Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 106
Filtrar
1.
Clin Cardiol ; 47(6): e24277, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38838029

RESUMO

BACKGROUND: Invasive hemodynamics are fundamental in assessing patients with advanced heart failure (HF). Several novel hemodynamic parameters have been studied; however, the relative prognostic potential remains ill-defined. HYPOTHESIS: Advanced hemodynamic parameters provide additional prognostication beyond the standard hemodynamic assessment. METHODS: Patients from the PRognostic Evaluation During Invasive CaTheterization for Heart Failure (PREDICT-HF) registry who underwent right heart catheterization (RHC) were included in the analysis. The primary endpoint was survival to orthotopic heart transplant (OHT) or durable left ventricular assist device (LVAD), or death within 6 months of RHC. RESULTS: Of 846 patients included, 176 (21%) met the primary endpoint. In a multivariate model that included traditional hemodynamic variables, pulmonary capillary wedge pressure (PCWP) (OR: 1.10, 1.04-1.15, p < .001), and cardiac index (CI) (OR: 0.86, 0.81-0.92, p < .001) were shown to be predictive of adverse outcomes. In a separate multivariate model that incorporated advanced hemodynamic parameters, cardiac power output (CPO) (OR: 0.76, 0.71-0.83, p < .001), aortic pulsatility index (API) (OR: 0.94, 0.91-0.96, p < .001), and pulmonary artery pulsatility index (OR: 1.02, 1.00-1.03, p .027) were all significantly associated with the primary outcome. Positively concordant API and CPO afforded the best freedom from the endpoint (94.7%), whilst negatively concordant API and CPO had the worst freedom from the endpoint (61.5%, p < .001). Those with discordant API and CPO had similar freedom from the endpoint. CONCLUSION: The advanced hemodynamic parameters API and CPO are independently associated with death or the need for OHT or LVAD within 6 months. Further prospective studies are needed to validate these parameters and elucidate their role in patients with advanced HF.


Assuntos
Cateterismo Cardíaco , Insuficiência Cardíaca , Hemodinâmica , Sistema de Registros , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Hemodinâmica/fisiologia , Medição de Risco/métodos , Prognóstico , Idoso , Fatores de Risco , Pressão Propulsora Pulmonar/fisiologia , Coração Auxiliar , Transplante de Coração , Estudos Retrospectivos , Estados Unidos/epidemiologia , Fatores de Tempo , Valor Preditivo dos Testes , Função Ventricular Esquerda/fisiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-38881398

RESUMO

OBJECTIVE: To evaluate the effect of prophylactic antibiotics on outcomes and complications following surgical reconstructions of nasal Mohs defects in the outpatient setting. STUDY DESIGN: Retrospective cohort study. SETTING: Single tertiary care center, July 2021 to June 2023. METHODS: All adult patients who underwent reconstruction of nasal Mohs defects in an outpatient office setting were examined. Patient demographics, surgical details, prophylactic postprocedural antibiotic use, and postprocedural complications (infection, flap or graft necrosis, wound dehiscence) were collected. Outcomes and complications were compared between patients who received and did not receive prophylactic antibiotics using χ2, Kruskal-Wallis, and multivariable logistic regression. RESULTS: A total of 211 patients met inclusion criteria. A majority of reconstructions utilized a local flap (70%), followed by a skin or composite graft (22%), then an interpolated flap (8%). Over half of patients (55%) were prescribed prophylactic antibiotics. Postprocedural complications were documented in 16 patients (7.6%), including infection (3.3%) and flap or graft loss or necrosis (1.4%). The rate of complications did not differ based on receipt of antibiotics. The only factors independently associated with the development of complications were history of chemoradiation and reconstruction with skin or composite grafts. CONCLUSION: Prophylactic antibiotics after nasal Mohs reconstructions performed in the office setting were not associated with any differences in the rate of postprocedural complications, including surgical site infections.

