BACKGROUND: Few validated aesthetic assessment instruments in breast reconstruction use discrete scales to facilitate studies with multiple evaluators.
OBJECTIVE: This research aimed to propose an aesthetic assessment scale for reconstructed breasts.
METHODS: A scale was suggested using discrete variables, with responses ranging from 1 to 10, and the responses for each category could be summed to obtain an average that could be used in studies with multiple evaluators. To test the instrument suggested in this study, 5 experienced plastic surgeons assessed 46 patients. For all the analyses, a rejection level for the null hypothesis of 5% (p < 0.05) was adopted.
RESULTS: The suggested scale obtained valid intraclass correlation coefficients, with 0.9 for the overall aesthetic evaluation of the breast and the lowest being 0.77 for defining the inframammary fold. We observed good diagnostic accuracy in all comparisons, with the area under the curve ranging from 0.85 to 0.97. Regarding convergent validity, we observed correlations of 0.77 (p < 0.001) between breast volume and volume symmetry, 0.66 (p < 0.001) between breast shape and contour naturalness. The test-retest reliability was 0.708, which is considered good.
CONCLUSIONS: The results of this study support the effectiveness of the proposed new aesthetic evaluation scale, revealing consistency among different evaluators and over time. Convergent validation strengthens the relationship between the variables of the new scale and those of the Garbay scale. Furthermore, the robust diagnostic accuracy highlights the clinical utility of the new scale in assessing aesthetic outcomes in breast reconstructions.

A skull- base defect with grade-3 cerebrospinal fluid (CSF) leak following a pituitary macroadenoma removal is rare and challenging. We provide a simple sample model of multilayer closure with naturally available hard and soft tissue components. Tamponade was provided to the reconstructed site with a simple inflated Foley\'s catheter bulb. There was no repair failure and cavities were well mucosalised on follow-up. Mucosal and turbinate preservation was fully achieved in this method as no turbinate flaps were raised or large raw surface exposure was there.

Reconstruction of craniomaxillofacial bone defects using 3D-printed hydroxyapatite (HA) bioceramic patient-specific implants (PSIs) is a new technique with great potential. This study aimed to investigate the advantages, disadvantages, and clinical outcomes of these implants in craniomaxillofacial surgeries. The PubMed and Embase databases were searched for patients with craniomaxillofacial bone defects treated with bioceramic PSIs. Clinical outcomes such as biocompatibility, biomechanical properties, and aesthetics were evaluated and compared to those of commonly used titanium or poly-ether-ether-ketone (PEEK) implants and autologous bone grafts. Two clinical cases are presented to illustrate the surgical procedure and clinical outcomes of HA bioceramic PSIs. Literature review showed better a biocompatibility of HA PSIs than titanium and PEEK. The initial biomechanical properties were inferior to those of autologous bone grafts, PEEK, and titanium but improved when integrated. Satisfactory aesthetic results were found in our two clinical cases with good stability and absence of bone resorption or infection. Radiological signs of osteogenesis were observed in the two clinical cases six months postoperatively. HA bioceramic PSIs have excellent biocompatible properties and imitate natural bone biomechanically and radiologically. They are a well-suited alternative for conventional biomaterials in the reconstruction of load-sharing bone defects in the craniomaxillofacial region.

暂无摘要。

Although rare, primary chondrosarcoma is the most frequent malignant tumor of the sternum. It commonly manifests as a painful, expanding mass arising from the costochondrosternal junction. Since it is resistant to radiotherapy and chemotherapy, surgical resection with reconstruction is the preferred treatment. A 50-year-old male presented with swelling over the left fourth sternocostal joint, gradually increasing in size. Imaging and clinical assessment suggested an infiltrative neoplasm, and surgical resection was indicated. The patient underwent a partial sternectomy, including a resection of the xiphoid process and costal cartilages two to seven and a partial resection of the manubrium. Postoperative pathohistological analysis specified the change as a low-grade chondrosarcoma in the pT1 stage. Chest wall reconstruction involved three pectus bars fixated around the ribs and the placement of a synthetic polypropylene mesh. The patient required postoperative rehospitalization due to partial skin layer wound dehiscence, serous drainage, and fever. Empirical antibiotic therapy was initiated, and the patient underwent a median superior laparotomy with partial omentoplasty of the sternal region, preserving the mesh and pectus bars. A culture analysis revealed methicillin-resistant Staphylococcus epidermidis, and postoperative antibiotic therapy was adapted to the antibiogram. Subsequently, all parameters of inflammation decreased, and wound healing followed. A one-year follow-up CT scan showed no disease recurrence. This case highlights the intricate surgical management that contributed to the successful treatment of sternal chondrosarcoma. Sternal wound infection, a severe postoperative complication with a high mortality rate, requires prompt identification, precise revision with culture-directed antibiotics, and effort to preserve the prosthetic material.

