The Potential Impact of COVID-19 on Aesthetic Fellowship Programs.

BACKGROUND: The COVID-19 pandemic has brought about immense change in health care. Surgical specialties in particular have had to make major adjustments because of the cancellation of nonemergent surgeries. Aesthetic surgery fellowships are uniquely affected because of the high number of elective cases and the length of the fellowship. The impact of the COVID-19 pandemic on current and upcoming aesthetic surgery fellows has not been studied. OBJECTIVE: The aim of this article was to study the potential impact of the COVID-19 pandemic on both American Society for Aesthetic Plastic Surgeons-endorsed and nonendorsed aesthetic fellowship programs. METHODS: A 23-question anonymous web-based survey was sent to aesthetic surgery fellowship directors with an active program in the United States. Surveys were collected from April 18, 2020, through May 14, 2020, with Qualtrics and then analyzed with Microsoft Excel. A 7-question follow-up survey was sent to directors, and a 23-question survey was sent to aesthetic surgery fellows. Data for these surveys were collected from June 6, 2020, through August 18, 2020. The surveys asked questions pertaining to adjustments and impact on current fellow training, as well as possible impact on fellows starting in 2020 and 2021. RESULTS: There was a 65.5% (19 of 29) response rate for the initial director survey, a 31% (9 of 29) rate for the director follow up survey, and a 28% (9 of 32) rate for the fellow-specific survey. All directors and fellows reported that the pandemic had some impact on aesthetic fellow training. A total of 5.3% of directors reported that they believe COVID-19 would have a "significant impact" on their fellows becoming well-trained aesthetic surgeons, whereas 66.7% of fellows reported that it will have a "mild impact." Predicted impact on future fellows was not as significant. CONCLUSION: Telemedicine, educational efforts, and standardization of guidelines can be increased to minimize loss of training due to COVID-19. Ongoing evaluation and shared experiences can assist fellowships in customizing programs to provide well-rounded education during the pandemic.

Dissection Technique for Abdominoplasty With Scarpa Fascia Preservation: Comparative Study on Avulsion Technique Versus Diathermocoagulation.

BACKGROUND: Many strategies have been developed to lower the high complication rate associated with a full abdominoplasty. The dissection technique may have a role to achieve this goal. OBJECTIVES: The present study compared 2 different dissection techniques to perform a full abdominoplasty with Scarpa fascia preservation: avulsion technique and electrodissection. METHODS: A retrospective observational cohort study was performed in 2 health institutions from January 2005 to January 2019. A total of 251 patients were involved: 122 patients submitted to abdominoplasty employing the avulsion technique (Group A) and 129 with diathermocoagulation (coagulation mode) (Group B). The latter was further divided into group B1 (57 patients with device settings according to surgeon's preferences) and B2 (72 patients with a specific regulation aiming at minimal tissue damage). Several variables were analyzed: population characteristics, time of hospital stay, time to drain removal, total and daily drain output, emergency department visits, readmission, reoperation, and local and systemic complications. RESULTS: The general characteristics of both groups did not statistically significantly differ except for previous abdominal surgery. The diathermocoagulation group had a significantly lower length of hospital stay and time to drain removal. Moreover, these advantages were maximized when electrocautery was conducted with a specific low-voltage setting as significant differences were found. The other outcomes were identical. CONCLUSIONS: Limiting the extension of electrodissection with the avulsion technique did not present any advantage. Utilizing diathermocoagulation (coagulation mode) during a full abdominoplasty with Scarpa fascia preservation, especially when it is aimed at minimal tissue damage, reduces patients' time with drains.

