OBJECTIVE:This study examines and contrasts the effect of risk disclosure on risk acceptance and perceived changes in quality of life (QoL) among individuals with and without facial disfigurement.
...SUMMARY OF BACKGROUND DATA:Psychological distress has been previously shown to alter patients’ perception of certain treatments. Due to the grave risks and complications of FT, it is important to understand whether the psychological trauma associated with facial disfigurement alters their perception of FT and its associated risks.
METHODS:Participants with and without facial disfigurement were recruited to complete a questionnaire about their perceived QoL, sense of identity, and willingness to proceed with FT in the context of 3 different hypothetical scenarios involving facial disfiguration.
RESULTS:Four hundred nine nonfacially disfigured and 74 facially disfigured participants were included. When both healthy and facially disfigured individuals were presented with the risks and benefits of a FT, they both perceived their QoL to be as low, or significantly lower, than if they had severe facial disfigurement. Furthermore, presenting the risks of FT significantly altered the decision making and risk acceptance of healthy individuals with no facial disfigurement. However, risk disclosure did not affect the decision making among facially disfigured individuals.
CONCLUSION:This study highlights that presenting the complication profile of FT decreases risk acceptance of FT in healthy individuals but has no significant effects on facially disfigured individuals. The psychological impact of facial disfigurement and its influence on accepting the significant risks of FT should be considered and warrants further investigation.
The development of mandibular distraction osteogenesis (MDO) and tongue-lip adhesion (TLA) has led to significant improvements in respiratory outcomes for the Robin sequence (RS) population. Despite ...such advances, there continues to be debate regarding management strategies. The authors present their experience managing the RS population with insights on technique selection.
A retrospective review of RS patients treated at the senior author's institution from 2003 to 2021 was conducted. Baseline patient demographics and clinical parameters including feeding and respiratory status were recorded. Outcomes included the need for tracheostomy or tracheostomy, decannulation rates, and feeding status. Patients were evaluated through overnight oximetry and drug-induced sleep endoscopy (DISE). Outcomes were stratified according to management technique (MDO, TLA, versus conservative) and compared through statistical analysis.
Fifty-nine RS patients were included. Twenty-eight were managed conservatively, 19 underwent MDO, 10 underwent TLA, one underwent both TLA and MDO, and one underwent tracheostomy primarily. Overall, 1.7% of the cohort required a tracheostomy and 86% achieved oral feeding after the procedure. The MDO cohort had lower Apgar scores and mean birth weight compared with the conservative and TLA cohorts ( P < 0.05). There were no statistical differences in respiratory and feeding outcomes across all three cohorts.
A therapeutic algorithm was developed with insight into the use of DISE and risk stratification with overnight oximetry to guide procedural selection. Using this approach, safe and satisfactory respiratory outcomes were achieved with a low tracheostomy rate. Risk stratification is possible without polysomnography, and DISE is a promising tool (that requires further validation) for procedural selection in this population.
Therapeutic, IV.
Evidence-Based Medicine: Nonsyndromic Craniosynostosis Tahiri, Youssef; Bartlett, Scott P; Gilardino, Mirko S
Plastic and reconstructive surgery (1963),
2017-July, 2017-Jul, 2017-07-00, 20170701, Volume:
140, Issue:
1
Journal Article
Peer reviewed
LEARNING OBJECTIVES:After reading this article, the participant should be able to1. Understand the craniofacial dysmorphology associated with nonsyndromic craniosynostosis. 2. Understand the ...functional concerns and preoperative considerations when treating patients with nonsyndromic craniosynostosis. 3. Understand the various treatment options available to address patients with nonsyndromic craniosynostosis. 4. Recognize the current debate with regard to timing and type of surgical intervention, and their impact on patient outcome, for patients with nonsyndromic craniosynostosis.
SUMMARY:Craniosynostosis is a pathologic condition associated with the premature fusion of one or more cranial sutures. When the cranial sutures fuse prematurely, the skull and the growing brain beneath the suture are restricted, leading to a compensatory expansion into regions of the skull that are not affected. Craniosynostosis can occur in isolation (nonsyndromic) or can be associated with other extracranial anomalies. When anomalies outside the skull are present, craniosynostosis is often part of a syndrome and usually involves multiple sutures (syndromic craniosynostosis). This article focuses on nonsyndromic craniosynostosis, and describes the current state of knowledge regarding its diagnosis, surgical management, and outcomes.
