Understanding the Appropriate and Beneficial Use of Before and After Photos in Breast Surgery: A North American Survey.

Introduction: Before and after photographs (BAPs) in breast surgery have been identified as important components of the informed consent process. Currently, there is limited consensus on the contents and presentation of BAPs. This study collected the opinions of prior and prospective patients on this topic. Methods: A survey, based on criteria identified by our previous nominal group technique (NGT) study, was designed to obtain patient perspectives on BAPs in breast surgery. Amazon Mechanical Turk, a validated crowd-sourcing tool, was used to identify and survey a group of 72 participants who indicated that they had undergone or were planning to undergo breast surgery. Likert items were analyzed using either chi-squared or Fisher's exact test. Results: Most respondents were cis-gendered-women (89%), Caucasian (83%), and between 31 and 41 years old (38%). Respondents agreed that BAPs are important to the consent process, for enabling patient-centered care, and should be presented in standardized sets. BAPs should be more accessible through different platforms, display multiple time points to show the healing process, and have multiple views including close-ups of scars. Photos should be unaltered except for de-identification, and have more diversity with regard to patient gender, age, skin color, and body mass index. These results align with results from our NGT study. Conclusion: Through this study we have identified many criteria that BAPs should meet according to prior and prospective breast surgery patients. Surgeons should think critically about how they present BAPs during the consent process to ensure effective patient-centered care.

Introduction : En chirurgie mammaire, les photos avant-après (PAP) font partie des aspects importants du processus de consentement éclairé. À l'heure actuelle, le consensus sur le contenu et la présentation des PAP est limité. La présente étude visait à recueillir l'avis de patientes passées et prospectives sur le sujet. Méthodologie : Les chercheurs ont préparé un sondage reposant sur les critères qu'ils avaient établis lors de leur étude antérieure sur la technique du groupe nominal (TGN) pour obtenir les points de vue des patients sur les PAP en chirurgie mammaire. Ils ont utilisé l'outil de production participative validé MechanicalTurk d'Amazon pour repérer et sonder un groupe de 72 participants qui ont indiqué avoir subi ou planifié de subir une chirurgie mammaire. Ils ont analysé les énoncés de l'échelle de Likert au moyen du test du chi carré ou de la méthode exacte de Fisher. Résultats : La plupart des répondants étaient des femme cisgenres (89%), blanches (83%), âgées de 31 à 41 ans (38%). Ces répondants ont convenu que les PAP constituent un aspect important du processus de consentement, qu'elles favorisent des soins axés sur les patients et qu'elles doivent être présentées sous forme d'ensembles standardisés. Les PAP devraient être plus accessibles sur diverses plateformes, présenter divers moments du processus de guérison et de multiples points de vue, y compris des gros plans des cicatrices. Les photos devraient être inaltérées, à part pour la désidentification, et refléter une plus grande diversité de genres, d'âges, de couleurs de peau et d'indices de masse corporelle. Ces résultats concordent avec ceux de l'étude antérieure par la TGN. Conclusion : Grâce à la présente étude, les chercheurs ont relevé de nombreux critères que doivent respecter les PAP selon les patients passés et prospectifs en chirurgie mammaire. Les chirurgiens devraient recourir à la réflexion critique quant à la manière de présenter les PAP pendant le processus de consentement pour s'assurer de prodiguer des soins efficaces axés sur les patients.

Nasal Tip Deprojection in Rhinoplasty.

