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Journal of Periodontal Research Aug 2016Several clinical trials describe the effectiveness of xenogeneic collagen matrix (XCM) as an alternative option to surgical mucogingival procedures for the treatment of... (Meta-Analysis)
Meta-Analysis Review
Several clinical trials describe the effectiveness of xenogeneic collagen matrix (XCM) as an alternative option to surgical mucogingival procedures for the treatment of marginal tissue recession and augmentation of insufficient zones of keratinized tissue (KT). The aim of this systematic review and meta-analysis was to evaluate the clinical and patient-centred outcomes of XCM compared to other mucogingival procedures. Applying guidelines of the Preferred Reporting Items for Systematic Reviews and Meta analyses statement, randomized controlled trials were searched for in electronic databases and complemented by hand searching. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and data were analysed using statistical software. A total of 645 studies were identified, of which, six trials were included with 487 mucogingival defects in 170 participants. Overall meta-analysis showed that connective tissue graft (CTG) in conjunction with the coronally advanced flap (CAF) had a significantly higher percentage of complete/mean root coverage and mean recession reduction than XCM. Insufficient evidence was found to determine any significant differences in width of KT between XCM and CTG. The XCM had a significantly higher mean root coverage, recession reduction and gain in KT compared to CAF alone. No significant differences in patient's aesthetic satisfaction were found between XCM and CTG, except for postoperative morbidity in favour of XCM. Operating time was significantly reduced with the use of XCM compared with CTG but not with CAF alone. There is no evidence to demonstrate the effectiveness of XCM in achieving greater root coverage, recession reduction and gain in KT compared to CTG plus CAF. Superior short-term results in treating root coverage compared with CAF alone are possible. There is limited evidence that XCM may improve aesthetic satisfaction, reduce postoperative morbidity and shorten the operating time. Further long-term randomized controlled trials are required to endorse the supposed advantages of XCM.
Topics: Collagen Type I; Collagen Type III; Esthetics, Dental; Gingiva; Gingival Recession; Heterografts; Humans; Surgery, Oral; Surgery, Plastic
PubMed: 26547393
DOI: 10.1111/jre.12333 -
Plastic and Reconstructive Surgery Mar 2021In this systematic review, the authors report on the current state of health disparities research in plastic surgery and consider how equity-oriented interventions are...
BACKGROUND
In this systematic review, the authors report on the current state of health disparities research in plastic surgery and consider how equity-oriented interventions are taking shape at the patient, provider, and health care system levels.
METHODS
The authors performed a systematic literature search of the PubMed/MEDLINE and Embase databases using search terms related to the social determinants of both health and plastic surgery. Two independent reviewers screened the article titles and abstracts for relevance and identified the plastic surgery focus and study characteristics of the included literature. The articles were then categorized as detecting, understanding, or reducing health disparities according to a conceptual framework. This review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
RESULTS
One hundred forty-seven articles published between 1997 and 2019 met the inclusion criteria. Health disparities research in gender-affirming, craniofacial, cosmetic, and hand surgery was lacking relative to breast reconstruction. Racial/ethnic and socioeconomic disparities were reported across subspecialties. Place of residence was also a large determinant of access to care and quality of surgical outcomes. Half of the included studies were in the detecting phase of research. Meanwhile, 40 and 10 percent were in the understanding and reducing phases, respectively.
CONCLUSIONS
Investigators suggested several avenues for reducing health disparities in plastic surgery, yet there is limited evidence on the actual effectiveness of equity-oriented initiatives. More comprehensive research is needed to disentangle the patient, provider, and system-level factors that underlie inequity across subspecialties.
Topics: Biomedical Research; Ethnicity; Health Status Disparities; Healthcare Disparities; Humans; Plastic Surgery Procedures; Residence Characteristics; Sex Factors; Social Class; Social Determinants of Health; Surgery, Plastic; United States
PubMed: 33587561
DOI: 10.1097/PRS.0000000000007682 -
Plastic and Reconstructive Surgery Jul 2022As plastic surgeons continue to evaluate the utility of nonopioid analgesic alternatives, nerve block use in breast plastic surgery remains limited and unstandardized,...
BACKGROUND
As plastic surgeons continue to evaluate the utility of nonopioid analgesic alternatives, nerve block use in breast plastic surgery remains limited and unstandardized, with no syntheses of the available evidence to guide consensus on optimal approach.