3.
Artigo em Inglês | MEDLINE | ID: mdl-38738913

RESUMO

OBJECTIVE: Few studies have examined the impact of preoperative and surgical factors on the change in cosmetic survey scores after nasal Mohs reconstruction using a subset of the 10-item Standardized Cosmesis and Health Nasal Outcomes Survey-Cosmesis (SCHNOS-C). We aim to determine preoperative and surgical factors that impact cosmetic outcomes following Mohs nasal reconstruction. STUDY DESIGN: Retrospective analysis. SETTING: Nasal Mohs reconstruction patients at a tertiary medical center. METHODS: All patients receiving Mohs reconstruction of any nasal subunit at a tertiary medical center were analyzed. Variables collected included demographic and Mohs defect/reconstruction characteristics. Primary outcomes were changes in cosmetic (SCHNOS-C) scores and revision rates. Multivariable analysis was used to identify independent predictors of cosmetic scores/revision. RESULTS: We included 296 patients for analysis. On multivariable logistic regression, factors contributing to better final cosmetic scores were receiving a skin/composite graft (odds ratio [OR]: 0.22, 95% confidence interval: 0.06-0.68, P = .014) compared to a local flaps. Women were more likely to have worsening cosmetic scores (OR: 2.27, 1.06-4.99, P = .037). Only initial cosmetic scores independently predicted receiving any revision (OR: 1.11, 1.03-1.20, P = .006). CONCLUSION: Average SCHNOS-C scores after nasal reconstruction of Mohs defects are low. Only worse patient reported SCHNOS-C scores predicted revision. It is important to understand preoperative and surgical factors that affect cosmetic outcomes to optimize patient counseling and reconstructive planning. Patient perception is a key factor in predicting revisions.

4.
Artigo em Inglês | MEDLINE | ID: mdl-38569157

RESUMO

Background: Little is known about how depression and appearance anxiety affect patient reporting of synkinesis severity. Learning/Study Objective: Measure prevalence of depression and appearance anxiety in facial synkinesis and correlations between subjective and surgeon-graded synkinesis severity. Design Type: Prospective cohort. Methods: Patients with synkinesis volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), facial clinimetric evaluation (FaCE) scale, Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Standardized videos were scored by facial plastic surgeons using Sunnybrook Scale and eFaCE. Multivariate linear regression was used to compare patient- and surgeon-graded metrics. Results: One hundred patients participated, 91 were female. Mean age was 56.4 (12.3). Eight percent identified as Black and 87% White. The most common nerve injury etiology was idiopathic (47%). Mean synkinesis duration was 7.6 years (6.2). Twenty percent and 15% reported history of an anxiety or depressive disorder, respectively. Patient (SAQ, FaCE) and clinician (Sunnybrook, eFaCE) scores were correlated (Pearson's r 0.223-0.294, p < 0.05). Upon adjusting for CES-D/FNAES, correlations between most patient and clinician metrics became stronger. As CES-D and FNAES worsened, patient-clinician correlations weakened. Conclusions: Depression and appearance anxiety may affect patient reporting of synkinesis severity. Worse mental health scores may decorrelate patient and clinician synkinesis assessments.

5.
Laryngoscope ; 134(3): 1214-1219, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37607106

RESUMO

OBJECTIVES: Microtia and anotia repair require techniques that consider both aesthetics and function. The outcomes of different reconstructive frameworks such as costal cartilage or a porous polyethylene implant have not been evaluated on a national scale. We aim to understand differences in outcomes/complication rates and operative times between different reconstructive frameworks used in microtia/anotia reconstruction. METHODS: This was a retrospective review of the National Surgical Quality Improvement Program Pediatric database between 2012-2019. Patients with ICD-9/10 codes for microtia/anotia were isolated. Reconstruction methods were identified using CPT codes for rib graft, ear cartilage graft, and alloplastic implants (biocompatible implants, porous polyethylene, etc). Outcomes included operative-time, wound complications, and unplanned re-operations within 30 days of surgery. Multivariable logistic regression was performed to control for confounders. RESULTS: We included 593 patients for analysis. Reconstruction with rib grafts (N = 506, 85%) was the most common. In 58 patients (9.8%), an implant was used for the auricular framework, whereas in 47 (7.9%) ear cartilage grafts were used. The overall wound complication rate was 3.4%. On univariate analysis, alloplastic implants exhibited a higher rate of wound complications (8.6% vs. 2.8%, p = 0.037) and longer operative times (350 min vs. 235 min, p < 0.001). After controlling for demographics and comorbidities, implants conferred an independently increased risk of wound complications (OR 3.52, 1.10-9.54, p = 0.020). CONCLUSION: Although the use of alloplastic implants (e.g., porous polyethylene) may confer an increased risk of early complications, the long-term clinical implications of these findings are unclear relative to aesthetic benefits. Multi-institutional studies are needed to validate these findings using patient-specific and surgeon-specific data. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1214-1219, 2024.