Quiste hidatídico pulmonar en paciente con diagnóstico de asma bronquial, a propósito de un caso / Hydatidpulmonary cyst in a patient with a diagnosis of bronchial asthma, on a case

La hidatidosis es una zoonosis distribuida mundialmente, causada por el Echinococcus granulosusen su fase larvaria. Prevalente en zonas agrícolas y ganaderas, su localización más habitual es hepática y pulmonar (>90 %), puede ser asintomática o manifestar síntomas de acuerdo con el órgano afecto o a la presencia de complicaciones. Es poco frecuente, siendo principalmente diagnosticada de manera incidental en estudios radiológicos de rutina. En Ecuador la incidencia de enfermedad hidatídica es baja a pesar de las condiciones epidemiológicas idóneas para el crecimiento del equinococo, en comparación con los países vecinos, donde la incidencia de esta enfermedad es superior, sin embargo, podrían faltar estudios que aporten datos estadísticos exactos que orienten hacia una realidad epidemiológica más clara de esta patología en el país.

Hydatidosis it's a worldwide distributed zoonosis, caused by the larval stage of Echinococcus granulosus. Prevalent in agricultural and livestock zones, the most common location is liver and lung (> 90 %), it can be asymptomatic or causing symptoms according with the injured organ or development of complications. Seems to be a rare condition, been in most cases incidentally diagnosed on a routine x-ray evaluation. Hydatid disease incidence in Ecuador is very low despite the epidemiological conditions suitable for the growth of Echinococcus, in comparison with neighboring countries where the incidence of this disease is higher. However, more studies could be needed to provide accurate statistics data than approach a clearer epidemiological reality of this disease in the country.

Abdominoplasty With Scarpa Fascia Preservation.

The plane of dissection used during a full abdominoplasty has been implicated on the seroma rate. Avoiding the classic plane of dissection on top of the rectus fascia and using a more superficial plane of dissection has been suggested as a strategy to improve recovery and lower the complication rate. The authors have been applying this principle in their practice for more than a decade, and they performed 2 prospective comparative studies to evaluate the clinical effects of using a more superficial plane of dissection (with Scarpa fascia preservation) during a full abdominoplasty.The technique is presented and explained along with the results of both comparative studies.The results of both studies are discussed particularly the effects on drain volume (total and daily), the duration of drain usage and the avoidance of "long drainers." These are very relevant advantages of the technique that have not been discussed in the literature. The results and surgical strategies used by other authors which apply a more superficial plane of dissection are presented.Controversy still exits on the manipulation of the deep fat compartment by liposuction or direct fat excision. No manipulation is another option which should be considered but it has been questioned due to the risk of aesthetic compromise. A morphometric study performed on the surgical specimens of 41 female patients submitted to a full abdominoplasty validates that option.Based on this evidence, the authors recommend that surgeons consider performing abdominoplasties using a more superficial plane of dissection in the infraumbilical area with total preservation of Scarpa fascia and the deep fat compartment. The classic plane of dissection, on top of the deep fascia, should be avoided in the lower abdomen.

Dissection Technique for Abdominoplasty: A Prospective Study on Scalpel versus Diathermocoagulation (Coagulation Mode).

BACKGROUND: The purpose of this study was to evaluate the effect of the dissection technique on outcomes and complications after a full abdominoplasty, comparing 2 different techniques used to raise the abdominal flap: the steel scalpel and the diathermocoagulation device on coagulation mode. METHODS: A prospective study was performed at a single center from January 2009 to December 2011 of patients submitted to abdominoplasty with umbilical transposition. Two groups were identified: group A, abdominoplasty performed with steel scalpel/knife; and group B, abdominoplasty performed with diathermocoagulation on coagulation mode. Several variables were determined: general characteristics, time until drain removal, daily and total volume of drain output, length of hospital stay, operative time, readmission, reoperation, emergency department visits, and local and systemic complications. RESULTS: A total of 119 full abdominoplasties were performed in women (group A, 39 patients; group B, 80 patients). There were no statistically significant differences between groups with respect to general characteristics, except for body mass index, comorbidities, and weight of the surgical specimen; there were no differences for operative time, systemic complications, hematoma, and necrosis incidence. The scalpel group had a highly significant reduction of 54.56% on total drain output, and a 2.65 day reduction on time to drain removal and no reported cases of seroma or healing problems (difference of 81.25% and 90.00%, respectively, between the 2 groups). CONCLUSIONS: Performing abdominal dissection with scalpel had a beneficial effect on patient recovery, as it reduced time requested for drain removal, total drain output, and incidence of seroma and wound healing problems.

