Periareolar minimally invasive approach for cardiac surgery: a case series and description of technique with a review of literature.

BACKGROUND: Minimally invasive cardiac surgery (MICS) has garnered significant attention for its potential benefits, including decreased surgical trauma, accelerated recovery, and improved aesthetic outcomes. This case series aims to elucidate the technical aspects and assess the aesthetic, functional, and quality of life outcomes associated with the utilization of a periareolar incision approach in female patients undergoing cardiac surgery. METHODS: The periareolar MICS technique, performed with or without high-definition (HD) 3D endoscopic visualization, limited rib-spreading, and a periareolar incision spanning the 3 to 9 o'clock positions, was employed. We present a case series encompassing five female patients who underwent various cardiac procedures for different pathologies using this approach. RESULTS: No intraoperative complications occurred, and all patients experienced uneventful postoperative recoveries. The periareolar approach resulted in well-healed incisions with minimal scaring, preserving breast contour and yielding satisfactory cosmetic outcomes. Patients reported negligible pain levels and expressed contentment with the scar appearance. CONCLUSION: The periareolar incision technique in MICS represents an efficacious approach characterized by favorable aesthetic outcomes and enhanced patient experience. Further investigations are warranted to compare different MICS approaches with respect to pain management and their impact on quality-of-life domains.

The Satisfaction and Quality of Life of Patients After Breast Reconstruction: A Cross-Sectional Multicenter Study Comparing Immediate, Delayed, and Nonreconstructive Outcomes.

BACKGROUND: Breast reconstruction following mastectomy can be performed through various surgical techniques that prioritize the patient's safety and quality of life. Plastic surgeons are trained to choose the most appropriate surgical approach based on the individual patient's needs and medical history. The safety of the patient is always the primary concern, followed by considerations such as aesthetic outcomes and long-term health implications. OBJECTIVES: The aim of this study was to assess and document patients' satisfaction and quality of life after breast reconstruction across Saudi Arabia. METHODS: This is a cross-sectional multicenter study among female patients who underwent mastectomy with or without breast reconstruction between 2015 and 2022. Two hundred eighty patients participated in this study through a call-based Arabic version of the BREAST-Q questionnaire to analyze the quality of their lives and satisfaction. RESULTS: Our results showed that patients who underwent delayed reconstruction had lower satisfaction than those who underwent immediate reconstruction. The average BREAST-Q score was lower in patients who used tissue expanders than those with implant-based reconstruction, autologous reconstruction, or combined approaches. Patients who underwent simple mastectomy had lower satisfaction (M = 66.1) than those who had a skin-sparing mastectomy (M = 71.1) and/or nipple-sparing mastectomy (M = 72.6). CONCLUSIONS: This retrospective multicenter study observed a significant association between the time of the reconstructive surgery and patient's satisfaction; patients who underwent immediate reconstruction had higher satisfaction rate. Lower satisfaction rate was associated with tissue expander breast reconstruction. There is a significant association between satisfaction rate and smoking history.

Does tranexamic acid effectively minimise blood loss in cleft palate repair? A rigorous assessment through comprehensive systematic review and meta-analysis.

Cleft palate repair is a common reconstructive procedure that can involve significant blood loss. Tranexamic acid (TXA) has been proposed to minimise blood loss during various surgical procedures, but its effectiveness in cleft palate repair remains unclear. This systematic review and meta-analysis aimed to assess the effectiveness of TXA to reduce postoperative blood loss. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search across multiple databases, including PubMed, Cochrane, and Web of Science, to identify relevant studies published up to September 2023. Only randomised controlled trials (RCTs) were included. Primary outcomes measured were total blood loss, transfusion rates, and postoperative complications. We identified four relevant RCTs, which included 275 cleft palate patients with a mean (range) age of 28.7 (6-65) months. The pooled analysis found no significant difference in duration of surgery (MD -18.40 minutes, p = 0.09), preoperative haemoglobin (MD 0.46 g/dl, p = 0.27), or postoperative haemoglobin (MD 0.07 g/dl, p = 0.86) between TXA and control groups. Intraoperative blood loss was lower with TXA, but with TXA, the difference was not statistically significant (MD -16.63 ml, p = 0.15). TXA significantly improved surgical field visibility (p = 0.004). No adverse events occurred with its use. While no significant differences were found in surgical outcomes with TXA, surgical field visibility significantly improved, and TXA showed a promising safety profile. Larger and higher-quality RCTs are still needed to validate these preliminary findings before TXA can be considered as a standard treatment.