Background:
Progressive hemifacial atrophy is a rare disorder characterized by gradual unilateral soft-tissue atrophy in the face, which may also include clinically significant degeneration of ...underlying muscle and bone. In recent years, there has been a growing body of evidence regarding different soft-tissue reconstructive strategies in progressive hemifacial atrophy and the impact of intervention timing on disease progression. This article provides a comprehensive synthesis of the latest evidence to guide optimal management.
Methods:
A comprehensive multidatabase search was performed through April of 2020 using relevant search terms to identify clinical studies. Outcomes, complications, and disease- and patient-related indications pertaining to different soft-tissue reconstructive strategies in progressive hemifacial atrophy were collected and critically appraised.
Results:
Thirty-five articles reporting on a total of 824 progressive hemifacial atrophy patients were evaluated; 503 patients (61 percent) were managed by microvascular free flaps, 302 patients (37 percent) were managed by autologous fat grafts, and 19 patients (2 percent) were managed by pedicled flaps. A detailed synthesis of outcomes is presented in this article, as is a comparative evaluation of different microvascular free flap options.
Conclusions:
Soft-tissue reconstruction in progressive hemifacial atrophy remains an evolving field. Operative decision-making is often multifaceted, and guided by specific volumetric, aesthetic, and functional deficiencies. Serial fat grafting is the primary modality used for patients with mild soft-tissue atrophy, whereas microvascular free flaps widely remain the treatment of choice for reconstruction of large-volume defects. There exists a growing role of graft supplementation to improve fat graft survival, whereas recent evidence demonstrates that early intervention may help curb disease progression.
GENERAL PURPOSE:To provide information about the clinical presentation of hypertrophic scars and keloids based on their varied structural components.
TARGET AUDIENCE:This continuing education ...activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES:After completing this continuing education activity, you should be able to:
ABSTRACTHypertrophic scars and keloids are firm, raised, erythematous plaques or nodules that manifest when the cicatrix fails to properly heal. They result from pathologic wound healing and often cause pain and decreased quality of life. The appearance of such cosmetically unappealing scars affects the confidence and self-esteem of many patients. These scars can also cause dysfunction by interfering with flexion and extension across joints. Both possess some unique and distinct histochemical and physiologic characteristics that set them apart morphologically and at the molecular level. While these entities have been the focus of research for many years, differentiating between them remains challenging for clinicians.This article reviews the clinical presentation of aberrant scars and illustrates how they can be differentiated. It outlines their pathophysiology and emphasizes the unique molecular mechanisms underlying each disorder. It also examines how altered expression levels and the distribution of several factors may contribute to their unique clinical characteristics and presentation. Further research is needed to elucidate optimal treatments and preventive measures for these types of aberrant scarring.
Patents are of great importance to plastic surgery, a field fueled by constant innovation. Familiarity with the patent process could promote further innovation by plastic surgeons. By granting ...proprietary rights to inventors in exchange for publication of their inventions, patents incentivize creativity and innovation while promoting diffusion and transfer of technology. The task of securing patent protection, however, is complex, and begins well before the patent application. Inventors must familiarize themselves with regulations to ensure that their inventions satisfy the criteria for patentability, which can differ among countries. Patents regarding surgical methods should undergo additional ethical deliberation given their potential interference with medical altruism. The patent application must be devised and written thoroughly, as it needs to withstand meticulous examination by patent offices and potential third-party opposition, and professional assistance in doing so should be sought. Filing of the application calls for intricate procedural and timing requirements that bear major benefits if well understood and respected by applicants. Given that patent rights only cover the issuing country's territorial scope, further endeavors must be pursued when seeking patent protection in additional countries. In this regard, two options exist, and the ultimate decision should be tailored to each inventor's personal needs. At every step of the patenting process, financial readiness is key because costs can be unpredictable and escalate quickly. In this article, the authors propose effective strategies directed at plastic surgeons to facilitate patenting of their ideas and protection of their intellectual property.
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