Assuntos
Microtia Congênita , Procedimentos de Cirurgia Plástica , Criança , Humanos , Microtia Congênita/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Polietileno , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Bases de Dados Factuais
6.
Laryngoscope ; 134(2): 671-677, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37314217

RESUMO

OBJECTIVE: Surgical management of cleft lip/palate and cleft rhinoplasty have historically been performed by plastic surgeons. No study has addressed temporal trends in cleft-associated surgeries. This study assesses trends in cleft surgical management and complications in a national database. METHODS: Cross-sectional analysis of the National Surgical Quality Improvement Program Pediatric database from 2012 to 2021. Patients receiving cleft lip and/or palate repair were isolated using CPT codes. A subset receiving cleft rhinoplasty was also analyzed. The yearly proportion of otolaryngologists compared to general plastic surgeons performing surgeries was noted. Regression analysis was used to identify trends and predictors of management by OHNS. RESULTS: We identified 46,618 cases of cleft repair, of which 15.6% (N = 7,255) underwent repair with otolaryngology. On univariate Pearson correlation analysis, neither cleft rhinoplasties performed by OHNS over time (R = 0.371, 95% CI -0.337 to 0.811, p = 0.2907) nor all cases (R = -0.26, -0.76 to 0.44, p = 0.465) exhibited a significant change. On multivariable regression, the operative year was not associated with being treated by otolaryngology (p = 0.826) for all cleft cases but was associated with such in cleft rhinoplasties (OR 1.04, 1.01-1.08, p = 0.024). On multivariable analysis, the operative year was correlated with a higher rate of complications overall (OR 1.04, 1.01-1.07, p = 0.002). Surgeon specialty was not associated with complication rates. CONCLUSIONS: In the last 10 years, no change in the proportion of cleft lip/palate repair performed by OHNS was observed. Otolaryngologists are performing more cleft rhinoplasty but at a marginal rate. Otolaryngologists also manage more complex patients with multiple comorbidities compared to their colleagues. Complication rates have increased overall regardless of surgeon specialty, warranting further investigation. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:671-677, 2024.


Assuntos
Fenda Labial , Fissura Palatina , Otolaringologia , Rinoplastia , Humanos , Criança , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estudos Transversais , Nariz/cirurgia
7.
ESC Heart Fail ; 11(1): 587-593, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38012064

RESUMO

In this case series, we describe the use of invasive cardiopulmonary exercise testing (iCPET) to diagnose heart failure due to preload reserve failure in two patients with progressive dyspnoea. We demonstrate that underlying liver disease contributes to preload reserve failure as a cause of exertional dysfunction. In liver diseases such as non-alcoholic fatty liver disease (NAFLD), fibrotic changes to the sinusoidal liver architecture occur leading to an increased transhepatic sinusoidal pressure gradient. Even at the earliest stage of hepatic fibrosis in patients with NAFLD, changes in hepatic blood flow are seen due to outflow block in the sinusoidal area. In this way, changes to the sinusoidal liver architecture can lead to limitations in preload reserve. This case series describes two patients with exertional dyspnoea found to have preload failure on iCPET due to underlying liver disease.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Humanos , Teste de Esforço , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Hemodinâmica , Dispneia
9.
Facial Plast Surg Aesthet Med ; 26(3): 256-261, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38150510

RESUMO

Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.