UNASSIGNED: Bladder exstrophy (BE) poses challenges both during the surgical repair and throughout follow-up. In 2013, a multi-institutional BE consortium was initiated, which included utilization of unified surgical principles for the complete primary repair of exstrophy (CPRE), real-time coaching, ongoing video capture and review of video footage, prospective data collection, and routine patient data analysis, with the goal of optimizing the surgical procedure to minimize devastating complications such as glans ischemia and bladder dehiscence while maximizing the rate of volitional voiding with continence and long-term protection of the upper tracts. This study reports on our short-term complications and intermediate-term continence outcomes.
UNASSIGNED: A single prospective database for all patients undergoing surgery with a BE epispadias complex diagnosis at 3 institutions since February 2013 was used. For this study, data for children with a diagnosis of classic BE who underwent primary CPRE from February 2013 to February 2021 were collected. Data recorded included sex, age at CPRE, adjunct surgeries including ureteral reimplantations and hernia repairs at the time of CPRE, osteotomies, and immobilization techniques, and subsequent surgeries. Data on short-term postoperative outcomes, defined as those occurring within the first 90 days after surgery, were abstracted. In addition, intermediate-term outcomes were obtained for patients operated on between February 2013 and February 2017 to maintain a minimum follow-up of 4 years. Outcomes included upper tract dilation on renal and bladder ultrasound, presence of vesicoureteral reflux, cortical defects on nuclear scintigraphy, and continence status. Bladder emptying was assessed with respect to spontaneous voiding ability, need for clean intermittent catheterization, and duration of dry intervals. All operating room encounters that occurred subsequent to initial CPRE were recorded.
UNASSIGNED: CPRE was performed in 92 classic BE patients in the first 8 years of the collaboration (62 boys), including 46 (29 boys) during the first 4 years. In the complete cohort, the median (interquartile range) age at CPRE was 79 (50.3) days. Bilateral iliac osteotomies were performed in 89 (97%) patients (42 anterior and 47 posterior). Of those undergoing osteotomies 84 were immobilized in a spica cast (including the 3 patients who did not have an osteotomy), 6 in modified Bryant\'s traction, and 2 in external fixation with Buck\'s traction. Sixteen (17%) patients underwent bilateral ureteral reimplantations at the time of CPRE. Nineteen (21%) underwent hernia repair at the time of CPRE, 6 of which were associated with orchiopexy. Short-term complications within 90 days occurred in 31 (34%), and there were 13 subsequent surgeries within the first 90 days. Intermediate-term outcomes were available for 40 of the 46 patients, who have between 4 and 8 years of follow-up, at a median of 5.7 year old. Thirty-three patients void volitionally, with variable dry intervals.
UNASSIGNED: Cumulative efforts of prospective data collection have provided granular data for evaluation. Short-term outcomes demonstrate no devastating complications, that is, penile injury or bladder dehiscence, but there were other significant complications requiring further surgeries. Intermediate-term data show that boys in particular show encouraging spontaneous voiding and continence status post CPRE, while girls have required modification of the surgical technique over time to address concerns with urinary retention. Overall, 40% of children with at least 4 years of follow-up are voiding with dry intervals of > 1 hour.

Liposarcomas are described as soft tissue sarcomas derived from adipose tissue. The finding of this tumor in the mandibular region is exceedingly rare. As of now, it has been described mainly in case reports and small series. A multidisciplinary approach is required to offer optimal treatment and may involve surgery, radiation and systemic therapies. Surgical repair of these defects represents a major challenge in oral and maxillofacial reconstructive surgery. We present the case of a 54-year-old man referred to our center with a progressively increasing mass in the anterior portion of the mandible. Biopsy revealed a well-differentiated myxoid liposarcoma. Resection of the tumor was performed with an additional primary reconstruction.

Background: This study aimed to explore a low-cost solution for virtual surgical planning/3D printed surgical guides in a training hospital, assessing the impact on intraoperative time and bleeding. Material and Methods: We included a total of 13 patients. 8 who underwent maxillofacial reconstruction surgery with fibula-free flap utilizing virtual surgical planning/3D printed guides (VP/SG), and 5 using conventional surgery (CS) from 2017 to 2020. The surgical time, bleeding, length of hospital stay, and comorbidities were collected and compared in two groups. We recorded the average cost for the complete surgical planning and 3D printed guides. We applied a qualitative survey to the surgeons involved in the surgical procedures. Results The mean surgical time in the VP/SG group was 8.16 ± 2.7, compared to the CS group 12.5 ± 3.8, showing a 4.34 hours difference with statistical significance (p = 0.033). Patients from the CS group had a higher bleeding volume of 921 ± 467.6 mL VS 760 ± 633.8 mL in the VP/SG group. The average cost for the complete surgical planning and 3D printed guides was 914.44 ± 46.39 USD. All the surgeons who answered the survey preferred to perform the procedure utilizing the virtual planning/3D printed guides. Conclusions Virtual planning and 3D printed surgical guides have the potential to reduce operation time in maxillofacial reconstruction.
Contexte : Cette étude visait à explorer une solution peu coûteuse pour la planification chirurgicale virtuelle/l’impression 3D de guides chirurgicaux dans un hôpital d’enseignement, en évaluant leur impact sur le temps peropératoire et le saignement. Matériel et méthodes : Nous avons inclus un total de 13 patients; 8 patients ont subi une chirurgie de reconstruction faciale avec lambeau libre de péroné (fibula) utilisant une planification chirurgicale virtuelle/des guides imprimés en 3D (VP/SG) et 5 patients ont subi une chirurgie conventionnelle (CS) entre 2017 et 2020. Le temps opératoire, le saignement, la durée de l’hospitalisation et les comorbidités ont été consignés et comparés entre les deux groupes. Nous avons enregistré le coût moyen pour la planification chirurgicale complète et les guides imprimés en 3D. Nous avons appliqué une enquête qualitative aux chirurgiens impliqués dans les procédures chirurgicales. Résultats : Le temps opératoire moyen dans le groupe VP/SG a été de 8,16 ± 2,7, comparativement à 12,5 ± 3,8 dans le groupe CS, soit une différence de 4,4 heures avec une signification statistique (P = 0033). Des patients du groupe CS ont perdu un plus grand volume de sang que les patients du groupe VP/SG (respectivement, 921 ± 467.6 mL contre 760 ± 633.8 mL). Le coût moyen de la planification chirurgicale complète et des guides imprimés en 3D a été de 914,44 ± 46,39 US$. Tous les chirurgiens ayant répondu à l’enquête ont préféré utiliser la planification virtuelle/les guides imprimés en 3D pour la réalisation de la procédure. Conclusions : La planification virtuelle et les guides chirurgicaux imprimés en 3D ont le potentiel de réduire les temps opératoires pour la reconstruction maxillo-faciale.

