoscopic browlift using the USBE system to test its clinical usefulness, all with good results and without complications or need for revision. The USBE was found to be reliable and easier to use than current video-endoscope equipment. The operative time needed to complete the procedure by the authors was reduced approximately 50%. The design and main technical characteristics of the USBE are presented.
Background: An objective in vivo measurement of viscoelastic skin properties is difficult. Consequently, the clinician's ability to evaluate the effectiveness of therapies that may affect skin ...pliability and skin surface characteristics is limited.
Objective: The purpose of this study was to evaluate the usefulness of the Biomechanical Tissue Characterization BTC-2000 System for objective, noninvasive assessment of viscoelastic skin properties, specifically by testing the hypothesis that cellulite-affected skin may have different biomechanical characteristics than skin without a cellulitic appearance.
Methods: A prospective study comparing 2 closely matched, nonrandomized groups of 15 women with and without cellulite in cellulite-prone areas was conducted. Biomechanical parameters including skin laxity, elastic and viscoelastic deformation, stiffness, energy absorption depicting overall tissue compliance, and elasticity were measured in an area prone to cellulite (the lateral thigh) and one not prone to cellulite (the posterior shoulder).
Results: The degree of the elastic deformation on the maximum pressure, stiffness, and elasticity was similar for all areas in both groups (
P > .05). Comparisons of individual parameters showed decreased elastic deformity and laxity of skin among individuals with no cellulite in the cellulite-prone area (
P < .05), whereas there was no significant difference between the groups in the cellulite-nonprone area (
P > .05). In addition, in volunteers with cellulite, lateral thigh and posterior shoulder skin was remarkably softer, as reflected by energy absorption, than in those without cellulite (
P < .05).
Conclusions: An assessment of volunteers with and without cellulite in cellulite-prone and non-prone areas demonstrated that BMT-2000 technology allows noninvasive, reproducible measurements of selected biomechanical skin properties. Such measurements will be useful in assessing changes in skin laxity and elasticity in aesthetic surgical and nonsurgical treatments, and in evaluating skin, skin care programs, and cosmeceutical agents.
(Aesthetic Surg J 2002;22:260-266.)
Surgeries conducted with the patient in the prone position are frequent and can be lengthy. Abdominal stomas and su- prapubic catheters require protection for the complete duration of the procedure ...to avoid complications such as stomal ischemia, bleeding, or mucocutaneous separation. Standard protection strategies such as pillows and wedges can eas- ily fail. In the course of managing several patients who had sustained ostomy complications following surgery in a prone position, a simple method of stoma protection was devised. Instead of discarding the foam headrest typically used dur- ing induction by anesthesia staff, this device is placed with its central recess over the stoma and secured to the patient's abdominal wall with gentle tape just before turning the patient into a prone position. This method, used in more than 80 patients, has been found to effectively relieve pressure, and no complications have been observed. The foam shape also enables unobstructed drainage of fluids, facilitating collection and preventing leakage and contamination of the surgical field. Because the device is widely used by anesthesia, it is readily available and does not add any extra cost.
In order to reexamine the possible association between bacterial presence and capsular contracture, 55 silicone devices (mammary implants or tissue expanders) were cultured at the time of their ...removal from 40 patients. Special culture techniques were used in an attempt to recover bacteria adhering to the smooth-surfaced implant and encased in glycocalyx biofilm. Bacteria were detected on 56% (15 of 27) of implants surrounded by contracted capsules and on 18% (5 of 28) of those without capsular contracture (p less than 0.05). Only three implants tested positive using routine plating techniques. The predominant isolate was Staphylococcus epidermidis. The concept that capsular contracture is associated with subclinical infection of silicone implants is supported by this study. With changes in the microbiological technique, bacterial recovery and growth occurs at a frequency greater than previously thought.
The purpose of this project was to examine the incidence of microbial presence on the surface of mammary implants and its correlation with clinical presentation. The significance of microbial ...presence without signs of overt infection is questioned. Several issues are raised, including whether the presence of micro-organisms may immunize the host, trigger autoimmune reactions, or locally change the course of healing (resulting in capsular contracture). A total of 150 explanted silicone mammary implants from 87 patients were cultured. Cultures of 81 devices were positive (54%); the predominant isolate was Staphylococcus epidermidis (found on 68 implants, or 84%). Bacteria were detected on 76% (62 of 82) of implants surrounded by contracted capsules and on 28% (19 of 68) of those without capsular contracture (p < 0.05). Among 40 patients (46%) who had no general health problems, 11 (28%) had positive cultures of explanted devices (15 of 62 explants, or 24%). In the remaining 47 patients (54%) who complained of myalgia (77%), arthralgia (68%), chronic fatigue (38%), skin rashes (21%), cognitive problems (19%), dry mucosal membranes (19%), episodes of low-grade fever (17%), and hair loss (13%), 38 (81%) had positive cultures (66 of 88 explants, or 75%) (p < 0.05). The hypothesis that capsular contracture or problems that might be related to chronic infection and immunization are associated with subclinical infection is supported by this study.
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