METHODS
A systematic review was performed to evaluate the role of pectoralis nerve blocks, paravertebral nerve blocks, transversus abdominus plane blocks, and intercostal nerve blocks in flap-based breast reconstruction, prosthetic-based reconstruction, and aesthetic breast plastic surgery, independently.
RESULTS
Thirty-one articles reporting on a total of 2820 patients were included in the final analysis; 1500 patients (53 percent) received nerve blocks, and 1320 (47 percent) served as controls. Outcomes and complications were stratified according to procedures performed, blocks employed, techniques of administration, and anesthetic agents used. Overall, statistically significant reductions in opioid consumption were reported in 91 percent of studies evaluated, postoperative pain in 68 percent, postanesthesia care unit stay in 67 percent, postoperative nausea and vomiting in 53 percent, and duration of hospitalization in 50 percent. Nerve blocks did not significantly alter surgery and/or anesthesia time in 83 percent of studies assessed, whereas the overall, pooled complication rate was 1.6 percent.
CONCLUSIONS
Transversus abdominus plane blocks provided excellent outcomes in autologous breast reconstruction, whereas both paravertebral nerve blocks and pectoralis nerve blocks demonstrated notable efficacy and versatility in an array of reconstructive and aesthetic procedures. Ultrasound guidance may minimize block-related complications, whereas the efficacy of adjunctive postoperative infusions was proven to be limited. As newer anesthetic agents and adjuvants continue to emerge, nerve blocks are set to represent essential components of the multimodal analgesic approach in breast plastic surgery.
Topics: Analgesics, Opioid; Humans; Mammaplasty; Nerve Block; Pain, Postoperative; Postoperative Nausea and Vomiting; Surgery, Plastic
PubMed: 35499513
DOI: 10.1097/PRS.0000000000009253 -
Aesthetic Surgery Journal Jun 2022Obesity is a potential risk factor for complications in plastic surgeries. However, the data presented by primary studies are contradictory. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obesity is a potential risk factor for complications in plastic surgeries. However, the data presented by primary studies are contradictory.
OBJECTIVES
The aim of this study was to summarize and clarify the divergences in the literature to provide a better understanding of the impact of obesity in different plastic surgery procedures.
METHODS
We conducted a systematic review and meta-analysis of the impact of obesity on plastic surgery outcomes. Searches were conducted in MEDLINE, LILACS, SciELO, Scopus, Embase, Web of Science, Opengrey.eu, and the Cochrane Database of Systematic Reviews. The primary outcomes assessed were surgical complications, medical complications, and reoperation rates. The secondary outcome assessed was patient satisfaction. Subgroup analysis was performed to investigate the impact of each BMI category on the outcomes.
RESULTS
Ninety-three articles were included in the qualitative synthesis, and 91 were used in the meta-analysis. Obese participants were 1.62 times more likely to present any of the primary outcomes (95% CI, 1.48-1.77; P < 0.00001). The highest increase in risk among plastic surgery types was observed in cosmetic procedures (risk ratio [RR], 1.80; 95% CI, 1.43-2.32; P < 0.00001). Compared with normal-weight participants, overweight participants presented a significantly increased RR for complications (RR, 1.16; 95% CI, 1.07-1.27; P = 0.0004). Most authors found no relation between BMI and overall patient satisfaction.
CONCLUSIONS
Obesity leads to more complications and greater incidence of reoperation compared with nonobese patients undergoing plastic surgeries. However, this effect is not evident in reconstructive surgeries in areas of the body other than the breast.
Topics: Humans; Obesity; Overweight; Plastic Surgery Procedures; Reoperation; Surgery, Plastic
PubMed: 35037936
DOI: 10.1093/asj/sjab397 -
Annals of Plastic Surgery Jun 2017Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine.... (Review)
Review
BACKGROUND
Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field.
METHODS
A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice.
RESULTS
A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise.
CONCLUSIONS
Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use by patients, referring physicians, and consulting dermatologists. Teledermatology has also been used as an educational tool for patients. A significant number of studies detailed strategies to improve the current state of teledermatology, either by implementing new programs or improving technologies. Telemedicine use is widespread among plastic surgeons and is enabling the spread of expertise beyond major medical centers. Further research is needed to conclusively demonstrate benefit in routine clinical care.
