Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at an NHS plastic surgery unit.

BACKGROUND: The study was an analysis of patients managed by plastic surgery services at Heatherwood and Wexham Park hospitals during the calendar year 2022 for complications following cosmetic surgeries performed both internationally and within the United Kingdom. METHODS: Patients were identified via local databases and encounters and management confirmed with retrospective studies of patient electronic medical records. RESULTS: 23 patients were managed during the year 2022 for complications post cosmetic surgery. 91% (n = 21) of complications were related to breast cosmetic surgery and/or abdominoplasties. 78% (n = 18) of patients presented within the first two months following their procedure. The most common complications identified were wound dehiscence 43% (n = 10), post-operative infection 39% (n = 9) and seromas 30% (n = 7). The most common country selected for surgery by patients was Turkey with 48% (n = 11) of managed patients. 52% (n = 12) of cases were managed conservatively and 48% (n = 11) of cases required invasive procedures including surgery. 87% (n = 20) of patients were discharged with completed treatment. CONCLUSION: Cosmetic surgery and tourism are an in-demand phenomenon and appear here to stay. The stringent regulatory and legal processes in place in the UK may not be applicable abroad to the detriment of patient care. Greater effort is needed to increase public awareness to the risks involved in seeking international options and how to self-screen suitable clinics. Ongoing current national auditing may need to be expanded to understand the true impact on NHS units in dealing with the aftermath of these surgical expeditions.

Tip Droop Prevention in Rhinoplasty: Dynamic Effect of Strut Graft on Smiling versus Depressor Muscle Release.

BACKGROUND: Aesthetic rhinoplasty is one of the most challenging procedures performed by aesthetic surgeons. Tip droop, especially on smiling, may not be noted by the surgeon postoperatively but can be concerning to patients. Our aim was to determine if the division of the depressor septi nasi or its combination with a columellar strut graft during rhinoplasty produce a measurable reduction in nasal tip droop on smiling. METHODS: A retrospective casenote and photograph review was conducted on patients who had undergone aesthetic endonasal rhinoplasty, performed by a single surgeon between 2015 and 2019. In total, 29 patients had release of the depressor septi nasi muscle, whilst 11 had release of the muscle along with a strut graft. Lateral smiling photographs were taken postoperatively. Tip droop was measured as a variation of the nasolabial angle from rest to smiling using the Frankfurt line. RESULTS: Photographs were taken at a mean of 14 months postoperatively. In the group who had muscle release only, a mean increase in nasolabial angle of 3.66 degrees was seen when smiling when compared with rest. In the group who had muscle release combined with strut graft, a mean increase of 2.27 degrees was seen. When using a columellar strut along with muscle release, tip droop on smiling was reduced. CONCLUSIONS: This study demonstrates that columellar strut grafting in combination with muscle release can alleviate drooping of the tip better than muscle division alone after rhinoplasty. The columellar strut graft provides tip stability and can therefore be used to enhance dynamic outcomes after rhinoplasty.

Outcome-based Comparative Study to Examine the Correction of Columella Deformitiesfollowing Rhinoplasty.

The columella is an underrepresented part of rhinoplasty. The objective of this study was to assess the outcome of columella correction following rhinoplasty and to assess any differences in the open and endonasal approach. METHODS: This is a retrospective study involving 65 rhinoplasty patients, who were divided into 2 groups depending on whether they had an open or endonasal approach. Fifteen patients underwent the open procedure, and 50 patients underwent the endonasal approach. Patients who underwent endonasal rhinoplasty were compared with open rhinoplasty patients in terms of their final outcome, with a focus on the columellar correction. The classification by Rohrich and Liu and Gunter's distance between the nasal axis and columella were used to assess the correction. RESULTS: The overall incidence of columellar correction was 90% in the endonasal group (45 of 50 patients) and 67% in the open approach group (10 of 15 patients); a comparison shows a P value of 0.043 (<0.05). An estimated 49 of 50 patients (98%) from the endonasal group saw a reduction in the nasal axis-columella distance when compared with the open rhinoplasty group, who saw a reduction in 12 of 15 patients (80%); statistical analysis shows a P value of 0.036 (<0.05). The quantitative reduction in this distance in all patients when compared between the 2 groups had a P value of <0.001, suggesting a greater overall reduction using the endonasal approach. This may be related to differences in distribution of the deformities within the 2 groups. CONCLUSIONS: There is no standard way to correct the columella, but it is important to identify the deformity and the need to correct it. In our patients, we found comparable outcomes in achieving a satisfactory columella in the open and endonasal groups.

Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting.

