The effect of therapeutic education program on quality of life among type 2 diabetic North-African patients: a randomized controlled trial.

INTRODUCTION: Type 2 Diabetes Mellitus (T2DM) is a chronic non-communicable disease with major impact on health in general and quality of life (QoL) in particular. The ultimate goal of all health interventions is to reduce the burden of this disease. AIM: To evaluate the effect of therapeutic education program on the QoL among patients with T2DM. METHODS: Between May 2021 and July 2022, 320 outpatients were enrolled in a randomized controlled trial in Sfax, Tunisia. The experimental group received the therapeutic education program, whereas the control group received only standard care. For data collection, the Arabic version of the Diabetes Quality of Life (DQoL-Arabic) questionnaire was used. RESULTS: In total, 263 patients completed the intervention, 132 in the experimental group and 131 in the control group. In terms of the main baseline characteristics, the two groups were comparable. After the intervention, there was a significant difference in all domains of QoL scores (median [interquartile]) between the experimental and control groups: satisfaction (3.14 [2.64-3.36] vs. 3.57 [3.43-3.71], p<0.001, respectively), impact (2.09 [1.91-2.36] vs. 2.45 [2.27 2.64], p<0.001, respectively) and worries (2.50 [2.25-2.75] vs. 3.00 [2.75 3.14], p<0.001, respectively). The QoL improves over time in the experimental group (3.01 [2.79-3.17] vs. 2.59 [2.21-2.80], p<0.001, respectively) and remains comparable in the control group (2.99 [2.81-3.14] vs. 3.01 [2.81-3.15], p=0.724, respectively). CONCLUSIONS: The benefits of implementing an educational program among patients with T2DM are observed in terms of all QoL domains.

Surgical techniques for the webbed neck: a narrative review with a comparative study and surgical decision-making algorithm for an optimal aesthetic result.

PURPOSE: A webbed neck is a conspicuous deformity that requires meticulous repair. Several surgical techniques are available; however, there is no guideline, or gold standard technique reference based on webbed neck characteristics. This article aims to conduct a narrative review of the surgical techniques with a comparative study to select those leading to the best aesthetic results and to propose a decision-making algorithm for surgical techniques according to the characteristics of the webbed neck. METHODS: A narrative review of surgical techniques of the webbed neck was performed by searching the PubMed and Google Scholar databases to summarize their particularities. A comparison of surgical techniques was made according to technicality and outcome characteristics. Clinical features of the webbed neck were reviewed to propose a classification of the webbed neck. RESULTS: Twenty-five articles were identified describing surgical techniques realized on 66 patients. Durak and Hikade techniques offered better results in the Z-plasty category. The Actaturk technique leads to better outcomes in the posterior approach techniques. Reichenberger and Mehri Turki's techniques were the most suitable lateral approach techniques. Otherwise, four types of webbed necks were defined based on the fibrotic band and the hair pattern. CONCLUSION: According to the typology of the web, a surgical decision-making algorithm is built to assist surgeons in finding the most suitable selected techniques for an optimal aesthetic result which corresponds to the achievement of a symmetrical neck contour with highly satisfactory hair placement while avoiding noticeable scars and recurrence.

Anatomical research of the clavicular pedicled flap for mandibular reconstruction: vascularization and harvesting technique.

PURPOSE: Mandibular reconstruction remains a challenging procedure despite the availability of various flaps and grafts. The ultimate objective is to restore oral functioning and attain acceptable morphological outcomes while considering donor site morbidity. This study describes the vascular supply and harvesting technique of a pedicled clavicular bone. The proximity of the clavicle is conducive to a mandibular replacement and allows the use of vascularized bone with a single surgical field. METHODS: The osteoperiosteal clavicular pedicled flap was harvested on the right side of ten fresh cadaver specimens. The cervical transverse artery was injected with colored latex in some cases and methylene blue in others. RESULTS: The vascular periosteal supply of the clavicular flap was highlighted. The clavicular bone was linked to its pedicle which was composed of vascular and adipose-fascial tissues, without any overlying skin paddle. Its vasculature was supplied by a reverse flow from the ascending cervical artery. The pedicled clavicular bone readily reached the mandible in all dissections. CONCLUSION: The osteoperiosteal vasculature of the clavicular flap is based on the transverse cervical artery which receives a reverse blood supply from the ascending cervical artery. This vascular pattern is reliable because of the existence of the sub-occipital microvascular network named the "Bosniak node." This pedicled clavicular flap seems to be a robust perspective in both mandibular and facial bone reconstruction. We do not claim that it will replace the existing approaches, but it will expand the surgical panel of mandibular reconstruction. Its clinical realisation will judge its functionality.

Parry-Romberg Syndrome: Successful Result in a Single Procedure Combining Silicone Implant and Structural Fat Grafting for Severe Facial Deformity.

Background: Parry-Romberg syndrome (PRS) is an enigmatic and acquired degenerative condition. It is characterized by a gradual and progressive facial hemiatrophy, after which facial deformities appear unexpectedly in a stable state. The degree of disfigurement depends on tissue involvement, illness onset, and duration. Nowadays, non-invasive treatments with lower morbidity, such as structured fat grafting (SFG) are preferred over traditional operations such as free flaps and bone grafts. However, for severe cases of PRS, multiple sessions of SFG are required. Case study: Despite the therapeutic failure that a 20-year-old lady had suffered after five previous conventional surgical procedures, the outcome was successful after only one surgical therapy employing a particular combination of SFG and malar silicone elastomers implant (SI). Conclusion: The author highlights the interest in a combination of non-invasive procedures using SFG and malar augmentation with SI to repair large volume loss while improving symmetry and skin texture. Otherwise, the role of adipose-derived stem cells in fat survival is crucial and should be the focus of future studies and the key to technological advancement.

Surgical correction of the webbed neck: an alternative lateral approach.

Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli. Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars. Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family.