Topics: Dermatology; Humans; Plastic Surgery Procedures; Surgery, Plastic; Telemedicine
PubMed: 28328635
DOI: 10.1097/SAP.0000000000001044 -
Plastic and Reconstructive Surgery Dec 2014Fat necrosis is a well-known complication of free tissue transfer and fat grafting that is becoming increasingly reported in the literature. However, there is no clear... (Review)
Review
BACKGROUND
Fat necrosis is a well-known complication of free tissue transfer and fat grafting that is becoming increasingly reported in the literature. However, there is no clear consensus on how fat necrosis is defined and classified in the plastic surgery literature.
METHODS
A systematic review of the literature was performed using the PubMed database of the National Library of Medicine and National Institutes of Health and Google Scholar from January 1, 2003, to November 1, 2013. The keywords used in the search included "fat necrosis" and "plastic surgery."
RESULTS
Sixty-nine articles were chosen that met the authors' criteria and were included in this review. There was wide variation on the size requirements and postoperative timing when defining fat necrosis. In addition, the workup sought after clinical examination to confirm a diagnosis of fat necrosis varied, including radiographic studies, histopathologic examination, or a series of studies.
CONCLUSIONS
Based on the articles reviewed in this article, a more uniform definition needs to exist that is clearly defined in all articles that report on fat necrosis. The authors suggest defining fat necrosis as a palpable, discrete, and persistent subcutaneous firmness found postoperatively that measures at least 1 cm during physical examination. Fat necrosis can be identified and confirmed by imaging and histopathology or through intraoperative findings. The authors provide a classification system for fat necrosis that can be used by clinicians to describe fat necrosis into varying grades of severity to ultimately help guide clinical decision-making.
Topics: Fat Necrosis; Humans; Postoperative Complications; Plastic Surgery Procedures
PubMed: 25415090
DOI: 10.1097/PRS.0000000000000700 -
Annals of Plastic Surgery Sep 2022Subsurface radiofrequency (RF) treatments produce skin contraction by causing coagulation of the underlying subcutaneous fat. This method is marketed to fill a treatment...
BACKGROUND
Subsurface radiofrequency (RF) treatments produce skin contraction by causing coagulation of the underlying subcutaneous fat. This method is marketed to fill a treatment gap for patients who do not wish to have surgery. A systematic review of this subject has not been previously published.
METHODS
An electronic search was performed using PubMed to identify the literature describing subsurface RF treatments.
RESULTS
Thirty articles were evaluated. An InMode device was used in 23 studies, and a Thermi device was used in 6 studies, with or without liposuction. Treatment areas included the face, neck, body, breasts, and labia. Most studies relied on patient satisfaction scores and physician review of photographs. The most frequent complications were induration and nodules. Most patients experienced prolonged swelling and numbness. Several studies reported marginal mandibular neuropraxias. The skin response after treatment of the abdomen was poor, and seromas were common. The incidence of burns improved after modification of the InMode device. Breast treatment did not appear to be effective in treating ptosis. Patient satisfaction scores were modest. Most studies (77%) were published by authors with a known conflict of interest. In some studies, the photographs did not accurately depict the treatment result. Institutional review board approval and disclosure of off-label regulatory status were often missing.
DISCUSSION
Thermal treatment of the subcutaneous tissue introduces extra risks without a compensatory benefit. Comparisons in terms of safety, cost, recovery time, results, and complications do not favor energy-based devices. A treatment gap may be fictitious; properly informed patients may be treated with existing surgical procedures at all ages.
CONCLUSIONS
Little evidence supports the efficacy and safety of subcutaneous RF treatments as an improvement over results that may be obtained using traditional surgical methods such as submental lipectomy, liposuction, and abdominoplasty. Photographic integrity is often lacking. Financial conflict of interest is pervasive. Marketing precedes the science. Plastic surgeons need to be aware of these serious limitations and the off-label regulatory status of these devices, before purchasing expensive equipment and recommending subsurface RF treatments to patients.
Topics: Abdominoplasty; Humans; Lipectomy; Radiofrequency Ablation; Subcutaneous Fat; Surgery, Plastic; Treatment Outcome
PubMed: 35081544
DOI: 10.1097/SAP.0000000000003093 -
Facial Plastic Surgery : FPS Jan 2024Artificial intelligence (AI) is a technology that is evolving rapidly and is changing the world and medicine as we know it. After reviewing the PROSPERO database of...