BACKGROUND: Rhinoplasty is one of the most commonly performed facial surgeries in the USA. There exist many major and minor nasal tip support structures that impact tip projection. Overprojection may result from anatomic factors or may occur iatrogenically during primary rhinoplasty. Achieving reliable, reproducible, and stable results is the aim of nasal tip deprojection rhinoplasty. This technique is designed to decrease nasal tip deprojection in patients with an overly projected nasal tip. METHODS: A retrospective chart review of 2,003 rhinoplasty cases in the senior author's practice was conducted between July 2014 and June 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases with nasal tip deprojection, with a minimum of 12 months of follow-up. Outcomes of interest included the rate of operative revisions and the rate of postoperative infection. RESULTS: 447 patients met the inclusion criteria. The mean age of our study group was 32.1 years old, with 409 females. 291 cases were primary rhinoplasties. Mean follow-up period was 22.4 months. Eight patients (1.8%) required empiric antibiotics postoperatively, with 17 patients (3.8%) requiring operative revision. CONCLUSIONS: Our case series demonstrates that combining resection of the medial crura with lateral crural steal and a columellar strut graft allows us to achieve considerable nasal tip deprojection. The comprehensive patient follow-up with a mean of 22.4 months further supports the reliability of our technique.

Does Soaking Fresh Frozen Costal Cartilage in an Antibiotic Solution Reduce Postoperative Infection in Rhinoplasty?

Background: Fresh frozen costal cartilage (FFCC), from the Musculoskeletal Transplant Foundation (MTF), has recently gained popularity for use in revision rhinoplasty or primary rhinoplasty when there is a paucity of autologous cartilage. However, there are currently no guidelines related to the use of intraoperative antibiotic soaking to reduce postoperative infection rates when using MTF FFCC. This study aimed to evaluate the efficacy of intraoperative antibiotic soaks in reducing surgical site infection rate when using MTF FFCC grafts in rhinoplasty. Methods: A retrospective chart review of patients who underwent rhinoplasty with the use of MTF FFCC in the senior author's practice was conducted between May 2017 and June 2022. The inclusion criteria were rhinoplasty cases using MTF FFCC with minimum of 12 months of follow-up. Fisher exact test was conducted to determine significance in rates of postoperative infection for patients who underwent rhinoplasty with the use of MTF FFCC with (1) intraoperative antibiotic solution soak versus (2) no antibiotic solution soak. Results: A total of 310 patients were included and separated into two cohorts, MTF FFCC intraoperative antibiotic solution soak (n = 200) and no antibiotic solution soak (n = 110). There were a total of four (1.3%) cases of infection, all in the antibiotic soak group. There was no statistically significant difference between the rate of infection in the two cohorts (P = 0.301). Conclusion: Our retrospective cohort study demonstrates that soaking MTF FFCC in an antibiotic solution intraoperatively does not reduce postoperative infection rates in rhinoplasty.

Mastoid Fascia Tissue Graft as a Tip Camouflage Technique in Rhinoplasty: A Reliable Alternative to Soft Cartilage Grafts.

BACKGROUND: Traditional rhinoplasty tip grafts often lead to visibility issues, prompting patients to seek revision surgery. The mastoid fascia tissue graft (MFTG) provides a natural-looking alternative with an acceptable risk of complication. MFTG remains less visible through the skin and helps camouflage and conceal tip irregularities. This study of 193 patients examines MFTG's effectiveness in nasal tip refinement, evaluating revision and infection rates. METHODS: A retrospective analysis of MFTG use for nasal tip aesthetics during open rhinoplasty in the senior author's practice was conducted from January 2019 to June 2022. Inclusion criteria encompassed open rhinoplasty cases using mastoid tissue for tip aesthetics with at least 12 months of follow-up. Among 2003 cases, 193 met these criteria and were evaluated for subsequent revision and infection rates. RESULTS: The average patient age was 34.2 years (175 females, 18 males). Primary rhinoplasties were done on 113 patients, with 80 receiving revision surgeries. Average follow-up was 14.8 months. 6 (3.1%) patients overall needed extended antibiotics, including 1 (0.9%) primary rhinoplasty and 5 (6.3%) secondary rhinoplasty patients. Overall, 6 (3.1%) patients required revision rhinoplasty, comprising of 1 (0.9%) primary and 5 (6.3%) secondary rhinoplasty patients. CONCLUSIONS: MFTG use for nasal tip aesthetics is a safe, convenient, and effective technique in camouflaging and concealing nasal tip contour irregularities in both primary and revision rhinoplasty. Use of MTFG is associated with minimal morbidity.

