Development of a questionnaire for a patient-reported outcome after nasal reconstruction.

INTRODUCTION: Our face plays an important role in communication and social life. Defects of the face have a big impact on socializing and psychics of patients with its deformities. A good esthetic outcome is an important task of each reconstructive surgery. With a modern concept of nose reconstruction, it is possible to achieve a better esthetic and functional outcome than it was possible with one phase reconstructions before. There was a specific tool missing to measure patients reported outcome and objectively evaluate benefits of nose reconstruction from a patients point of view and get reliable feedback about the whole procedure.  The goal of this paper is to develop such a questionnaire. MATERIALS AND METHODS: A pilot questionnaire was developed with literature input. The questionnaire was tested on five patients. Based on patients feedback and a review from a psychologist, the second version of the questionnaire was made. It was sent to 39 patients, who underwent nose reconstruction in the years 2016-2020. After two appeals, 34 completed questionnaires were sent back (87,2%). The final version of the questionnaire was developed after a thorough mathematic and statistical analysis of collected data. RESULTS: The group of patients who completed the questionnaire consisted of 16 females (47%) and 18 males (53%). On average, the patients were 69 years old (17-88 years). The final questionnaire is structured into six categories from A to F: A - general information defining the patient and purpose for reconstruction, B - satisfaction with esthetic outcome, C - satisfaction with function and stability, D - satisfaction with medical treatment, E - social and psychological impact, F - overall satisfaction. Most of the questions use a 5-point rating scale. CONCLUSION: The questionnaire enables the patients to provide feedback on particular aspects of the treatment and their overall satisfaction with the whole procedure and its outcome. With statistical analysis, it is possible to discover specific treatment aspects that have crucial impact on overall satisfaction with the whole procedure. A patient-reported outcome helps to improve the quality of provided health care and the quality of patient life.

Experimental Electrophysiological and Pressure Responses of Urinary Bladder Detrusor to Lumbar to Sacral Nerve Rerouting - An Animal Study with Negative Results.

Background/Aims/Objectives: To verify the transfer of evoked potentials through anastomosis of an experimentally created micturition reflex arc and to detect said potentials directly on the detrusor and sphincter of rabbit urinary bladder. METHODS: During 2013-2015, 17 rabbits were operated upon and measurement followed during reoperation 3-16 months later. Suitable ventral spinal roots were electrophysiologically detected following laminectomy, and a somatic-central nervous system-autonomic micturition reflex arc was created. During reoperation, the ventral root was stimulated above and below the anastomosis, the evoked potentials on the bladder detrusor and sphincter were measured, and intravesical pressure was monitored. RESULTS: With stimulation above the anastomosis, 9 animals (53%) displayed a urinary bladder detrusor response and 7 (41%) a sphincter response. Four rabbits (24%) had elevated intravesical pressure. During the control stimulation below the anastomosis, we detected a detrusor response in 7 animals (41%), a sphincter response in 5 (29%), and elevated pressure in 4 (24%). Neither induction of micturition nor decrease in external sphincter activity occurred. CONCLUSIONS: Creation of a somatic-CNS-autonomic reflex arc is technically possible. However reflex activity transferring through the anastomosis is detectable on the detrusor only in some individuals, and is unable to induce a micturition reflex with or without accompanying detrusor-sphincter dyssynergia.