INTRODUCTION: The National Institute for Health and Clinical Excellence guidelines recommend that breast reconstruction should be available to all women undergoing mastectomy and discussed at the initial surgical consultation (2002, and updated 2009). The National Mastectomy and Breast Reconstruction Audit (2009) showed that 21% of mastectomy patients underwent immediate breast reconstruction (IBR) and 11% had delayed breast reconstruction (DBR). Breast reconstruction has been shown to have a positive effect on quality of life postmastectomy. This retrospective study investigated the impact of the introduction of a dedicated oncoplastic multidisciplinary meeting (OP MDM) on our unit's breast reconstruction rate. PATIENTS AND METHODS: A retrospective analysis of 229 women who underwent mastectomy, of whom 81 (35%) underwent breast reconstruction between April 2014 and March 2016. Data were analyzed before and after introduction of OP MDM in April 2015. Data on patient age, type of surgery (mastectomy only, mastectomy and reconstruction), timing of reconstruction (IBR, DBR), and type of reconstruction (implant, autologous) were collected. RESULTS: Between April 2015 and March 2016, following establishment of OP multidisciplinary team in April 2015, of the 120 patients who had mastectomy, 50 (42%) underwent breast reconstruction with 78% (39/50) choosing IBR (56% implant reconstruction and 22% autologous). Compared to the period between April 2014 and March 2015 preceding the OP MDM, of 109 patients who underwent mastectomy, only 31 (28%) had breast reconstruction with 64% (20/31) choosing IBR (45% implant reconstruction and 19% autologous). The rate of DBR was lower, 22% (11/50), following OP MDM compared to 35% (11/31) before OP MDM. CONCLUSION: There has been an increased uptake of breast reconstruction surgery from 28% to 42%. The biggest impact was on those opting for the immediate type reconstruction option (78%). The OP MDM has significantly contributed to this increased rate of reconstruction.

Improved access in endonasal rhinoplasty: the cross cartilaginous approach.

BACKGROUND: The popularity of open rhinoplasty has increased such that it is the first choice of approach for many surgeons undertaking primary rhinoplasty. Despite the benefits of this approach, the drawbacks are often not emphasized. We present a review, with quantitative assessment of 24 rhinoplasty patients using the cross-cartilaginous incision. This new approach optimizes access without an external scar and ligament disruption that ensues after the open approach. METHODS: 24 consecutive patients underwent primary rhinoplasty from March 2009 to April 2011 using the cross-cartilaginous approach. Preoperative measurements of defined anatomical sites of the nose were taken. Independent assessments of the postoperative results were undertaken by a surgical resident and a senior nurse using preoperative and postoperative photographs using the new Independent Rhinoplasty Outcome Score (IROS). Evaluation of patient satisfaction and postoperative patient concerns were carried out. RESULTS: The range of preoperative measurements (average) were: radix 12-19 mm (15.0), keystone 20-34 mm (24.5), alar base 14-20 mm (17.0), nose length 48-58 mm (50.2), tip width 11-25 mm (15.9), and tip projection 21-37 mm (29.6). Three months after the operation, the patient satisfaction scores were rated 67% good to excellent, 25% were acceptable, and 8% were dissatisfied. After 3 months, 17% of patients reported swelling, 0% bruising, 8% irregularities, 8% asymmetry, and 4% airway issues. Independent assessment of the photographs showed that overall result was: 31% good, 56% average, and 13% had no improvement. CONCLUSION: Preoperative anatomical measurement allows reliable assessment of nasal characteristics and comparison with postoperative outcomes. Our simple grading system for outcome assessment in rhinoplasty allows the assessment to be reliable and reproducible (IROS). The cross-cartilaginous approach is suitable for a majority of primary rhinoplasty patients, providing good access and visibility, although, open rhinoplasty is required for selected complex revision cases. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Investigation of the spinal cord as a natural receptor antenna for incident electromagnetic waves and possible impact on the central nervous system.

The effects of electromagnetic field (EMF) exposure on biological systems have been studied for many years, both as a source of medical therapy and also for potential health risks. In particular, the mechanisms of EMF absorption in the human or animal body is of medical/engineering interest, and modern modelling techniques, such as the Finite Difference Time Domain (FDTD), can be utilized to simulate the voltages and currents induced in different parts of the body. The simulation of one particular component, the spinal cord, is the focus of this article, and this study is motivated by the fact that the spinal cord can be modelled as a linear conducting structure, capable of generating a significant amount of voltage from incident EMF. In this article, we show, through a FDTD simulation analysis of an incoming electromagnetic field (EMF), that the spinal cord acts as a natural antenna, with frequency dependent induced electric voltage and current distribution. The multi-frequency (100-2400 MHz) simulation results show that peak voltage and current response is observed in the FM radio range around 100 MHz, with significant strength to potentially cause changes in the CNS. This work can contribute to the understanding of the mechanism behind EMF energy leakage into the CNS, and the possible contribution of the latter energy leakage towards the weakening of the blood brain barrier (BBB), whose degradation is associated with the progress of many diseases, including Acquired Immuno-Deficiency Syndrome (AIDS).

