A 10-Year Review of Collagenase Versus Fasciectomy in the Treatment of Dupuytren Contracture.

BACKGROUND: Dupuytren disease (DD) is one of the most common disorders of the hand, affecting 5.7% to 11.7% of the global population. This study seeks to evaluate the 10-year efficacy of the 2 most prominent treatment modalities for DD in Veterans Affairs hospitals, injectable collagenase Clostridium histolyticum versus open fasciectomy. METHODS: A retrospective review was conducted of all electronic medical records of patients who underwent open fasciectomy or collagenase injection to treat their persistent Dupuytren contracture between April 2011 and April 2021. All procedures were performed by 1 of 5 senior surgeons at the same Veterans Affairs Hospital. RESULTS: A total of 232 patients were treated for DD, with 247 collagenase injections and 44 open fasciectomies performed in this sample. Collagenase patients were, on average, 6.51 years after intervention at the time of review. Open fasciectomy patients were, on average, 4.56 years after operation at the time of review. Collagenase decreased contractures, on average, by 29.40 degrees, whereas open fasciectomy decreased contractures, on average, by 38.59 degrees. Of the contractures that were initially classified as resolved, 50 of 155 (32.2%) treated with collagenase and 6 of 56 (10.7%) treated with open fasciectomy recurred. The use of open fasciectomy compared with collagenase injections to treat contracture was associated with a 74.2% decrease in the likelihood of recurrence. CONCLUSIONS: This study found that treatment of DD with collagenase injection is associated with a significantly lower degree of deformity correction, lower rate of resolution, and increased rate of recurrence when compared with open fasciectomy.

Preference for Averaging in East Asian Faces: A Source of Potential Guidance in Aesthetic Plastic Surgery.

Background: Relatively little research has been done on the application of objective tools in guiding Ethnic Plastic Surgery in Asian patients. The evolutionary psychology theory of koinophilia, or love of average features, presents the basis for a solution to build a foundation for crowd-sourced East Asian aesthetic standards. Objectives: The authors hypothesize that the averaged composite face in a cohort will be viewed as significantly more attractive than their respective cohort. Methods: Cohorts were created based on the gender of the individual in the photograph (40 females and 40 males of East Asian descent). Two surveys were created, 1 for the female cohort and the other for the male. The surveys assessed the aesthetic preference of each photograph using a Likert scale ranging from 1 to 7. Surveys were distributed using the popular crowdsourcing program Amazon Mechanical Turk (Amazon, Seattle, WA). Results: The authors received 875 respondents for the male cohort survey and 876 respondents for the female cohort survey. For both the female and male cohorts, the composite images had a statistically significantly higher rating (P < .001) than the mean of the other images. Among other significant demographic findings, when considering both ethnicity and location of residence, Asian raters living in Asia preferred the composite significantly more than Asian raters living in North America (P < .001). Conclusions: Raters' preference for the composite average face is in concordance with the evolutionary psychology literature. Thus, this study affirms the utility of using facial composites to guide surgeons in identifying aesthetic standards for patients of East Asian descent.

The Impact of Comorbidities on Patient Outcomes in the Upper Body Lift: A Retrospective Review.

Background: Nonsurgical and surgical weight loss options have improved over the past several decades resulting in an increased number of patients who present with body contour deformities. This review focuses on the upper truncal deformity. This deformity is discernable by its residual tissue laxity in the upper arm, back, lateral chest, and breast. Objective: The purpose of this study is to evaluate the morbidity of this procedure when these regions are treated in one operative setting. Methods: A retrospective chart review of patients who underwent an upper body lift for truncal deformities after massive weight loss by the senior author between August 2006 and December 2019 was performed. Patient comorbidities and demographics, preoperative parameters, operative factors, and minor and major complications were assessed. Results: No intraoperative or major complications occurred. The overall complication rate was 71% (20/28), which were all minor and most related to wound breakdown. Using logistical regression analysis, we found that neither BMI nor amount of weight resected contributed to a higher complication rate in this cohort. Simple matching coefficients analysis identified anemia, hypertension, lifetime smoking history, celecoxib use, and multiple concurrent procedures as comorbidities and intraoperative factors with an increased risk for adverse outcomes. Conclusions: This review helps define the role of upper body lift in the care of patients with massive weight loss and addresses the morbidity of a comprehensive approach to upper body deformity. Appropriate patient selection, preoperative patient counseling, sound operative technique, and supportive postoperative care can help to avoid adverse outcomes.

Two Surgeons' Approaches to the Upper Body Lift: A Video Discussion.

Body contouring post massive weight loss is becoming increasingly more common. In this article and accompanying video, 2 experienced surgeons, Jeffrey Kenkel, MD, and Al Aly, MD, discuss the upper body lift procedure through a moderated discussion. The goal of this article is to elucidate the similarities and differences between the surgeons' guiding principles and specific approaches to this procedure. Topics covered in this discussion include indications, intraoperative sequencing, male chest, brachioplasty, closing technique, postoperative complications, and the typical postoperative course.