Reconstrucción de la mama: ¿qué hacer cuando la reconstrucción primaria falla? / Breast reconstruction: what to do when primary reconstruction failure?

La reconstrucción de la mama, aunque muy perfeccionada y segura, está colmada de complicaciones. Se presentan casos ilustrativos y directrices cuando la reconstrucción inicial falla, de acuerdo con nuestra experiencia de 30 años en el tema. El uso de expansores en el pecho después de la irradiación no se recomienda debido a la alta incidencia de fracasos. La radioterapia después de la reconstrucción del seno con un implante produce contractura capsular; y después de la reconstrucción con colgajo TRAM, produce fi brosis y retracción de la mama reconstruida. La cada vez mayor recurrencia del cáncer de mama después de la tumorectomía y la radiación se maneja con mastectomía con preservación de piel, y a menudo con una mastectomía profi láctica contralateral. Se describe la utilidad y el diseño del colgajo tóraco-abdominal epigástrico y Mid TRAM

Reconstruction of the Breast, although more sophisticated and safer, is fraught with complications. Illustrative cases and guidelines are presented when the initial reconstruction fails based on our 30-year experience in the subject. The use of expanders on post-irradiated chest is not recommended because of the high incidence of failures. Radiation therapy after breast reconstruction with an implant produces capsular contracture; and after TRAM fl ap reconstruction, produces fi brosis and shrinkage of the reconstructed breast. The increasing of breast cancer recurrence after lumpectomy and radiation is managed by non-skin sparing completion mastectomy, and often with a contralateral prophylactic mastectomy. The utility and design of the thoraco-epigastric and Mid Abdominal TRAM fl ap is described

Morphometric study (macroscopic and microscopic) of the lower abdominal wall.

BACKGROUND: Abdominoplasty using a more superficial plane of dissection has several advantages. Previous studies described a trilaminar structure (superficial and deep fat compartments separated by the Scarpa fascia) in the lower abdominal wall. This study aimed to gain a clearer understanding of compartment dominance and changes with increasing adiposity. METHODS: The study was performed on the surgical specimens of 41 female patients submitted to a full abdominoplasty. A morphometric study was performed on 82 sides to evaluate the thickness of the fat layers at predetermined locations (point A over the external oblique muscle and point B over the rectus abdominis muscle). A histologic study was performed in 31 samples to analyze the structure of the fat compartments and Scarpa fascia. RESULTS: A trilaminar structure was always present, and the Scarpa fascia did not become vestigial with increasing adiposity. Total thickness at point B was significantly higher than that at point A; this difference was mainly attributable to the superficial compartment. The deep fat compartment was always thinner than the superficial, corresponding to 25 percent of total thickness in point A and 23 percent in point B. It was less susceptible to an increase in thickness in cases of obesity. Histologic analysis demonstrated constant morphology, with an average Scarpa fascia thickness of 0.29 mm (point A) and 0.28 mm (point B). CONCLUSIONS: This study demonstrates a trilaminar structure with superficial compartment dominance and Scarpa fascia presence irrespective of adiposity in the lower abdominal wall. The deep fat compartment has a minor contribution to the lower abdominal wall thickness.

Scarpa fascia preservation during abdominoplasty: randomized clinical study of efficacy and safety.

BACKGROUND: Scarpa fascia preservation has been suggested as a way of reducing complications associated with conventional abdominoplasty. A prospective randomized study was conducted to evaluate the effect on results and complications of preserving the Scarpa fascia during a full abdominoplasty. METHODS: This was a single-center study conducted from August of 2009 to February of 2011. Patients were assigned randomly to one of two procedures: classic full abdominoplasty (group A) or a similar type of abdominoplasty except for the preservation of the Scarpa fascia and the deep fat compartment in the infraumbilical area (group B). Four surgeons were involved in the study. Several variables were determined: general characteristics, time to suction drain removal, total volume of drain output, length of hospital stay, systemic complications, local complications, and aesthetic result. RESULTS: A total of 160 full abdominoplasties were performed in women (group A, 80 patients; group B, 80 patients) equally divided by the four involved surgeons. There were no statistically significant differences between groups with respect to general characteristics, complications (except for the seroma rate), and aesthetic result. The Scarpa fascia preservation group had a highly significant reduction of 65.5 percent on the total drain output, 3 days on the time to drain removal, and 86.7 percent on the seroma rate. CONCLUSION: Preservation of the Scarpa fascia during an abdominoplasty had a beneficial effect on patient recovery, as it reduced the total drain output, time to drain removal, and seroma rate without compromising the aesthetic result.

Adipose-derived stromal cells accelerate wound healing in an organotypic raft culture model.

Adipose tissue is a known reservoir of multipotent mesenchymal stem cells, which can be manipulated in culture to produce cells with different phenotypes. The goal of this study was to determine whether the addition of these multipotential cells to organotypic, human skin equivalent cultures would accelerate wound healing after laser injury. For our initial studies, we were able to obtain 3-dimensional raft cultures from adult skin explanted directly onto the dermal equivalent containing human fibroblasts with or without adipose-derived stromal cells (ADSCs). Two days after laser injury, the raft cultures of skin explants that contained ADSCs had a completely healed multilayered epidermis, whereas the control raft culture without the adipose-derived cells still had areas of injury. With this encouraging outcome, these experiments were then repeated in a raft culture system initiated from dissociated primary adult human keratinocytes on the humanized dermal equivalent. Again, the cultures containing ADSCs healed faster than the control cultures. In conclusion, these data provide support to our hypothesis that ADSCs are an excellent and readily available source of factors necessary for accelerated wound healing and tissue regeneration.

A simple technique for augmentation of axonal ingrowth into chondroitinase-treated acellular nerve grafts using nerve growth factor.

BACKGROUND AND PURPOSE: Improvement in axonal regeneration may lead to the development of longer nerve grafts and improved outcomes for patients with peripheral nerve injury. Although the use of acellular nerve grafts has been well documented (Groves et al, Exp Neurol. 2005;195:278-292; Krekoski et al, J Neurosci. 2001;21:6206-6213; Massey et al, Exp Neurol. 2008;209:426-445; Neubauer et al, Exp Neurol. 2007;207:163-170; Zuo et al, Exp Neurol. 2002;176:221-228), less is known about the ability of neurotrophic factors to enhance axonal regeneration. This study evaluates axonal ingrowth augmentation using acellular, chondroitinase-treated nerve grafts doped with nerve growth factor (NGF). METHODS: Acellular chondroitinase-treated murine nerve grafts were placed in experimental (NGF-treated grafts) and control (carrier-only grafts) rats. Five days after implantation, axonal regeneration was assessed by immunocytochemistry along with digital image analysis. RESULTS: Higher axon count was observed throughout the length of the nerve in the NGF group (P < 0.0001), peaking at 3 mm from proximal repair (P = 0.02). Although the NGF group displayed a higher axon count per slice, the mean diameter of individual NGF axons was smaller (P < 0.0001), potentially consistent with induction of sensory axons (Rich et al, J Neurocytol. 1987;16:261-268; Sofroniew et al, Annu Rev Neurosci. 2001;24:1217-1128; Yip et al, J Neurosci. 1984;4:2986-2992). CONCLUSION: The simple technique of doping acellular, chondroitinase-treated nerve grafts with NGF can augment axonal ingrowth and possibly preferentially induce sensory axons.

Neck rejuvenation--anatomy and clinical correlation.

The restoration of the aesthetic contour of the neck is a challenging but important component of facial rejuvenation. Numerous techniques have been developed to improve the aesthetic outcome. We plan to give an overview of anatomic principles and their clinical correlation.

Scarpa fascia preservation during abdominoplasty: a prospective study.

BACKGROUND: Preservation of the Scarpa fascia has been suggested as a way of lowering complications associated with conventional abdominoplasty. Objective evidence regarding this strategy is lacking. The purpose of this investigation was to evaluate the effect of preserving the Scarpa fascia in the infraumbilical area during a full abdominoplasty. METHODS: A prospective study was performed at a single center from November of 2005 to November of 2007 of the patients submitted to abdominoplasty with umbilical transposition. Two groups were identified: group A, classic full abdominoplasty; and group B, full abdominoplasty with preservation of infraumbilical Scarpa fascia. Several variables were determined: age, body mass index, previous surgical procedures, comorbid conditions, specimen weight, time to suction drain removal, total volume of drain output, and length of hospital stay. RESULTS: A total of 208 full abdominoplasties were performed (group A, 143 patients; group B, 65 patients). There was no statistically significant difference between groups with respect to body mass index, previous abdominal operations, comorbid medical conditions, or weight of the surgical specimen (p > 0.05). The group with preservation of the Scarpa fascia had an average reduction of the total amount of drain output of more than 50 percent (p < 0001). This group also had an average reduction of 2.0 days until the time to drain removal (p < 0.001) and 1.9 days of the hospital stay (p < 0.001). CONCLUSION: Preservation of the Scarpa fascia during abdominoplasty has a beneficial effect on patient recovery, as it reduces the total drain output, time to drain removal, and length of hospital stay.

Lateral orbicularis oculi muscle plasty in conjunction with face lifting for periorbital rejuvenation.

BACKGROUND: The purpose of this study was to evaluate the lateral orbicularis oculi muscle plasty as an alternative periorbital rejuvenation technique during face lift. METHODS: The authors conducted a retrospective review of patients who underwent face lifts between 2004 and 2007. Postoperative follow-up, complications, aesthetic outcome, and patient satisfaction were recorded. The patients were further divided into four groups for the analysis: lateral orbicularis oculi muscle plasty with lower blepharoplasty (group 1), lower blepharoplasty without lateral orbicularis oculi muscle plasty (group 2), lateral orbicularis oculi muscle plasty without lower blepharoplasty (group 3), and neither lateral orbicularis oculi muscle plasty nor lower blepharoplasty (group 4). RESULTS: A total of 76 patients were identified as having had a midface lift with or without lateral orbicularis oculi muscle plasty in the study period. Sixty-eight percent of the patients had a lateral orbicularis oculi muscle plasty procedure. Group 3 showed the lowest complication rate followed by group 4, but there were no statistical differences in complication rates among the study groups. The higher aesthetic result and patient satisfaction were obtained by groups 3 and 4 (p < 0.01). Group 2 had the highest complication rate and lowest overall outcomes. CONCLUSION: The authors have been able to demonstrate that lateral orbicularis oculi muscle plasty is a safe technique that may be considered a good alternative for periorbital rejuvenation and may help in avoiding lower lid incisions or extensive dissections during face lifting in some cases.

Suture suspension technique for midface and neck rejuvenation.

Seventeen patients averaging 51 years of age underwent 23 surgical procedures, including suture suspension for both midface and neck rejuvenations. A 3/0 polypropylene thread with bioabsorbable cones with multiple point fixations in addition to 2 x 0.5-cm polypropylene surgical mesh are used in this technique. The mean postoperative, follow-up time was 9 months. Of the 17 patients, 12 underwent this procedure for midface rejuvenations, 3 for facial palsy, 5 for neck aesthetic procedures, 2 for brow ptosis, and 1 for brow asymmetry. The average number of sutures used for each face was 4 and 2 were used for each neck. The authors present an anatomic study for the safe placement of sutures, the surgical technique, and a microscopic photo documentation of the fibrosis around the suture knot and cone. All patients developed temporary edema. Two patients had a moderate aesthetic improvement of the face, and 1 patient underwent resuspension of the sutures 4 months postsurgery. Overall early patient satisfaction at 9 months was 90%. This technique has the potential to be a useful and effective clinical tool for minimally invasive face and neck rejuvenations.