This study aimed to analyze cases of anterolateral thigh (ALT) free flap used for hand reconstruction with terminal perforator-to-digital artery anastomosis. Patients who underwent ALT free flap placement with terminal perforator-to-digital artery anastomosis for hand reconstruction between January 2011 and August 2021 were included. The number, length, and diameter of the perforators and veins, flap size, and operative time were investigated through a retrospective review of charts and photographs. The occurrences of arterial thrombosis, venous thrombosis, arterial spasm, and flap necrosis were analyzed. In total, 50 patients were included in this study. The mean diameter and length of the perforators were 0.68 mm and 3.25 cm, respectively, and the mean number of veins anastomosed was 1.88, with a mean diameter of 0.54 mm. Complications included four cases of arterial thrombosis, one case of venous thrombosis, seven cases of partial necrosis, and one case of total flap failure. Regression analysis showed that a longer perforator was associated with arterial thrombosis whereas larger flap size and number of anastomosed veins were associated with partial necrosis ( p  < 0.05). The terminal perforator-to-digital artery anastomosis offers advantages in using compact free flaps with short pedicle lengths to cover small hand defects.

BACKGROUND: Epispadias, which occurs on the more mild end of the Bladder Exstrophy Epispadias Complex (BEEC) spectrum, presents still with a wide range of severity in boys, from mild glanular epispadias to penopubic epispadias with severe urethral and bladder neck defects. Surgical management ranges from isolated epispadias repair to epispadias repair with bladder neck reconstruction (BNR) with or without pelvic osteotomies.
OBJECTIVE: We aimed to evaluate outcomes in epispadias treated at three institutions prior to formation of a formal collaboration. In addition, we sought to delineate outcomes based on anatomic severity at time of diagnosis, and initial procedure performed in cases of penopubic epispadias.
METHODS: IRB approved databases were retrospectively queried at three institutions for patients who underwent repair of epispadias between 1/1993 and 1/2013. Degree of epispadias, age and technique at initial repair, and self-reported continence status at last follow-up were recorded. Continence was categorized as: wet, intermediate (dry 2-3 h), or dry, while also distinguishing those who void and those who require clean intermittent catheterization (CIC). Those not seen since 1/1/2015, younger than 10 years at last follow up, or in whom continence data were not recorded were excluded.
RESULTS: A total of 48 boys were identified; 36 met inclusion criteria. The epispadias cohort consisted of 8 glanular epispadias (GE) (22%); 8 penile epispadias (PE) (22%), and 20 penopubic epispadias (PPE) (56%) with a median follow-up of 11.3 years (3.2-26.2 years). Overall, 33 of 36 (92%) boys void per urethra. Within the group that voids, 19/33 (58%) are completely dry, while 6/33 (18%) are wet. Among patients who underwent initial epispadias repair without concurrent or subsequent bladder neck reconstruction, continence rates were: GE 63% (5/8); PE 75% (6/8); PPE 71% (5/7). Among the 9 boys with PPE who underwent initial epispadias repair with concurrent BNR, 22% (2/9) were dry with no further surgeries. Overall, 8/20 (40%) of boys with PPE void with complete dryness.
CONCLUSIONS: This multi-center retrospective review of continence in epispadias demonstrates that even some boys with glanular and penile epispadias can have challenges with continence, and boys with penopubic epispadias may remain wet despite careful preoperative assessment of bladder neck functionality and concurrent BNR.
CONCLUSIONS: Continence outcomes in boys with all degrees of epispadias can be variable. Even boys with more distal defects may have significant bladder neck deficiency. And those with the most severe form of epispadias may require bladder neck reconstruction to achieve continence.