Calculating Tumor Volume Using Three-Dimensional Models in Preoperative Soft-Tissue Sarcoma Surgical Planning: Does Size Matter?

This feasibility study aims to explore the use of three-dimensional virtual surgical planning to preoperatively determine the need for reconstructive surgery following resection of an extremity soft-tissue sarcoma. As flap reconstruction is performed more often in advanced disease, we hypothesized that tumor volume would be larger in the group of patients that had undergone flap reconstruction. All patients that were treated by surgical resection for an extremity soft-tissue sarcoma between 1 January 2016 and 1 October 2019 in the University Medical Center Groningen were included retrospectively. Three-dimensional models were created using the diagnostic magnetic resonance scan. Tumor volume was calculated for all patients. Three-dimensional tumor volume was 107.8 (349.1) mL in the group of patients that had undergone primary closure and 29.4 (47.4) mL in the group of patients in which a flap reconstruction was performed, p = 0.004. Three-dimensional tumor volume was 76.1 (295.3) mL in the group of patients with a complication following ESTS treatment, versus 57.0 (132.4) mL in patients with an uncomplicated course following ESTS treatment, p = 0.311. Patients who had undergone flap reconstruction had smaller tumor volumes compared to those in the group of patients treated by primary closure. Furthermore, a larger tumor volume did not result in complications for patients undergoing ESTS treatment. Therefore, tumor volume does not seem to influence the need for reconstruction. Despite the capability of three-dimensional virtual surgical planning to measure tumor volume, we do not recommend its utilization in the multidisciplinary extremity soft-tissue sarcoma treatment, considering the findings of the study.

Identification of predictors for wound complications following preoperative or postoperative radiotherapy in extremity soft tissue sarcoma.

INTRODUCTION: In extremity soft tissue sarcoma (ESTS), external beam radiotherapy (EBRT) has been used in addition to limb-sparing surgery (LSS). This study aims to identify predictors for major wound complication (MWC) development following EBRT and LSS in ESTS. METHODS: This retrospective study includes ESTS patients treated with EBRT and LSS between 2005 and 2017. Two groups were formed; Group I included preoperatively irradiated patients, whereas Group II included patients who underwent postoperative EBRT. Multivariate logistic regression analyses were performed to create a prediction model for MWC development. RESULTS: One hundred twenty-seven patients were included, 58 patients (45.7%) in Group I and 69 patients (54.3%) in Group II. Some differences in baseline characteristics were found between the groups, e.g. in tumor size and grade, histological subtype and total RT dose. Twenty-three patients (39.7%) in Group I and 14 patients (20.3%) in Group II developed a MWC (p = 0.02). Preoperative EBRT was identified as independent predictor for MWC development, OR 2.75 (95%CI 1.21-6.26), p = 0.02. Furthermore, a trend towards an increased MWC risk was shown for patients' age (OR 1.02 (0.99-1.04)), delayed wound closure (OR 3.20 (0.64-16.02)) and negative surgical margins (OR 2.26 (0.72-7.11)). The area under the curve (AUC) of the model was 0.68 (0.57-0.79). CONCLUSIONS: This study corroborates the increased MWC risk following preoperative EBRT in ESTS. It remains important to carefully weigh the MWC risk against the expected long-term functional outcome, and to consider the liberal use of primary plastic surgical reconstructions in an individualized multidisciplinary tumor board prior to treatment.

The effect of upper eyelid blepharoplasty on eyebrow position.

BACKGROUND: Although upper eyelid blepharoplasty is one of the most frequently performed facial plastic surgical procedures, there is no consensus of opinion about the effect of an upper eyelid blepharoplasty on the position of the eyebrows in a general population. OBJECTIVES: This study was undertaken to determine this effect and to investigate whether preoperative compensatory rhytidosis of the forehead may cause a significantly greater postoperative lowering of the eyebrows. METHODS: An evaluation of 140 consecutive patients with complaints of visual impairment was performed, who underwent an upper eyelid blepharoplasty. The position of the eyebrows was measured pre- and postoperatively at three positions for each eye. In addition, the role of compensatory rhytidosis on eyebrow position was determined by classifying horizontal forehead lines. RESULTS: The mean drop in eyebrow position for all patients ranged from 0.35% to 1.23%. In females (n = 126), there was no significant postoperative drop in eyebrow position. In males (n = 14), however, one out of six measured distances (centre of pupil, lateral iris and lateral canthus) displayed a significant lowering of the eyebrow (p = 0.005). CONCLUSIONS: Our results show that the position of the eyebrow is not lowered significantly after an upper eyelid blepharoplasty performed among women with dermatochalasis and functional complaints of visual impairment. Male patients showed a slight trend of lowering of the eyebrows postoperatively. Preoperative lifting of the eyebrows by means of frontalis muscle activity did not influence the position of the eyebrows postoperatively, although forehead lines did seem to diminish significantly.

Facial reconstruction in the developing world: a complicated matter.

Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinical objectives had been achieved in 14/17 who had simple procedures but in only 5/18 who had complex operations (p=0.004). We conclude that complex procedures are technically possible within an under-privileged health care system but successful outcome depends on paying attention to multiple factors in patients' care and wound management. Early outcome studies may be a useful way to measure the quality of humanitarian surgical missions.

Early outcome of facial reconstructive surgery abroad: a comparative study.

Every year, many medical missions are undertaken in the developing world but there is almost a universal lack of outcome data on the quality of these missions. The present study compares early clinical outcome and complication rate in two consecutive missions (facial reconstruction) undertaken to Ethiopia in 2007 and 2008. The object was to establish if measures adopted following feedback from the first mission led to improvement of the results. A significant improvement was observed in early clinical outcome and there were less severe complications in the 2008 compared to the 2007 mission. On both occasions, significantly more complications were experienced after complex compared to simple procedures. Despite improved outcome in 2008, 50% of the complex cases had an unfavourable clinical result. The data suggest that early outcome studies are a useful method of critically evaluating the quality of surgical mission. The unsatisfactory outcome of complex procedures underlines the need for feedback on the quality of these missions.

Gull wing midforehead lift: when a poor man's forehead lift becomes the treatment of choice for brow ptosis.

In case of both medial and lateral brow ptosis in a balding candidate with a furrowed forehead, one may consider a midforehead lift, a technique that has not gained much popularity because of concerns regarding clearly visible scarring. We have applied this technique in a selected group of patients and wish to share our experience discussed among a review of the English-language literature. Our series of 10 male patients (average age, 56.9; operated in period between 2003 and 2006) were contacted, asked to return for a follow-up, and interviewed; all data were collected, including the excised amount of tissue and postoperative complications. Patient satisfaction was assessed (Likert scale) as well as the objective aesthetic result using the Strasser scoring system. Eyebrow position increased significantly (P < 0.035) after surgery, and remained stable over the follow-up period of 3 years. Postoperatively, the majority of the patients (7 of 10) was satisfied with the result and would repeat surgery based on their experience (average visual analog scale score, 7; range, 4-8). In all cases, functional complaints had decreased significantly. Although most patients reported to be somewhat bothered with the initial aesthetical aspect of the scar, only 1 of 10 patients was not satisfied with the overall aesthetic result. Four patients were graded as good, 3 patients as mediocre, and 1 patient as poor as based upon the Strasser grading system. These results demonstrate that there is a limited but definite indication for the gull wing midforehead lift in cases of generalized ptosis of the forehead in balding males with high and furrowed foreheads.