The efficacy of preoperative mapping of perforators in reducing operative times and complications in perforator flap breast reconstruction.

Reconstruction using perforator flaps can be technically demanding and in inexperienced hands may result in longer operative times and increased costs. This has implications for the postoperative recovery of patients as well as associated complications such as atelectasis and deep vein thrombosis. This study examined different aspects of perforator flap reconstruction including operative times, ischaemia time, flap re-exploration rate, complications and inpatient length of stay. The mean operative times were as follows: for Deep Inferior Epigastric Artery Perforator (DIEAP) flaps it was 4 h 49 min (n=17), for bilateral DIEAP it was 7 h 23 min (n=12) and for SGAP it was 4 h 56 min (n=2). Since CT preoperative perforator mapping was introduced it has resulted in a mean reduction of operative time by 1 h 16 min (21%). This has also led to costs saving of 471 pounds sterling per patient. Preoperative mapping of perforators can reduce operative times as well as allowing the selection of the most reliable perforators beforehand. Good flap perfusion is assured which leads to reduced length of stay as well as fewer complications such as postoperative fat necrosis and delayed healing. Reduced operative times also contribute to major cost savings for the hospital. Although both CT and Duplex perforator mapping can reduce operative times, this study found that operative times were reduced more after CT scanning was introduced.

Donor-site morbidity after autologous costal cartilage harvest in ear reconstruction and approaches to reducing donor-site contour deformity.

BACKGROUND: Harvesting of rib as a source of cartilage can result in significant donor-site morbidity. In experienced hands, excellent results from using autologous rib cartilage are achievable for ear reconstruction, rhinoplasty, and otolaryngology. The authors report the morbidity associated with the harvest of costal cartilage in 42 patients who underwent ear reconstruction. METHODS: The notes were examined retrospectively and further data were collected with a questionnaire. Patients noted their experience of pain, clicking, and satisfaction with the donor site. Fifteen patients underwent additional clinical assessments of their donor scar and contour deformity using a standardized scale. Five donor sites were reconstructed with spare cartilage left over from carving the ear framework. RESULTS: The results showed that pain and clicking of the chest wall represented the commonest complaints. These peaked in the first week after surgery and diminished slowly over 3 months. The donor-site scar and deformity were acceptable to most patients. There was an improvement in the contour deformity of the chest wall harvest site in the five patients who underwent reconstruction of their donor site. CONCLUSIONS: To improve the outcome for patients undergoing cartilage harvest, efforts must be made to further reduce pain and donor-site morbidity. Reconstruction of the donor site with spare cartilage should be attempted where possible to improve the contour defect of the donor site. Refinements in the methods of cartilage harvest or donor-site reconstruction may achieve this in the future.

Urinary levels of nicotine & cotinine in tobacco users.

BACKGROUND & OBJECTIVES: Of the various biochemical markers used to validate the smoking status of a person, nicotine and continine are considered as good markers for both active and passive smoking. In the present study an attempt was made to estimate urinary levels of nicotine and cotinine in healthy individuals from north India using different types of tobacco to identify and validate the smoking status. METHODS: Twenty four hour urine sample of 130 healthy volunteers (smokers=70, passive smokers=20, tobacco chewers=20, non smokers=20) were analyzed by high-pressure liquid chromatography (HPLC) assay. Smokers were divided into different groups, viz., cigarette, bidi and hooka smokers. RESULTS: The mean values of nicotine (ng/ml) and cotinine (ng/ml) in urine were highest in cigarette smokers (nicotine=703.50+/-304.34; cotinine=2736.20+/-983.29), followed by hooka smokers (nicotine 548.0+/-103.47 and cotinine 2379.0+/-424.25), and bidi smokers (nicotine=268.53+/-97.62, cotinine=562.60+/-249.38). There was no correlation of nicotine or cotinine values with smoking index. In passive smokers (nicotine=109.75+/-22.33, cotinine=280.75+/-86.30) and in nonsmokers, the values were much lower (nicotine=55.00+/-13.71, cotinine=7.30+/-2.47) compared to smokers. In tobacco chewers, the values for nicotine and cotinine were 447.75+/-145.09 and 2178.30+/-334.29 respectively. INTERPRETATION & CONCLUSION: All forms of tobacco users had significantly higher values compared to passive smokers and nonusers. Thus, cotinine and nicotine levels in urine may be considered as good indicators to assess the exposure to tobacco in our population.