Quality-of-life outcomes after cosmetic surgery.

Cosmetic surgery is an increasingly common medical procedure whose benefits to patients have not been quantified objectively. The purpose of this study was to prospectively examine long-term quality-of-life outcomes for patients undergoing elective cosmetic surgery. In this prospective, correlational study of 105 consecutive patients undergoing elective cosmetic surgery, the parameters of quality-of-life index, depression, social support, and coping were determined preoperatively and at 1- and 6-month intervals postoperatively. The data from the four study instruments were analyzed using Pearson correlation and repeated measures of multivariate analysis of variance for differences in each variable over time. The multivariate analysis of variance quality-of-life index scores for patients improved from baseline preoperative mean levels of 3.24 to a mean of 2.56 at 1 month, and then to 2.11 (f = 518.5, p = < 0.0001) at 6 months postsurgery. Mean scores for depression [determined by using the Center for Epidemiologic Studies Depression Scale (CESD)], improved from 11.2 preoperatively to 6.5 at 1 month, and to 6.3 (f= 79.3, p = < .0001) at 6 months after surgery. Surgical intervention produced no significant differences between preoperative and postoperative ways of coping and social support scores. Cosmetic surgery produces positive psychological benefits by significantly improving quality-of-life outcomes that persist long term, without adversely affecting social support and ways of coping.

Sentinel lymph node mapping in melanoma of the ear.

Primary nodal drainage basins in melanoma of the head and neck are often unpredictable. The ear is a notorious example of an anatomic site with ambiguous patterns of lymphatic drainage. Preoperative lymphoscintigraphy has recently emerged as one modality to assist in identifying clinically relevant nodes. We propose that the addition of intraoperative lymph node mapping techniques that utilize radioactive tracers ("intraoperative lymphoscintigraphy") can increase the accuracy of identifying sentinel nodes and help to determine which patients may benefit from a complete neck dissection. This report demonstrates the ambiguity in identifying drainage patterns in melanoma of the ear and offers a reliable method of sentinel lymph node mapping. This report also addresses current issues regarding treatment protocols of patients with micrometastatic disease in the periauricular region.

Pediatric peripheral neuropathy in proteus syndrome.

Proteus syndrome is a rare congenital disorder comprised of subcutaneous and internal hamartomas, pigmented skin nevi, skull exostoses, hemihypertrophy, and macrodactyly of the hands and feet. A 5-year-old girl diagnosed with Proteus syndrome presented with distal median compression neuropathy with the primary complaint of severe pain involving the left hand. Surgical exploration of the hand revealed a lipofibromatous hamartoma of the median nerve. The transverse carpal ligament was released and epineurectomy of the median nerve was performed. The patient remains symptom free at the 9-month follow-up. This report is the first description of a hamartoma directly involving a peripheral nerve in Proteus syndrome. Decompression of the nerve with the removal of the fibrofatty neural sheath resulted in the resolution of the symptoms in this patient. The surgeon should consider this approach as a potential first line of treatment before a more radical resection of the nerve is contemplated.

Immediate breast reconstruction in the high-risk adjuvant setting.

High-dose chemotherapy with autologous stem cell support (or bone marrow transplantation) in the treatment of primary breast cancer has been developed in the hopes of increasing survival among patients traditionally regarded as "high risk". These patients have locally advanced disease (stage IIB or higher) and have a greater than 50% risk of developing systemic illness. This report addresses the issue of whether reconstructive breast surgery can be offered to high-risk patients. It is hoped that as survival among women with advanced or high-stage primary breast cancer increases, options for immediate breast reconstruction can be routinely offered.

Reconstruction of extensive scalp defects with rectus free flaps.

This review represents the largest reported series involving reconstruction of complex scalp and calvarial defects with rectus abdominis free flaps. Sixteen patients presented with extensive (up to 300 cm2) scalp and calvarial defects requiring free tissue transfer for closure. All of the 11 patients who underwent a rectus abdominis free flap had a technically successful microvascular transfer. The defects encountered involved a wide spectrum of complexities including extensive multilaminar defects with exposed brain and dura, irradiated fields, and infection. In our institutions, the rectus abdominis muscle has evolved as a uniquely superior donor choice for restoring extensive scalp defects for several reasons: (1) accessibility, which eliminates intraoperative patient repositioning and allows for a simultaneous two-team approach; (2) minimal donor-site morbidity; (3) vascular reliability; and (4) the ability to supply abundant, easily contoured tissue.

Surgical management of syndactyly in a dog.

This report describes the treatment of simple syndactyly in a Golden Retriever. The left forepaw lacked cutaneous separation between the digits and had confluent metacarpal and digital pads. After vigorous exercise, the dog had intermittent non-weight-bearing lameness involving the affected forepaw. The lameness may have resulted from stretching of the thin skin on the dorsum of the paw as the digits attempted to spread during weight bearing. Surgical separation of digits 3 and 4 was performed by creating an interdigital web space with dorsal and palmar skin flaps and by covering the exposed axial surfaces with full-thickness skin grafts. At 11 weeks after surgery, the lameness had improved and the dog's level of activity had increased.

Midline defects of the orofaciodigital syndrome type VI (Váradi syndrome).

The orofaciodigital syndromes (OFDS) represent a spectrum of anomalies of the palate, cranium, hands, and feet. Váradi syndrome, designated OFDS type VI, is a rare disorder that is additionally characterized by cerebellar anomalies. The following report is of a patient with OFDS VI and characteristic multiple midline defects: median cleft lip and palate, lingual cleft with nodules, and midline brain malformation. In addition, this case is uniquely associated with the presence of midline (metopic and sagittal) craniosynostoses as well. It is unusual that deformities which result from premature fusion of cranial vault sutures would appear synchronously in a syndrome based on the concept of failure of fusion or coalescence of facial growth centers. The midline represents an independent developmental field, whereby CNS defects and midline anomalies can present concurrently.

Buried inferiorly based gluteus maximus musculocutaneous flap for reconstruction of large, recurrent ischiopubic pressure sores.

The ischium is the most common site for recurrence of pressure sores in the paraplegic population. Successful reconstruction of these wounds depends on the total excision of ulcer, soft tissue debris, bony prominence, and the durability of the soft tissue repair. The V-Y gluteus maximum musculocutaneous flap based on the inferior gluteal vessels can be advanced medially, deepithelialized, and buried to fill large, deep soft tissue ischial wounds. Local rotational flaps close the superficial wound. This buried flap, although not previously described, is useful for the reconstruction of large ischiopubic pressure sores initially or at the time of recurrence.

Oral cancer in women nonusers of tobacco and alcohol.

A retrospective study of private surgical experience (L.J.T.) in the treatment of primary oral carcinoma was undertaken to compare the demographics, disease history, and clinical behavior patterns in women nonusers versus users of tobacco and alcohol. From a clinical group of 109 patients with oral carcinoma, an unexpectedly high percentage were women (41%, 45/109) and of these women, 31% (14/45) were nonusers of either substance. Differences were found in age (71 vs. 60 years), location of the primary tumor (0% vs. 35% floor of mouth), clinical stage at presentation (early, 80% vs. 50%), histologic parameters, clinical behavior patterns, and occurrence of secondary primaries (0% vs. 26%). The differences identified have prognostic and therapeutic implications.