The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis.

Using a co-surgeon model has been suggested to improve perioperative outcomes and reduce the risk of complications. Therefore, we evaluated if a co-surgeon model compared with a single microsurgeon model could decrease the surgical time, length of stay, rate of complications, and healthcare-associated costs in adult patients undergoing microvascular breast reconstruction (MBR). A comprehensive search was performed across PubMed MEDLINE, Embase, and Web of Science. Studies evaluating the perioperative outcomes and complications of MBR using a single-surgeon model and co-surgeon model were included. A random-effects model was fitted to the data. Seven retrospective comparative studies were included. Ultimately, 1411 patients (48.23%) underwent MBR using a single-surgeon model, representing 2339 flaps (48.42%). On the other hand, 1514 patients (51.77%) underwent MBR using a co-surgeon model, representing 2492 flaps (51.58%). The surgical time was significantly reduced using a co-surgeon model in all studies compared with a single-surgeon model. The length of stay was reduced using a co-surgeon model compared with a single-surgeon model in all but one study. The log odds ratio (log-OR) of recipient site infection (log-OR = -0.227; P = 0.6509), wound disruption (log-OR = -0.012; P = 0.9735), hematoma (log-OR = 0.061; P = 0.8683), and seroma (log-OR = -0.742; P = 0.1106) did not significantly decrease with the incorporation of a co-surgeon compared with a single-surgeon model. Incorporating a co-surgeon model for MBR has minimal impact on the rates of surgical site complications compared with a single-surgeon model. However, a co-surgeon optimized efficacy and reduced the surgical time and length of stay.

Functional Rhinoplasty.

The nose is composed of intricate intranasal anatomy to serve its sophisticated functions. Although it only occupies a small area, it is the central focal point of the face and demands the highest level of understanding of the delicate interplay of form and function. Functional rhinoplasty, as opposed to aesthetic rhinoplasty, primarily aims to enhance nasal breathing and olfaction without altering the nose's appearance. The goal of this study is to describe the anatomy and physiology of the nose as well as the pathophysiology of nasal obstruction and the surgical approaches available for functional rhinoplasty. Whether when performed alone or combined with cosmetic rhinoplasty, functional rhinoplasty is a procedure that can bring significant benefits and improve the quality of life of our patients. Understanding nasal anatomy and physiology is key for successful management and outcomes. To provide optimal treatment for the patients, plastic surgeons must be familiarized with various techniques that have been documented.

Maximizing Safety and Optimizing Outcomes of Labiaplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: The considerable increase in labiaplasty requires plastic surgeons to be acquainted with the surgical techniques, their respective complications, and satisfaction rates. The authors conducted a systematic review of the available evidence on labia minoraplasty, looking at surgical techniques, clinical outcomes, and patient satisfaction. METHODS: A comprehensive search across PubMed, Web of Science, SCOPUS, and CochraneCENTRAL was performed through October of 2020. A random-effects model meta-analysis was performed to assess satisfaction and complication rates. RESULTS: Forty-six studies including 3804 patients fulfilled the inclusion criteria. The pooled satisfaction rate after labia minoraplasty was 99 percent (95 percent CI, 97 to 99 percent). Substantial heterogeneity was present across studies ( I2 = 63.09 percent; p < 0.001). The highest pooled incidence of dehiscence was reported for laser-assisted labiaplasty (5 percent; 95 percent CI, 2 to 8 percent) and wedge resection (3 percent; 95 percent CI, 1 to 5 perecent). The highest pooled incidence of hematoma formation (8 percent; 95 percent CI, <1 to 23 percent) and postoperative bleeding (2 percent; 95 percent CI, <1 to 15 percent) was reported for W-shape resection. The highest pooled incidence of transient pain or discomfort was reported for de-epithelialization (2 percent; 95 percent CI, <1 to 23 percent) and W-shape resection (2 percent; 95 percent CI, <1 to 15 percent). Three cases of flap necrosis were reported; two occurred using wedge resection labia minoraplasty and one was not specified. The most common causes for revision surgery ( n = 169) were dehiscence and aesthetic concerns. CONCLUSIONS: Labia minoraplasty is a safe procedure, but serious complications requiring surgical management have been reported. Surgical experience, knowledge of female genital anatomy, and thorough technique selection in accordance with the patient characteristics are mandatory.

Peripheral Neurectomy for Management of Trigeminal Neuralgia Refractory to Multiple Surgical Procedures.

Trigeminal Neuralgia (TN) is defined as a recurrent, unilateral, brief, electric shock-like pain and is associated with a significant deterioration in quality of life due to the debilitating nature of the pain. The first line treatment is medical therapy, and surgical treatment is reserved for patients with inadequate pain control or undesirable side effects. Surgical options for treatment may include microvascular decompression (MVD), stereotactic radiosurgery, percutaneous radiofrequency rhizotomy, and percutaneous balloon compression of trigeminal ganglion. MVD is considered the procedure of choice due to its high efficacy and safety profile; however, it carries a recurrence rate of 1%-5% annually and 15%-35% long term. Although re-operative MVD has been reported for recurrent cases, it carries a high risk of complications due to arachnoid adhesions and distorted anatomy. Peripheral neurectomy is a simple, expeditious, low-risk procedure that is well tolerated by patients and can be done even under local anesthesia. We report a case of a 69-year-old man who presented with a debilitating TN in the V1 and V2 territory refractory to MVD, stereotactic radiosurgery, and percutaneous balloon compression of the trigeminal ganglion, who had been treated with neurectomy of the left supraorbital, supratrochlear, and infraorbital nerves, with an excellent outcome at 6 months follow-up. Peripheral neurectomy is an effective alternative for patients with refractory TN who failed multiple surgical interventions. Previous publications have reported an elevated long-term recurrence rate after this procedure, perhaps due to peripheral nerve regeneration or neuroma formation. It is not yet studied whether using nerve conduits may lead to a decrease in recurrence.