Assuntos
Testa , Padrões de Prática Médica , Retalhos Cirúrgicos , Humanos , Estudos Transversais , Testa/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Rinoplastia/métodos , Inquéritos e Questionários , Procedimentos de Cirurgia Plástica/métodos , Cirurgia Plástica/métodos , Estados Unidos
10.
Am J Otolaryngol ; 45(2): 104148, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38101139

RESUMO

BACKGROUND: Management of facial fractures is variable. Understanding how time to operative management impacts outcomes can help standardize practice. METHODS: Retrospective analysis of the ACS Trauma Quality Improvement Program (TQIP) database between 2016 and 2019. Adult patients with operative facial fractures were isolated by ICD-10 procedure codes, and further stratified by fracture location, including the mandible, orbit, maxilla, zygoma, and frontal bone. Multivariable logistic regression was conducted to predict in-hospital complications (both surgical and systemic complications) adjusting for time-to-operation, comorbidities, fracture location, AIS, and demographics. RESULTS: 1678 patients with operative facial fractures were identified. The median time-to-operation was 2 days (IQR 1.0-2.0 days). Most patients only had one operative fracture (95 %) and orbital fracture was the most common (44 %). The overall complication rate was higher for those operated after 2 days compared to those operated between 1 and 2 days and within 24 h (2.8 % vs 0.6 % vs 0.7 %; p < 0.001). Patients who were operated on after 48 h exhibited an increased risk of any complication (OR 4.72, 95 % CI 1.49-16.6, p = 0.010) on multivariable models. CONCLUSION: Delays in the management of facial fractures are associated with more in-hospital complications. However, the incidence of short-term postoperative complications remains low. Injury characteristics are the primary predictor of delays in operation, however Hispanic patients independently experienced delays in care.


Assuntos
Traumatismos Faciais , Fraturas Cranianas , Ferida Cirúrgica , Adulto , Humanos , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fraturas Cranianas/cirurgia , Fraturas Cranianas/complicações , Hospitais , Ossos Faciais/cirurgia
12.
Facial Plast Surg ; 39(5): 537-546, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37437583

RESUMO

Preservation of native nasal structures in rhinoplasty has aesthetic and functional benefits. This ideology can be implemented within open surgical approaches and in the context of structural modifications of the nose, particularly the nasal tip (structural preservation). In addition, modifications of preservation techniques and hybrid approaches to the osseocartilaginous vault have resulted in expanded indications for preservation of the nasal dorsum. These modifications and indications, as well as septal management in preservation cases, are discussed here in the context of an open approach. Importantly, patient-reported measures suggest that both preservation and structural approaches can yield excellent outcomes. An understanding and integration of both techniques offer great versatility for the rhinoplasty surgeon.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Septo Nasal/cirurgia , Estética Dentária , Nariz/cirurgia
13.
J Med Educ Curric Dev ; 10: 23821205231177181, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37324048

RESUMO

Objectives: There is a paucity of data on pathway programs that seek to increase underrepresented in medicine (URiM) students in medicine. Therefore, this investigation aimed to describe the status and associations of pathway programs at US medical schools. Methods: From May to July 2021, the authors obtained information by (1) accessing pathway programs listed on the Association of American Medical Colleges (AAMC) website, (2) reviewing websites of US medical schools, (3) calling medical schools to obtain further information. The data retrieved from the medical school websites was compiled into a 27-item checklist based on the maximum number of different items that was extracted from any of the medical school websites. The data included program characteristics, curricula, activities, and outcomes. Each program was assessed on the number of categories of which information was available. Statistical analyses determined significant associations of URiM-focused pathways and other factors. Results: The authors identified 658 pathway programs: 153 (23%) listed on AAMC website and 505 (77%) identified from medical school websites. Only 88 (13%) programs listed outcomes and 143 (22%) had adequate website information. URiM-focused programs (48%) were independently associated with AAMC website listing (adjusted odds ratio [aOR] = 2.62, P = .001), no fees requirement (aOR = 3.33, P = .001), oversight by diversity departments (aOR = 2.05, P = .012), Medical College Admission Test preparations (aOR = 2.70, P = .001), research opportunities (aOR = 1.51, P = .022), and mentoring (aOR = 2.58., P < .001). Programs targeting K1-12 were less likely to offer mentoring, shadowing or research or include URiM students. Programs with outcomes were more likely to be college programs with longer durations and offer research, while programs listed on AAMC website provided more resources. Conclusion: Although pathway programs are available for URiM students, accessibility issues due to inadequate websites information and early exposure are barriers. Most programs have insufficient data on their website, including a lack of outcome data which is detrimental in today's virtual climate. Medical schools should update their websites to ensure that students requiring support to matriculate into medical school have adequate and relevant information to make informed decisions regarding participation.

