Interpersonal functioning and body image dissatisfaction in patients referred for NHS aesthetic surgery: A mediating role between emotion regulation and perfectionism?

BACKGROUND: Few studies have explored psychological factors associated with body image dissatisfaction in individuals seeking aesthetic surgery on the NHS. In NHS Scotland, The Adult Exceptional Aesthetic Referral Protocol (AEARP) states that individuals are only eligible for consideration for surgery where there is significant psychological distress and physical criteria associated with perceived problem of appearance. The AEARP necessitates that individuals seeking aesthetic surgery on the NHS must have a psychological assessment. It is therefore crucial to identify psychological factors associated with body image dissatisfaction that may highlight contraindications for surgery or are amenable to psychological intervention. METHOD: A total of 311 consecutive patients seeking aesthetic surgery who were referred for psychological assessment under the AEARP completed a series of psychometric measures as part of routine clinical practice. Multiple mediation analyses using bootstrapped method was used to explore the relationship between interpersonal functioning, emotion regulation, perfectionism, and body image dissatisfaction. RESULTS: Multiple mediation analysis indicated that emotion regulation partially mediates the relationship between interpersonal functioning and body image dissatisfaction in this clinical population. CONCLUSION: This study indicates that interpersonal functioning and emotion regulation significantly relate to body image dissatisfaction in this patient group. Psychological assessment of patient suitability for aesthetic surgery should include assessment of interpersonal functioning and emotion regulation which may be amenable to psychological intervention and be of significant benefit to patients either pre- or post-operatively or instead of surgery.

Vacuum-assisted closure and primary cutaneous aspergillosis in a burn - a management dilemma!

The advent of vacuum-assisted closure (VAC) devices has changed many wound management practices by application of topical negative pressure. A 20-year-old male sustained 21% total body surface area circumferential full-thickness burns to both legs from knees to feet. The VAC dressing was used in the management of his wounds. The patient had persistent pyrexia and graft destruction and subsequently the wounds cultured Aspergillus fumigatus. The increasing popularity of the VAC dressing is well deserved in the management of complex burn wounds. This case highlights the fact that in the care of complex burn patients the development of opportunistic infections should be considered, especially in situations such as persistent pyrexia or following the breakdown of healed grafts, particularly during the use of topical negative pressure.

The timing of autologous latissimus dorsi breast reconstruction and effect of radiotherapy on outcome.

INTRODUCTION: The optimal timing of breast reconstruction is controversial. Immediate breast reconstruction (IBR) has been gaining in popularity due to the aesthetic and psychological benefits, although its role is less certain when postoperative radiotherapy may be required. There is some evidence that long term cosmetic outcome of IBR using the autologous latissimus dorsi (ALD) flap may be impaired if the reconstruction is subjected to postoperative radiotherapy. We compared the long term cosmetic outcome and patient satisfaction between a group of patients who underwent IBR with postoperative radiotherapy and a group who underwent delayed ALD reconstruction. METHODS: Patients who underwent ALD breast reconstruction between 1997 and 2000 were invited to attend a research clinic. At the clinic up-to-date photographs were obtained and a quality of life questionnaire was completed. Cosmetic outcome was assessed by a panel of judges including surgeons, nurses and lay people. RESULTS: Thirteen patients who had IBR and postoperative radiotherapy and 11 patients who had delayed reconstruction attended for follow up. In the long term both groups fell within an acceptable cosmetic outcome range. However, there was a trend towards a better outcome in patients undergoing delayed reconstruction, with the volume and contour of the upper pole being most affected in the irradiated reconstructions. Patient satisfaction was similar between the two groups, however most patients in retrospect would have preferred an immediate reconstruction. CONCLUSIONS: Immediate ALD breast reconstruction, even in the setting of postoperative radiotherapy, yields satisfactory results. We continue to offer it to patients undergoing mastectomy operations, even when postoperative radiotherapy is likely to be required.

Sebaceous carcinoma of the periorbital and extraorbital regions.

Sebaceous carcinomas are uncommon amongst cutaneous malignancies. These lesions can broadly be classified into 2 groups; (i) periorbital, which behave aggressively, and (ii) extraorbital, which are reported to metastasize rarely. A retrospective review has identified 12 cases of primary sebaceous carcinoma treated at Canniesburn Hospital over the decade from mid-1983 to mid-1993. Out of 7 cases with periorbital primary lesions, one patient died from metastatic disease and another developed local recurrence which was successfully excised. The series included an unusual case of metastasizing primary extraorbital sebaceous carcinoma.