What comes first: teeth or face? Recommendations for an interdisciplinary collaboration between facial esthetic surgery and dentistry.

OBJECTIVE: The aim of the present study was to provide recommendations in order to facilitate communication between dental professionals and surgeons who are collaborating in the field of dentofacial esthetics. CLINICAL CONSIDERATIONS: Smile esthetics are beyond the scope, both of the surgeons who are collaborating with facial esthetics and of the dentists, as a wide range of treatment options from both sides is available. It can be difficult for the surgeon or the dentist that first comes in contact with the patient to conduct an individualized global treatment plan, in order to find out how the various phases of the treatment can be sequenced, as a workflow for an efficient interaction between facial surgery and dentistry still does not exist in the scientific literature. CONCLUSIONS: Facial cosmetic procedures and dental treatment have to be planned as individual elements of the whole dentofacial esthetic rehabilitation. The treatment has to be initiated with the design of the smile and the intraoral mock-up, followed by the required surgical interventions, and to be finished with the delivery of the definitive dental restoration. CLINICAL SIGNIFICANCE: Dentofacial esthetics require comprehensive communication between surgeons and dentists. Following the proposed recommendations, an individualized interdisciplinary treatment plan can be conducted, defining the role of each specialty.

The Edmonton Obesity Staging System Predicts Postoperative Complications After Abdominoplasty.

BACKGROUND: This study investigates the relationship between Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after abdominoplasty in massive weight loss patients. METHODS: A single-institution retrospective review of patients undergoing abdominoplasty between 2009 and 2019 after massive weight loss. Demographic data, laboratory findings, known risk factors for postoperative complications, as well as data on major and minor complications were extracted from the patient charts. Logistic regression models were used to investigate the relationship between the variables. RESULTS: Four hundred and five patients were included in the study. The prevalence of EOSS stages was: 0 (no comorbidities, N = 151, 37%), 1 (mild conditions, N = 40, 10%), 2 (moderate conditions, N = 149, 36%) and 3 (severe conditions, N = 70, 17%). Regression analysis showed that, controlling for body mass index (BMI), BMI Δ (maximal BMI - BMI at presentation), bariatric surgery, volume of resected tissue, and duration of surgery, EOSS stage significantly associated with the occurrence of postoperative complications. Compared with EOSS stage 0, EOSS stages 2 and 3 patients were associated with significantly more minor and major complications, respectively. The volume of resected tissue, BMI Δ, and age were associated with the occurrence of major complications. A regression model of comorbidities comprising the EOSS revealed a significant association of variables diabetes mellitus and hypertension with the occurrence of postoperative complications. CONCLUSIONS: Edmonton Obesity Staging System is a robust predictor of postoperative complications in abdominoplasty.

Improved accuracy of breast volume calculation from 3D surface imaging data using statistical shape models.

BACKGROUND: Three-dimensional (3D) scanning is an established method of breast volume estimation. However, this method can never be entirely precise, since the thoracic wall cannot be imaged by the surface scanner. Current methods rely on interpolation of the posterior breast border from the surrounding thoracic wall. Here, we present a novel method to calculate the posterior border and increase the accuracy of the measurement. METHODS: Using principal component analysis, computed tomography images were used to build a statistical shape model (SSM) of the thoracic wall. The model was fitted to 3D images and the missing thoracic wall curvature interpolated (indirect volumetry). The calculations were evaluated by ordinary least squares regression between the preoperative and postoperative volume differences and the resection weights in breast reduction surgery (N = 36). Also, an SSM of the breast was developed, allowing direct volumetry. Magnetic-resonance images (MRI) and 3D scans were acquired from 5 patients in order to validate the direct 3D volumetry. RESULTS: Volumetry based on a SSM exhibited a higher determination coefficient (R2 = 0,737) than the interpolation method (R2 = 0,404). The methods were not equivalent (p = 0.75), suggesting that the methods significantly differ. There was no influence of BMI on the correlation in either method. The MRI volumetry had a strong correlation with the 3D volumetry (R2 = 0,978). CONCLUSION: The SSM-based method of posterior breast border calculation is reliable and superior to the currently used method of interpolation. It should serve as a basis of software applications aiming at calculation of breast volume from 3D surface scanning data.