"Outcomes of the Use of Fresh Frozen Costal Cartilage in Rhinoplasty".

BACKGROUND: Rhinoplasty is made more challenging when there is insufficient septal cartilage for use as graft material. Several autologous and homologous graft options have been used in the past, though each comes with its own set of challenges. Fresh frozen costal cartilage (FFCC) is an increasingly popular alternative that yields the benefits of homologous tissue while having a lower theoretical risk profile. Given the relatively novel nature of this option, this study aims to analyze the complication rates of MTF (Musculoskeletal Transplant Foundation) FFCC. METHODS: A retrospective chart review of the use of FFCC in rhinoplasty in the senior author's practice was conducted between March 2018 to December 2021. 282 cases were reviewed and analyzed for rates of infection, warping, and resorption. The inclusion criteria were cases with a minimum of 12 months of follow-up. RESULTS: The mean age of our study group was 35.8 years old, with 27 males and 255 females. 40 cases were primary rhinoplasties while the remaining 242 were revisions. Mean follow-up period was 20.3 months. Six patients (2.1%) required empiric antibiotics postoperatively, zero patients had clinical signs of warping, resorption, or displacement, and six patients (2.1%) required operative revision unrelated to the FFCC. CONCLUSIONS: This study provides long-term follow up data on the complication profile of FFCC in rhinoplasty. Acute infection, warping, and resorption rates were found to be no greater than rhinoplasty complication rates when autologous or homologous tissue are used. FFCC is a safe, convenient, and patient-centered option for graft tissue in rhinoplasty.

Evaluation of Early Markers of Ischemia-reperfusion Injury and Preservation Solutions in a Modified Hindlimb Model of Vascularized Composite Allotransplantation.

BACKGROUND: Ischemia-reperfusion injury plays an important role in vascularized composite allotransplantation (VCA). Currently, there is no ideal preservation solution for VCA. In this study, we investigated the effects of 4 different preservation solutions on different tissues within an allogeneic hindlimb rat model. METHODS: Sprague Dawley rat hindlimbs were flushed and placed at 4°C for 6 h in heparinized saline, histidine-tryptophan-ketoglutarate, University of Wisconsin (UW), and Perfadex and heterotopically transplanted for ease of ambulation. Apoptosis, necrosis, and the extracellular matrix of the tissues within the allograft were analyzed 2 h posttransplantation using immunohistochemistry, terminal deoxynucleotidyl transferase 2'-deoxyuridine 5'-triphosphate nick-end labeling (TUNEL) assay, and enzyme-linked immunoassay. RESULTS: Higher expression of cleaved caspase 3, a significant increase of high-mobility group box 1 and TUNEL-positive apoptotic cells were observed in the muscle and vessels preserved with heparinized saline compared with UW and Perfadex following reperfusion. Higher expression of TUNEL-positive apoptotic cells was observed in the skin at 12 h of ischemia and in the nerve following reperfusion with histidine-tryptophan-ketoglutarate as a preservation solution. CONCLUSIONS: Our data suggest that UW and Perfadex are preferred solutions in VCA. The vessels within the allografts appear to be very susceptible, with laminins and CD31 playing a role in ischemia-reperfusion injury.

Preservation solutions for attenuation of ischemia-reperfusion injury in vascularized composite allotransplantation.

Vascularized composite allotransplantation represents the final level of the reconstructive ladder, offering treatment options for severe tissue loss and functional deficiencies. Vascularized composite allotransplantation is particularly susceptible to ischemia-reperfusion injury and requires preservation techniques when subjected to extended storage times prior to transplantation. While static cold storage functions to reduce ischemic damage and is widely employed in clinical settings, there exists no consensus on the ideal preservation solution for vascularized composite allotransplantation. This review aims to highlight current clinical and experimental advances in preservation solution development and their critical role in attenuating ischemia-reperfusion injury in the context of vascularized composite allotransplantation.