Measurement of Postoperative Quality of Pain in Abdominoplasty Patients-An Outcome Oriented Prospective Study.

(1) Background: Postoperative pain is a frequently underestimated complication significantly influencing surgical outcome and patient satisfaction. While abdominoplasty is one of the most commonly performed plastic surgery procedures, studies investigating postoperative pain are limited in current literature. (2) Methods: In this prospective study, 55 subjects who underwent horizontal abdominoplasty were included. Pain assessment was performed by using the standardized questionnaire of the Benchmark Quality Assurance in Postoperative Pain Management (QUIPS). Surgical, process and outcome parameters were then used for subgroup analysis. (3) Results: We found a significantly decreased minimal pain level in patients with high resection weight compared to the low resection weight group (p = 0.01 *). Additionally, Spearman correlation shows significant negative correlation between resection weight and the parameter "Minimal pain since surgery" (rs = -0.332; p = 0.013). Furthermore, average mood is impaired in the low weight resection group, indicating a statistical tendency (p = 0.06 and a Χ2 = 3.56). We found statistically significant higher maximum reported pain scores (rs = 0.271; p = 0.045) in elderly patients. Patients with shorter surgery showed a statistically significant (Χ2 = 4.61, p = 0.03) increased claim for painkillers. Moreover, "mood impairment after surgery" shows a dramatic trend to be enhanced in the group with shorter OP duration (Χ2 = 3.56, p = 0.06). (4) Conclusions: While QUIPS has proven to be a useful tool for the evaluation of postoperative pain therapy after abdominoplasty, only continuous re-evaluation of pain therapy is a prerequisite for constant improvement of postoperative pain management and may be the first approach to develop a procedure-specific pain guideline for abdominoplasty. Despite a high satisfaction score, we detected a subpopulation with inadequate pain management in elderly patients, patients with low resection weight and a short duration of surgery.

Seasonal Impact on Free Flap Surgery in Terms of Flap Loss and Wound Healing Disorders: A Retrospective Cohort Study of 158 Free Flaps.

(1) Background: Postoperative flap loss and wound healing disorders are severe complications after microsurgical free flap surgery. Despite multiple clinical observations, a possible influence of season and external temperature on outcome are largely missing. (2) Methods: Retrospectively, data were collected from 151 patients receiving microsurgical free flaps from March 2018 to August 2019. Patients were divided into two cohorts. The winter group includes all patients who underwent surgery from October 2018 to March 2019 and the summer group al those who underwent surgery from April 2018 to September 2018. Data included demographic information, pre-existing conditions, flap characteristics, and postoperative complications like flap losses and wound healing problems. External temperatures during the first 14 postoperative days were documented and the predictor of flap loss and wound healing disorders was detected. (3) Results: In the winter group (October-March; Ø 7.24 °C) 72 patients (46 female, 24 males; Ø 57.0 years) and in the summer group (April-September; Ø 18.79 °C) 81 patients (48 female, 33 males; Ø 56.0 years) received free flap surgery. There were no significant differences in demography (age: p = 0.593; gender: p = 0.419; BMI: p = 0.141). We found a significant increase in flap loss during summer (χ2(1) = 6.626; p = 0.010; V = 0.209) strengthened by logistic regression analysis (p = 0.037; Exp(B) = 9.655). Additionally higher average temperatures 14 days postoperatively represents another main driver (p = 0.023, Exp(B) = 1.161) for postoperative flap loss. (4) Conclusions: The data confirm a significantly higher postoperative flap loss in the summer group. This information may potentially contribute to optimization of perioperative management and planning of elective and semi-elective surgeries.

Social Media Marketing: What Do Prospective Patients Want to See?

BACKGROUND: Platforms such as Instagram, Facebook, Twitter, and Google+ have created a worldwide audience of almost 3 billion people. Society is dramatically changing, demanding evolution of marketing strategies by plastic surgeons and aesthetic doctors alike. This unknown territory provides excellent opportunities, but creates many pitfalls as well; uncertainty remains as to the most effective manner to promote one's practice/services. OBJECTIVES: The aim of this study was to design a social experiment based on Instagram to give guidance for efficient self-promotion. METHODS: An Instagram account called "doctor.aesthetics" was created. Content was produced, and categorized into 4 groups: Aesthetics, Private Life, Disease, and Science. No bots or other Instagram-based promotion were utilized. Every post was evaluated regarding likes, comments, clicks, new followers, impressions, and savings. RESULTS: After 5 months and 37 posts, 10,500 people followed the account. "Scientific" posts were excluded from the analysis due to a low response rate. A significantly enhanced number of likes for "Private" postings was found. Additionally, "Private" posts led to most clicks and new followers, whereas "Aesthetics" posts were saved by most people. CONCLUSIONS: To benefit the most from social media advertising, it is necessary to offer insights into private life. Although "Aesthetics" and "Disease" postings showed similar response rates, "Scientific" posts failed to attract people.