Volar dislocation of the triquetrum - case report and review of literature.

In contrast to triquetral fractures, dislocations of the triquetrum are very uncommon because of the very strong ligamentous support. They occasionally occur in association with complex wrist injuries, isolated dislocations however are extremely rare. We report a case of a male athlete who sustained an isolated volar dislocation of the triquetrum. The injury was treated by open reduction, fixation with Kirschner-wires and direct repair of torn ligaments. Kirschner-wires were removed after 6 weeks and physiotherapy was started. At 3 years follow-up he reported to be free of pain and showed only slightly restricted grip strength and range of motion when compared to his uninjured hand. A review of the literature indicates that final outcomes are usually satisfactory if prompt diagnosis and treatment occurs. However persistent pain and impaired hand function may result because of delayed diagnosis or insufficient repair of associated ligament injuries.

Case of combined thenar and hypothenar hammer syndrome: case report and brief review of the literature.

Acute or chronic arterial thrombose due to repetitive blunt trauma to the palm of the hand is a rare occupational vascular disease. In most of the cases it affects the ulnar artery and its superficial palmar branch. Repetitive crush is pathogenic and the unique anatomy of the superficial branch of the ulnar artery lying next to the hook of hamate is causative. In rare cases it may affect the superficial palmar branch of the radial artery, called thenar hammer syndrome. The combination of both is an absolute rarity. Both syndromes are occupational diseases in workers using the hand as a hammer. Patients typically present with Raynaud phenomenon or complain about ischemic pain, cold intolerance, or cyanosis. The gold standard in diagnosis is the angiography. Surgical or conservative treatment can be performed successfully. We present a case of combined thenar and hypothenar hammer and a brief review of the literature.

The use of the anterolateral thigh flap for microsurgical reconstruction of distal extremities after oncosurgical resection of soft-tissue sarcomas.

Prior to the advent of a multidisciplinary approach to the treatment of soft-tissue sarcomas, surgical treatment consisted of extremity amputation. Advances in treatment modalities such as radiotherapy allowed more limited resections with similar survival rates. As local control is the primary objective in the management of these neoplasms, distally located tumours pose a particular reconstructive challenge. Limb preservation is now possible due to the availability of microsurgical techniques. A retrospective analysis was conducted assessing the suitability of the free anterolateral thigh (ALT) flap for distal-extremity reconstruction after wide local excision of sarcomas. Nine patients were included in the study with a median follow-up period of 36 months. In all patients, tumours were located at or distal to the elbow and knee, respectively. All flaps survived. In one patient, the ALT donor site was addressed with a split-thickness skin graft after wound dehiscence was observed postoperatively after initial primary closure. The free ALT perforator flap is an ideal flap for the reconstruction of distal-extremity defects after sarcoma resection as it allows coverage of large skin defects with minimal donor-site morbidity. Its thinness addresses the shallow defects typically encountered in the distal extremity and thus avoids the bulkiness encountered after reconstruction with musculocutaneous flaps.

Reconstruction of distal phalangeal injuries with the reverse homodigital island flap.

Reconstruction of extensive distal phalangeal defects with exposure of tendon, bone, or joint can be particularly a difficult problem. For assessment of the value of the reverse homodigital island flap patients with distal phalangeal avulsion and crush injuries who were treated from January 2005 to April 2006 were analysed retrospectively. Main outcome measurements included flap survival rate, sensory restoration, occurrence of cold intolerance, length of occupational disability, and joint mobility. Eleven patients were included in the study. Only one patient suffered from venous congestion with partial flap necrosis, requiring debridement with subsequent skin grafting. The minimum follow-up was 6 months. The static 2-point discrimination had a mean value of 9 mm. None of our patients complained of cold intolerance or residual joint contracture. All patients returned to full occupational activity within an average time period of 4.5 weeks. In conclusion, the reverse homodigital island flap is an excellent option for 1-stage reconstruction of distal phalangeal defects.