Artificial intelligence (AI) is a technology that is evolving rapidly and is changing the world and medicine as we know it. After reviewing the PROSPERO database of systematic reviews, there is no article related to this topic in facial plastic and reconstructive surgery. The objective of this article was to review the literature regarding AI applications in facial plastic and reconstructive surgery.A systematic review of the literature about AI in facial plastic and reconstructive surgery using the following keywords: Artificial Intelligence, robotics, plastic surgery procedures, and surgery plastic and the following databases: PubMed, SCOPUS, Embase, BVS, and LILACS. The inclusion criteria were articles about AI in facial plastic and reconstructive surgery. Articles written in a language other than English and Spanish were excluded. In total, 17 articles about AI in facial plastic met the inclusion criteria; after eliminating the duplicated papers and applying the exclusion criteria, these articles were reviewed thoroughly. The leading type of AI used in these articles was computer vision, explicitly using models of convolutional neural networks to objectively compare the preoperative with the postoperative state in multiple interventions such as facial lifting and facial transgender surgery.In conclusion, AI is a rapidly evolving technology, and it could significantly impact the treatment of patients in facial plastic and reconstructive surgery. Legislation and regulations are developing slower than this technology. It is imperative to learn about this topic as soon as possible and that all stakeholders proactively promote discussions about ethical and regulatory dilemmas.
PubMed: 37992752
DOI: 10.1055/a-2216-5099 -
Plastic and Reconstructive Surgery.... Mar 2021Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall...
BACKGROUND
Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall survival. Several interventions have been found to successfully reduce surgical bleeding, including the antifibrinolytic agent. After aprotinin was withdrawn from the market in 2008, TXA remained the most commonly used medication. The safety and efficacy of TXA has been well studied in other specialties. TXA has been rarely used in plastic surgery, except in craniofacial procedures. Since the last review, the number of articles examining the use of TXA has doubled; so the aim of this systematic review is to update the readers on the current knowledge and clinical recommendations regarding the efficacy of TXA in plastic surgical procedures.
METHODS
A systematic literature search was conducted in Medline, SciELO, Cochrane, and Google Scholar to evaluate all articles that discussed the use of TXA in plastic surgery in the fields of aesthetic surgery, burn care, and reconstructive microsurgery.
RESULTS
A total of 233 publications were identified using the search criteria defined above. After examination of titles and abstracts, and exclusion of duplicates, a total of 23 articles were selected for analysis.
CONCLUSIONS
The literature shows a clear benefit of using TXA to decrease blood loss regardless of the administration route, with no risk of thrombosis events. Also, TXA elicits a potent anti-inflammatory response with a decrease in postoperative edema and ecchymosis, which improves recovery time. Further investigations are needed to standardize the optimal administration route and dosage of TXA.
PubMed: 33907653
DOI: 10.1097/GOX.0000000000003172 -
Annals of Plastic Surgery Sep 2020Surgical learning curves reflect the trainee's rate of progress in gaining skills and competence for new procedures. Complex interventions such as free tissue transfers,...
BACKGROUND
Surgical learning curves reflect the trainee's rate of progress in gaining skills and competence for new procedures. Complex interventions such as free tissue transfers, with various linked skills and competences, transferred to one procedure are likely to have steep learning curves. This work aimed to report influence of learning curves on outcomes such as success rate, operative time, and complication rates in plastic surgery procedures.
METHODS
The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic database literature search (PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trails) was performed. Articles were included when reporting effects of learning curves on outcomes in plastic surgery procedures.
RESULTS
Twenty-nine articles focusing on learning curves in plastic surgery procedures were included. Studies reported on non-free flap breast reconstruction, mastectomy, and free flap reconstruction in general and for breast reconstruction and did not allow for pooling of the data because of heterogeneity. Most common outcomes for measuring improvements were success rate, operation time, and complication rate, which demonstrated improvements in almost all studies. Plateaus were reached in 45 to 100 cases for breast reconstructions and were not reported for other procedures. Only 2 studies did not find associations between surgical experience and clinical outcomes.
CONCLUSIONS
There are sparse data on learning curves in plastic surgery. Existing studies draw a heterogeneous picture, but especially free flap breast reconstructions seem to undergo learning curves with improvements in operative time, complication rates, and success rates. However, well-designed studies with clearly defined outcomes and comparison between surgeons of different levels over time should be performed.Systematic review registration: PROSPERO: CRD42018108634.
Topics: Breast Neoplasms; Humans; Learning Curve; Mammaplasty; Mastectomy; Surgeons
PubMed: 31913887
DOI: 10.1097/SAP.0000000000002211