Mechanical irritation by protruding bone: A possible cause of breast implant rupture.

Although breast implants have been in clinical use for almost 6 decades and have undergone considerable development during this time, implant rupture is still a dreaded long-term complication. Some obvious external factors, such as trauma, can lead to implant rupture, but many studies have reported a high rate of "spontaneous" implant rupture. Herein, we present two cases with the aim of raising awareness of a new possible cause of "spontaneous" implant rupture: mechanical irritation by bony protrusions.

Seasonal Impact on Surgical-Site Infections in Body Contouring Surgery: A Retrospective Cohort Study of 602 Patients over a Period of 6 Years.

BACKGROUND: Postoperative surgical-site infections are severe complications following body contouring surgery. Here, the authors evaluate whether surgical-site infection rates are influenced by higher temperatures during the summer season. METHODS: We enrolled 602 patients who underwent body contouring surgery between 2009 and 2015 in a retrospective cohort study. Data collected included demographics, surgical data, and postoperative outcome. Body contouring surgery procedures included lower and upper body lift, abdominoplasty, breast reduction, mastopexy, brachioplasty, and thigh lift. Infection rates were calculated on a seasonal basis and compared using Fisher's exact test and logistic regression analysis. RESULTS: There were 136 patients (125 women and 11 men) in the warm season [June to August; with an average temperature of 67.622°F (19.79°C)] and 466 patients (438 women and 28 men) in the cold seasons group [September to May, with an average temperature of 45.45 °F (7.47°C)]. The composition of the study cohorts was comparable. The average age was 40 years and the average body mass index was 27 kg/m. From a total of 602 patients, the authors observed 33 surgical-site infections, representing a rate of 5.48 percent. A statistically significant increase of postoperative surgical-site infections could be detected during summer (10.29 percent versus 4.08 percent; p = 0.0071), representing an increase of 150 percent. In addition, a logistic regression analysis determined "season" as the strongest predictor for surgical-site infections, with a risk increase of 2.693 times in the warm season. CONCLUSIONS: Body contouring operations are elective procedures, making careful risk consideration an absolute prerequisite. The authors demonstrate a significantly increased infection risk during summer and establish a causal link between the warm season and surgical-site infection accumulation. Consequently, preoperative patient information and operative planning should be adjusted accordingly. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

[Comparison of the regenerative cytokine profile of adipose-derived stromal cells (ASCs) harvested via abdominoplasty, suction-assisted liposuction (SAL) and ultrasound-assisted liposuction (UAL)]. / Vergleich des Regenerativen Zytokinprofils von Adipose Derived Stromal Cells (ASCs) Gewonnen Mittels Abdominoplastik, Suction Assisted Liposuction (SAL) und Ultrasound Assisted Liposuction (UAL).

INTRODUCTION: Mesenchymal stem cells are already used in numerous areas of medicine. In the field of plastic surgery, the main focus of recent research has been to utilise adipose-derived stromal cells (ASCs), mainly harvested via liposuction. The ability to release regenerative cytokines is supposed to be the key mechanism for the therapeutic efficacy of ASCs. There are currently a variety of methods and devices in clinical use for harvesting lipoaspirate and consequently ASCs. For most of these devices, the effect on the regenerative cytokine profile of ASCs is unknown. The aim of this study is to compare the expression of key regenerative cytokines of ASCs derived by three standard procedures of plastic surgery: abdominoplasty, suction-assisted liposuction (SAL) and ultrasound-assisted liposuction (UAL). PATIENTS AND METHODS: UAL and SAL lipoaspirates were obtained from 3 healthy female volunteers before abdominoplasty was performed in the same patients. ASCs were isolated from UAL and SAL lipoaspirates as well as from abdominoplasty resections and RNA expression of important regenerative cytokines (HGF (hepatocyte growth factor), FGF-2 (basic fibroblast growth factor), MCP-1 (monocyte chemotactic protein 1), SDF-1 (stromal cell-derived factor 1) and VEGF (vascular endothelial growth factor) was compared. RESULTS: There was no difference in the expression of HGF, FGF-2, SDF-1 and VEGF between the individual samples, but we were able to demonstrate significantly increased expression of MCP-1 in ASCs obtained from UAL lipoaspirate. CONCLUSION: UAL and SAL lipoaspirates are suitable for obtaining functional ASCs and are comparable to minimally manipulated cells from abdominoplasty resections.