The cosmetic outcome of external dacryocystorhinostomy scar and factors affecting it.

Purpose: To study the cosmetic outcome of external dacryocystorhinostomy (Ex-DCR) and to detect the factors affecting it. Patients and Methods: Prospective randomized interventional study included forty patients who were treated by 40 Ex-DCRs. In twenty patients, medial canthal vertical incision was used and in the other twenty cases, subciliary incision was used. The skin was closed using vicryl 6-0 or prolene 6-0 interrupted sutures, and each one was randomly used in twenty patients (10 patients of each incision type). Cosmetic outcome was evaluated 6 months postoperative by the patients and by an oculoplastic surgeon on a four grades scale. Cosmetic results and its correlation to patients’ age, sex, skin complexion, type of incision, and type of skin sutures were studied. Results: The mean scar grading was 0.98 ± 1.0 and 1.3 ± 1.0 in patients’ and examiner’s assessment. About 27.5% described their scars as cosmetically significant. The cosmetic outcome was significantly affected by the type of incision with only 5% significant scars in subciliary incision group. Prolene 6-0 suture was associated with better cosmetic results with 15% significant scars. 50% of dark-skinned patients showed cosmetically significant scars. Although no correlation was found between patients’ age and cosmetic outcome, pediatric patients showed higher tendency to scar visibility with mean scar grade 1.2 ± 1.0 and 1.5 ± 0.9 in patients’ and examiner’s assessment. Conclusion: Dark skinned and pediatric patients are more prone to visible Ex-DCR scar. The use of subciliary approach and prolene 6-0 skin sutures is associated with more favorable cosmetic outcome.

Comparison of Two Methods of Laparoscopic Single Port Appendectomy and Conventional Three Port Laparoscopic Appendectomy

PURPOSE: Acute appendicitis is a type of abdominal disease that requires emergency surgery. Over the past three decades, laparoscopic appendectomy has become the standard operation for acute appendicitis. The aim of this paper is to compare the methods of single port appendectomy and conventional appendectomy and to illustrate the advantages of single port appendectomy. METHODS: The first group of patients underwent single port appendectomy using a surgical glove (Group 1), and those in the second group underwent surgery using the TriPort system (Group 2). The third group of patients underwent conventional three port surgery (Group 3). Questionnaires regarding patient satisfaction with scars were administered via telephone interview. Patient characteristics, histopathological data, postoperative data, and satisfaction score were analyzed by t-test and Pearson chi2 test. RESULTS: A statistically significant difference in satisfaction scores was observed among the three groups. Overall, patients in the single port group using a surgical glove would be more likely to recommend the procedure to friends and family than would patients in the other two groups. Better cosmetic results were achieved for both groups of patients who underwent laparoscopic single port appendectomy, compared to those who underwent conventional three port laparoscopic appendectomy, with statistically significant difference. CONCLUSION: Laparoscopic single port appendectomy using a surgical glove is a feasible and safe procedure and shows no differences in terms of risk, such as postoperative complication, compared to a conventional three-trocar technique. Use of this method resulted in better satisfaction compared with the other two groups, illustrating its cosmetic improvement.

Surgical Outcome of Levator Recession for Correction of Upper Eyelid Retraction

PURPOSE: To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction. METHODS: Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated. RESULTS: Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean +/- standard deviation of 27.7 +/- 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 +/- 1.3 mm from 6.3 +/- 1.5 mm preoperatively to 3.2 +/- 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession. CONCLUSIONS: Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.

Cosmetic effects of oncoplastic volume displacement technique in breast-conserving surgery / 中华医学美学美容杂志

Objective To explore the cosmetic effect of oncoplastic volume displacement in breastconserving surgery.Methods 43 cases of breast cancer in stages I and Ⅱ with pathological diagnosis by core needle biopsy were operated by extended resection of tumor combined with axillary lymph nodes dissection.Among the patients,wound cavity was repaired by direct skin suture without suture of mammary gland deletion in 22 cases,and another 21 cases were repaired by oncoplastic volume displacement technique in which skin suture followed by freeing remaining breast tissue flap and translocation to repair the mammary defect.All of them were treated with three-dimension conformal radiotherapy,standard chemotherapy and endocrine therapy after operation.3 years after partial removal of breast,a retrospective historical control study had been fulfilled to analyze breast cosmetic results between two groups.Results In direct suture group,the cosmetology score was 4.3 points and fine rate was 40.9% (9/22).In breast reconstruction group.the score was 4.8 points and fine rate was 71.4% (15/21).The breast cosmetic effect in breast reconstruction group was significantly better than that in direct suture group (P<0.01).Conclusion It will get better breast cosmetic results after operation to utilize oncoplastic volume displacement suture technique in breast-conserving surgery.

Treatment of Conjunctival Nevus with Argon Laser

PURPOSE: To evaluate the clinical efficacy of Argon laser photocoagulation in patients with conjunctival nevus. METHODS: Twenty-seven patients (27 eyes) who were clinically diagnosed with conjunctival nevus from January to September 2003 were included in this study. The conjunctival nevus was eliminated by Argon laser after topical anesthesia with proparacaine. The power density varied between 200 and 400 mW and the spot size ranged from 100 to 300 microgram. The duration of argon laser was 0.15~0.2 sec. The spot count was varied according to the size and degree of pigment density of conjunctival nevus. The mean follow-up period was 7.0 months. RESULTS: The wounds after Argon laser treatment were completely healed within 1 week. Twenty-three eyes were treated completely with only one laser treatment but 4 needed an additional laser treatment for more satisfactory cosmetic results. There were no postoperative complications such as infections, conjunctival degeneration or recurrence. CONCLUSIONS: Argon laser treatment for conjunctival nevus has benefits such as no intraoperative hemorrhage, low recurrence rate, easier method and good cosmetic results.

Multi-factors analyses affecting cosmetic results after breast conservation therapy / 中华医学美学美容杂志

Objective To investigate the factors affecting the cosmetic results in the breast cancer treated with breast conservation to get the better cosmetic results.Methods Treated breasts were scored by the plastic surgeon and the patient independently.Mann-Whitney U test was used in univariate analyses whereas logistic regression was used in multivariate analyses.Results In the surgeon's evaluation, the satisfactory rate was 65.7 %.In univariate analyses,age(P=0.003),body mass index(BMI)(P=0.002),menopausal status(P=0.002),the radiation dose(P=0.022),the number of the incisions as the tumour was located in the outer-upper quadrant(P=0.036),the resection times(P=0.036),fibrosis(P=0.002),the type of surgery(P=0.002) were the significant factors affecting cosmetic results.In multivariate analyses,fibrosis,the type of surgery and the radiation dose(P=0.009,0.001,0.019) were the significant factors affecting cosmetic results.In the patient's evaluation,the satisfactory rate was 76.1%.In univariate analyses,the type of surgery (P=0.001) and fibrosis(P=0.045) were found to be significant factors. In multivariate analyses using logistic regression,the type of surgery(P=0.005) were the most significant factors.Conclusions The satisfactory rate has positive correlation between the surgeon and the patient.In the twenty-seven possible factors affecting the cosmetic results,age,body mass index,menopausal status,radiation dose,the number of the incisions as the tumour located in the outer-upper quadrant,the resection times,fibrosis and the type of surgery are the main factors affecting the cosmetic results significantly.