14.
J Card Fail ; 29(11): 1507-1518, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37352965

RESUMO

BACKGROUND: Invasive hemodynamic measurement via right heart catheterization has shown divergent data in its role in the treatment of patients with heart failure (HF) and cardiogenic shock. We hypothesized that variation in data acquisition technique and interpretation might contribute to these observations. We sought to assess differences in hemodynamic acquisition and interpretation by operator subspecialty as well as level of experience. METHODS AND RESULTS: Individual-level responses to how physicians both collect and interpret hemodynamic data at the time of right heart catheterization was solicited via a survey distributed to international professional societies in HF and interventional cardiology. Data were stratified both by operator subspecialty (HF specialists or interventional cardiologists [IC]) and operator experience (early career [≤10 years from training] or late career [>10 years from training]) to determine variations in clinical practice. For the sensitivity analysis, we also look at differences in each subgroup. A total of 261 responses were received. There were 141 clinicians (52%) who self-identified as HF specialists, 99 (38%) identified as IC, and 20 (8%) identified as other. There were 142 early career providers (54%) and late career providers (119 [46%]). When recording hemodynamic values, there was considerable variation in practice patterns, regardless of subspecialty or level of experience for the majority of the intracardiac variables. There was no agreement or mild agreement among HF and IC as to when to record right atrial pressures or pulmonary capillary wedge pressures. HF cardiologists were more likely to routinely measure both Fick and thermodilution cardiac output compared with IC (51% vs 29%, P < .001), something mirrored in early career vs later career cardiologists. CONCLUSIONS: Significant variation exists between the acquisition and interpretation of right heart catheterization measurements between HF and IC, as well as those early and late in their careers. With the growth of the heart team approach to management of patients in cardiogenic shock, standardization of both assessment and management practices is needed.


Assuntos
Insuficiência Cardíaca , Choque Cardiogênico , Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hemodinâmica , Cateterismo Cardíaco/métodos , Débito Cardíaco
15.
Facial Plast Surg ; 39(4): 333-361, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37160159

RESUMO

Preservation rhinoplasty encompasses a number of techniques that minimize disruption of the native cartilaginous and soft tissue nasal architecture. These techniques have gained popularity resulting in an increase in publications relevant to preservation rhinoplasty. However, many studies that present patient outcomes are of low-level evidence and do not incorporate validated patient-reported outcome measures. While these studies do consistently report positive outcomes, there are few high-level comparative studies that support the theoretical benefits of preservation relative to structural rhinoplasty. As contemporary preservation rhinoplasty techniques will continue to evolve and become incorporated into clinical practice, there will be the need for parallel emphasis on robust clinical studies to delineate the value of these methods.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Nariz/cirurgia , Cartilagem/transplante , Medidas de Resultados Relatados pelo Paciente , Septo Nasal/cirurgia
16.
Am J Transplant ; 23(7): 1048-1057, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37059177

RESUMO

Nontuberculous mycobacteria are emerging pathogens, yet data on the epidemiology and management of extrapulmonary nontuberculous mycobacteria infections in orthotopic heart transplantation (OHT) and ventricular assist device (VAD) recipients are scarce. We retrospectively reviewed records of OHT and VAD recipients who underwent cardiac surgery at our hospital and developed Mycobacterium abscessus complex (MABC) infection from 2013 to 2016 during a hospital outbreak of MABC linked to heater-cooler units. We analyzed patient characteristics, medical and surgical management, and long-term outcomes. Ten OHT patients and 7 patients with VAD developed extrapulmonary M. abscessus subspecies abscessus infection. The median time from presumed inoculation during cardiac surgery to the first positive culture was 106 days in OHT and 29 days in VAD recipients. The most common sites of positive cultures were blood (n = 12), sternum/mediastinum (n = 8), and the VAD driveline exit site (n = 7). The 14 patients diagnosed when alive received combination antimicrobial therapy for a median of 21 weeks, developed 28 antibiotic-related adverse events, and underwent 27 surgeries. Only 8 (47%) patients survived longer than 12 weeks after diagnosis, including 2 patients with VAD who experienced long-term survival after an explantation of infected VADs and OHT. Despite aggressive medical and surgical management, OHT and VAD patients with MABC infection experienced substantial morbidity and mortality.


