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Purpose of Study Surgical site infections (SSI) burden U.S. hospitals with around $1.5 billion annually. To reduce SSI, irrigating the incision with an antimicrobial solution before closure is recommended. Hence, we evaluate the impact of Irrisept, a form of diluted chlorohexidine 0.05%, on reducing the prevalence of SSI in a high-risk breast cosmetic surgery population. Methods Used We conducted a retrospective cohort study using data in the electronic medical record for breast implant exchange patients in one practice and analyzed infection rates between 42 patients from July 2018-June 2019 that did not receive Irrisept irrigation (control group) with 16 patients from July 2019-July2020 that received Irrisept irrigation (experimental group;significantly less due to Covid-19). We executed descriptive analyses, independent T test, ANOVA (for 3 types of incision location), and Chi-squared to assess comorbidities and intraoperative factors. Summary of Results Among the control group (n=42), 4 patients had a postoperative infection;in the experimental group (n=16), 0 had an infection (9.52% vs. 0%;p=0.04) suggesting the use of Irrisept significantly decreases SSI. The p values from the T test and ANOVA (p<0.05=significant) showed no significant differences in breast cancer (0.84), previous radiation (0.32), history of chemotherapy (0.57), obesity (0.40), renal failure (0.32), smoker/previous smoker (0.41), type of implant (0.32), incision location (0.68), acellular dermal matrix use (0.32), or drain use (0.58) between two groups. The only significant comorbidity was diabetes (p=0.04) with 9.52% (control) vs. 0% (experimental). However, greater percentage of experimental group were obese (25% vs.14.29%) and had a history of smoking (25% vs. 9.52%). Conclusions A concern regarding the implementation of Irrisept irrigation is associated costs. However, the results show the use of Irrisept decreases the infection rates, ultimately relieving the financial burden of postoperative infections. Therefore, we recommend irrigating the incisions of breast surgery patients with Irrisept as both a preventative and economic measure.
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Introduction: With the relaxation of pandemic-related operative restrictions, there has been an increase in elective facial plastic surgical cases in comparison with 2018, prior to the COVID-19 pandemic. The objective of this study is to compare the surgical volume of pre-COVID-19 pandemic cosmetic facial plastic surgery (FPS) in 2018 with the postpandemic volume in 2021, in both a tertiary care academic practice and community practice. Method(s): This is a retrospective chart review of adult patients undergoing cosmetic FPS at an academic tertiary care center and community practice: Louisiana State University Health Shreveport (LSU) and Kenneth Sanders Facial Plastic Surgery in Louisiana, respectively. Information assessed included demographics, surgical date, and surgical procedure performed during the first 6 months of 2018 and 2021. Categorical variables were compared using 2-proportion z test and Pearson chi2 test. Odds ratio (OR) was used to calculate the likelihood of procedural year predicting subsequent FPS. Result(s): One hundred thirty-nine patients were identified: 58 (41.7%) patients in 2018 and 81 (58.3%) patients in 2021. The number of patients having FPS in the <30-year-old age group increased by 13.6% from 2018 to 2021 (P=.02). The number of septorhinoplasties increased by 20.5% from 2018 to 2021 (P=.01). Furthermore, the odds of one having a septorhinoplasty in 2021 increased 144% compared with 2018 (OR: 2.44 [95% CI, 1.19, 5.11]). The only cosmetic surgery to significantly decrease in volume during the postpandemic time period was rhytidectomy (OR: 0.33 [95% CI, 0.12, 0.82]). Conclusion(s): The COVID-19 pandemic has seen a significant rise in FPS in patients younger than 30 years and those electing to have septorhinoplasty. The etiology of this increase is not clear;however, possible explanations include the following: increased disposable income, "Zoom dysmorphia," and the ability for conspicuous recovery behind a mask.
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Introduction: Keloids of the head and neck can result in significant disfigurement and psychological stress. Here we report a novel case of keloid formation at a well-healed postauricular incision presenting after a year of daily ear loop mask use and discuss unique considerations for management. Method(s): This is a retrospective case review of a 35-year-old African American man with Klinefelter syndrome, type 2 diabetes mellitus, and a history of hypertrophic scar formation who presented to otology clinic in 2015 with chronic left otitis media and cholesteatoma. He underwent left tympanoplasty and mastoidectomy in 2016 through a postauricular incision 1 cm posterior to retroauricular sulcus in a standard fashion. In 2018, the patient was noted to have a hypertrophic scar without extension beyond the borders of the incision that was stable until 2021. Result(s): In 2021, the patient was noted to develop a 12A 7-cm postauricular keloid in the setting of mechanical irritation from his mask worn throughout the COVID-19 pandemic. Given the disfiguring cosmesis and resulting challenges securing an ear loop mask, he elected to undergo complete excision of the postauricular keloid with tension-free primary closure of the wound, intralesional corticosteroid injection (triamcinolone acetonide 40 mg/mL), and pressure dressing. The patient was counseled on options for mask wearing to avoid contact with the postauricular incision. Conclusion(s): When designing postauricular incisions in patients prone to hypertrophic scar or keloid formation, the point of postauricular contact of ear loop masks is a novel consideration to minimize risk of future pressure-related injury. Counseling on alternative face masks that tie behind the head or anchoring ear loops to buttons sewn onto a hat or headband are other preventative pressures.
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The twenty-first century has transformed individuals’ perceptions and behaviors by providing higher connection with digital technology. Especially, it has been observed that the digital transformation in business and government models has accelerated during the Covid-19 pandemic. On the other hand, the fact that spending more time on digital platforms as socializing has created new concerns on physical appearance and visual perceptions. While activities such as taking selfie, photo sharing, and content sharing are increasing, aesthetic concern is increasing, too. This study aims to explore the link between digitalization and aesthetic concern by using qualitative research methodology. Firstly, this study will give a literature review and then selected Turkish cases will be analyzed by using descriptive content analysis. Thus, it is thought to give a brief framework explaining how digitalization and social media influence aesthetic concern and the desire for aesthetic surgery as a result. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Background/Purpose: Cleft Surgery in our centre is delivered by a single specialist surgeon in a regional Burns and Plastic service. We see 35-45 cleft-affected births per annum and, prior to the COVID-19 pandemic, ran 6 theatre lists per month, conducting 170-180 cleft procedures annually. The pandemic severely hindered elective operating in even tertiary centres, due to the redeployment of theatre staff and resources to manage the emergency care load. Cleft surgery was suspended entirely during the first wave (March-June 2020), before efforts in collaboration with the RCPCH (UK) to conserve the cleft pathway restored it as a priority. Primary palatine reconstruction is recommended at 6-9 months of age to optimise velopharyngeal function and speech proficiency by 5 years (Slater et al 2019). Our service was restarted at 1-2 ad hoc lists a month, which was both insufficient to manage ongoing demands and deal with rising outstanding cases. We faced a major challenge in safely distributing scarce surgical time and capacity across the entire cleft surgical burden. Therefore, we aim to examine our response to these limitations in the face of rising cases and time pressures, illustrating our methods in prioritising cleft procedures. Methods/Description: We reviewed the current literature to determine which of the main cleft procedures were most time critical, and compiled a cleft priority document with a broad evidence basis. Babies with palate involvement were top priority, in light of the strong evidence advocating primary palate repair by 13 months of age (CRANE 2020), after which there is a risk of speech delay (Shaffer et al 2020). Primary lip +/- alveolar involvement were prioritised lower and performed later (∼1 year), as cosmesis during infancy was deemed less detrimental, although there remained the psychological impact on the parent (Grollemund et al 2020). Secondary speech surgery was next, the lack of which can inhibit education and require intensive speech therapy to support patients (Baillie and Sell 2020). This was followed by alveolar bone grafting, ideally performed prior to canine eruption at ∼8-9 years to limit further dental reconstructions (Vandersluis et al 2020). As per national consensus, all adult cleft surgery was suspended to accommodate higher priorities. Focusing on early palate repair helped restart the cleft pathway and prevent functional delay as well as further interventions and schoolage support. However, late lip repair saw a rise in complications - two cases of dehiscence were associated with self-inflicted toddler trauma. This is in addition to the psychosocial implications of cosmesis, including early maternal interactions (Montirosso et al 2011), stigmatisation by peers (Bous et al 2021), and parental anxiety (Bous et al 2020). We recommend isolated lip reconstructions are also undertaken within 9 months. Long-term physical and psychosocial impacts of delay in surgery should guide resource allocation in the event of future operating limitations.
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Introduction: Baldness is a current problem in aesthetic medicine. This cosmetic defect can lead to serious psychological and emotional stress. Most of the time, the solution to this problem consists of removing or attenuating its cause: alopecia. Among the current hair restoration technique to treat alopecia, one is the biocompatible artificial hair implant. Materials and Methods: The certified medical device used for this study is the biocompatible artificial hair Biofibre4.0. The clinical study was done by collecting clinical data from 18 clinics located in 15 different countries and 4 continents to evaluate the efficacy, safety, and performance of a new artificial hair device generation compared to previous artificial hair. Automatic and manual implanter were utilized by doctors participating in these trials. A new needles material was also used for this study. The standard medical protocol was applied with some differences in the doctor’s personal experience, patient’s situation, and climate. Results: The data collected show that in a sample of about 1337 patients treated in 2020/2021, inflammation and infections are around 7%, and curling is <1%. There were no phenomena of fibre breakage. Itching appeared in about <3% of cases. The problems encountered in most cases were mild and resolvable with appropriate therapy, and only in rare cases (<1%) it was necessary to proceed with the total removal of the fibres. In some cases (<1%), it was just necessary to partially extract the fibres that cause recurrent discomfort for the patient. In most patients, satisfaction was 96%. The limitations in patient movement and lowering of the immune response in many of them caused by COVID SARS 2 might partially affect the final data. Conclusion: This surgery does not imply scar formation and hospitalization. It can be used alone or with other treatments to provide psychological benefits and improve quality of life. Indications are poor donor area, request for immediate aesthetic result and scarce trauma. Patient selection, respect for medical protocol and proper aftercare must be complied with. Contraindicated cases must be avoided, and partial or total removal of fibres is required in case of recurrent problems. Additional improvements to this technique are expected to enable an ever vaster application.
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Goals: There is no doubt, that Severe Acute Respiratory Syndrome Coronavirus-2 and it’s associated disease (COVID19) has been quite challenging not only for all Health Systems worldwide, but also for all medical professionals, particularly those dealing with cancer patients. There has been a rearrangement of healthcare resources, so that the health systems to be able to deal with the high volume of covid19 patients and the required facilities for their treatment. As a result, routine treatment pathways have been modified. Surgical management of breast cancer patients could not be exempted from treatment pathway modification in the covid19 outbreak era. Main goal is to reduce hospital stay and minimizing the risk for complications and consequently hospital visits, facilitating at the same time oncologic efficiency. Aim of this study is apart from comparing breast surgery cases in two consecutive years, to evaluate the efficacy of therapeutic mammoplasty in breast cancer patients in Covid Outbreak era. Methods: We compared all the breast cases done by a Consultant Oncoplastic Breast Surgeon during covid19 outbreak from March until June in 2020 to the cases done during the same period of time in 2019. Parametres like tumor characteristics, hospital stay, complications, oncologic efficacy, and cosmetic outcome were evaluated. Results: Asseen in theTable1, all breast cases duringCovid19outbreak were cancer cases, without any reconstruction or surgery for benign breast diseases. The number of cases in total was slightly smaller during the outbreak, compared to ones in 2019. As anticipated, there was no reconstruction or benign cases surgery during Covid19 in compliance with Association of Breast Surgery recommendations and regional/national guidelines during Covid19 outbreak. In terms of Wide Local Excisions all of our cases underwent therapeutic mammoplasties, mainly with Modified Round Block technique. (Table Presented) Conclusion(s): In view of Covid19 outbreak, surgical approach to breast cancer patients should ensure oncologic efficiency and minimize exposure to hospital environment. As our data demonstrate, therapeutic mammoplasty is a safe and oncologically efficient approach for breast cancer patients, with minimum complication rates and high satisfaction rates in terms of cosmesis. Therefore, even in challenging pandemic times we are, it can be safely performed by trained Oncoplastic Surgeons. Conflict of Interest: No significant relationships.
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INTRODUCTION: SPE is a rare entity reported in medical literature. Clandestine silicone application has been increasing in Mexico, leading to increased rates of SPE and death. Symptoms include dyspnea, chest pain, fever, cough, diffuse alveolar hemorrhage (DAH), and acute respiratory distress syndrome. In Mexico, from 2005-2014, 21.8% SPE deaths have been reported related to cosmetic procedures. DESCRIPTION: A 21-year-old, previously healthy transgender patient, with a history of multiple cosmetic surgeries, underwent to a gluteal augmentation procedure through injection of 1000 cc of liquid silicone in an outpatient clinic. The procedure was canceled after administration of 500 cc of silicone due to dyspnea and cough, and the patient was discharged. Two days later, the symptoms worsened, and she was admitted to the emergency department, with a blood pressure of 90/64 mmHg, SpO2 60%, respiratory rate of 40 bpm, and heart rate of 125 bpm. She was intubated and admitted to ICU. On clinical examination, we identified basal crackles, petechial hemorrhage, and erythematous puncture sites. CT pulmonary angiogram showed bilateral basal ground-glass opacities, ruling out thrombus in pulmonary circulation;and lung ultrasound with B pattern. Blood test showed thrombocytopenia, hypoxia (Pa02:FiO2 97 mmHg), elevated alveolar-arterial gradient, negative PCR SARS-CoV-2, and no renal failure. She was diagnosed with SPE;supportive management with lung protective ventilation, prone positioning (PP) and systemic steroids (SS) was initiated. She also had hemoptysis, new pulmonary infiltrates, and abnormal liver enzymes at ICU, which resolved spontaneously. After 8 sessions of PP, oxygenation improved, tracheostomy was performed due to ICU acquired weakness and was discharged home after 20 days of hospital stay. DISCUSSION: There is a paucity of reports of this complication. Our patient showed a significant improvement after administration of SS, which consists with an immunomediated mechanism. Studies have reported mortality from 24 to 33%, but can reach up to 100% if neurological symptoms are present. It is important to recognize that silicone injections are not safe and can lead to serious complications. Recognizing rare manifestations can help to distinguish this entity from other etiologies.