Assuntos
Transplante de Coração , Coração Auxiliar , Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Humanos , Coração Auxiliar/efeitos adversos , Estudos Retrospectivos , Transplante de Coração/efeitos adversos , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/epidemiologia
18.
Facial Plast Surg ; 39(3): 220-229, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36603830

RESUMO

This review provides a comprehensive presentation of the evidence available in facial reconstruction post-Mohs micrographic surgery. Given the large diversity in post-Mohs reconstruction, there are limited guidelines in the management of defects. The aim of the present work is to provide a review of the best evidence as it pertains to several considerations in facial reconstruction. Data suggests that Mohs micrographic surgery and many reconstructive procedures can be performed as outpatient procedures under local anesthesia, with narcotic pain medication only given in certain patient populations following a minority of reconstructive procedures. Perioperative and topical antibiotics are generally not indicated. Aspirin and warfarin can generally be continued for most reconstructive procedures, but clopidogrel and novel anticoagulants may predispose to increased bleeding complications. Delayed reconstruction appears to be safe, although data are discordant on this topic. No specific wound closure technique or suture choice appears to be consistently superior. Given the lack of robust comparative studies, consistent methodology, and variable defect sizes/locations, no robust evidence-based guidelines can be generated for reconstruction techniques of facial subsites.


Assuntos
Neoplasias Faciais , Neoplasias Cutâneas , Humanos , Retalhos Cirúrgicos , Neoplasias Faciais/cirurgia , Neoplasias Cutâneas/cirurgia , Cirurgia de Mohs/efeitos adversos , Face/cirurgia
19.
Facial Plast Surg Aesthet Med ; 25(1): 35-39, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35593902

RESUMO

Background: The Nasal Obstruction Symptom Evaluation (NOSE) scale is widely used by clinicians in evaluation of nasal airway obstruction (NAO). Objective: To determine normative values for the NOSE scale among both symptomatic and asymptomatic members of the general U.S. population. Methods: A survey of NAO symptoms in adults of age 18 years and older was performed. The distribution of NOSE scores among the general population was estimated. Influence of features including age, gender, race, location, and symptomatology on NOSE scores was evaluated. Results: Surveys were completed by 2333 participants. Mean NOSE score was 11 (standard deviation [SD] 11) in the asymptomatic, and 28 (SD 22) in the symptomatic population (p < 0.0001). Increasing age was associated with an increase in scores until 45 years, after which it was associated with decreasing scores. No significant differences were found related to other investigated demographics. Conclusions: Normative ranges for the NOSE scale are established, and are largely consistent with values in the existing literature. NOSE scores do not appear to be influenced by gender, race, or geography, although age should be considered in their interpretation.


Assuntos
Obstrução Nasal , Adulto , Humanos , Adolescente , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Avaliação de Sintomas , Inquéritos e Questionários
20.
Facial Plast Surg Clin North Am ; 31(1): 1-11, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36396280

RESUMO

Renewed interest in dorsal preservation rhinoplasty (DPR) stems from theoretic esthetic and functional advantages over conventional hump resection. DPR fundamentally consists of en bloc dorsal lowering via a combined septal resection and mobilization of the bony pyramid. Several technical modifications exist, allowing for the expansion of DPR indications. Although studies suggest success with these techniques, comparative data to conventional hump resection are limited. Challenges and stigmata of DPR include a radix step-off, hump recurrence, supratip saddling, and widening of the midvault. The fusion of structural techniques with preservation ideology will facilitate the incorporation of DPR into clinical practice.


Assuntos
Rinoplastia , Humanos , Rinoplastia/métodos , Estética
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA