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AMA Journal of Ethics Apr 2018Facial disfigurement can significantly affect personal identity and access to social roles. Although conventional reconstruction can have positive effects with respect... (Review)
Review
Facial disfigurement can significantly affect personal identity and access to social roles. Although conventional reconstruction can have positive effects with respect to identity, these procedures are often inadequate for more severe facial defects. In these cases, facial transplantation (FT) offers patients a viable reconstructive option. However, FT's effect on personal identity has been less well examined, and ethical questions remain regarding the psychosocial ramifications of the procedure. This article reviews the literature on the different roles of the face as well as psychological and social effects of facial disfigurement. The effects of facial reconstruction on personal identity are also reviewed with an emphasis on orthognathic, cleft, and head and neck surgery. Finally, FT is considered in this context, and future directions for research are explored.
Topics: Body Image; Esthetics; Ethics, Medical; Face; Facial Transplantation; Humans; Self Concept; Transplantation
PubMed: 29671724
DOI: 10.1001/journalofethics.2018.20.4.peer1-1804 -
Cutis Nov 2019Hidradenitis suppurativa (HS) is a common dermatologic condition in which chronic and recurrent inflammation affects the pilosebaceous unit and can lead to permanent... (Review)
Review
Hidradenitis suppurativa (HS) is a common dermatologic condition in which chronic and recurrent inflammation affects the pilosebaceous unit and can lead to permanent disfigurement with scars and sinus tracts. Multimodal individualized treatment typically is required to address the medical, surgical, and psychosocial needs of affected patients. This article discusses several aspects of HS treatment that often are overlooked: educating patients about disease pathophysiology, counseling on smoking cessation, offering laser hair removal, planning for flares, and considering childbearing status.
Topics: Combined Modality Therapy; Hidradenitis Suppurativa; Humans
PubMed: 31886798
DOI: No ID Found -
Seminars in Plastic Surgery Nov 2020Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for... (Review)
Review
Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
PubMed: 33380909
DOI: 10.1055/s-0040-1721760 -
International Journal of Nanomedicine 2024Hypertrophic scars and keloids are common fibroproliferative diseases following injury. Patients with pathologic scars suffer from impaired quality of life and... (Review)
Review
Hypertrophic scars and keloids are common fibroproliferative diseases following injury. Patients with pathologic scars suffer from impaired quality of life and psychological health due to appearance disfiguration, itch, pain, and movement disorders. Recently, the advancement of hydrogels in biomedical fields has brought a variety of novel materials, methods and therapeutic targets for treating hypertrophic scars and keloids, which exhibit broad prospects. This review has summarized current research on hydrogels and loaded components used in preventing and treating hypertrophic scars and keloids. These hydrogels attenuate keloid and hypertrophic scar formation and progression by loading organic chemicals, drugs, or bioactive molecules (such as growth factors, genes, proteins/peptides, and stem cells/exosomes). Among them, smart hydrogels (a very promising method for loading many types of bioactive components) are currently favoured by researchers. In addition, combining hydrogels and current therapy (such as laser or radiation therapy, etc.) could improve the treatment of hypertrophic scars and keloids. Then, the difficulties and limitations of the current research and possible suggestions for improvement are listed. Moreover, we also propose novel strategies for facilitating the construction of target multifunctional hydrogels in the future.
Topics: Humans; Keloid; Cicatrix, Hypertrophic; Hydrogels; Quality of Life; Pruritus
PubMed: 38293605
DOI: 10.2147/IJN.S448667 -
Otolaryngologic Clinics of North America Apr 2016Parotidectomy is a commonly performed procedure for both benign and malignant lesions. When a significant portion of the gland is resected and the lost tissue volume is... (Review)
Review
Parotidectomy is a commonly performed procedure for both benign and malignant lesions. When a significant portion of the gland is resected and the lost tissue volume is not replaced, a disfiguring contour defect can result. This defect can be disfiguring and have a profound impact on quality of life. Large defects are best replaced with vascularized tissue to provide stable volume.
Topics: Humans; Parotid Neoplasms; Quality of Life; Plastic Surgery Procedures; Surgical Flaps
PubMed: 27040588
DOI: 10.1016/j.otc.2015.10.008 -
Journal of the European Academy of... Feb 2015Radiation-induced morphea (RIM) is a rare and under-recognized skin complication of radiotherapy. It is commonly wrongly diagnosed as other dermatological conditions or... (Review)
Review
Radiation-induced morphea (RIM) is a rare and under-recognized skin complication of radiotherapy. It is commonly wrongly diagnosed as other dermatological conditions or malignancy because of similar clinical characteristics. This literature review analyses 66 cases that have been reported in the literature since 1989. The clinical appearance often includes pain and disfiguration of affected area, which may influence the patient's quality of life. There is no clear connection between the radiotherapy dose, the fractionation scheme, the use of a boost, age, the presence of other dermatological conditions or other connective tissue diseases and the occurrence of RIM. Its pathogenesis is still unclear, but several theories are proposed to explain this phenomenon. The available data suggest that the abnormally high secretion of some cytokines (interleukin 4, interleukin 5, transforming growth factor) induced by radiation causes an extensive fibrosis after an activation of fibroblasts. Histological confirmation is crucial in distinguishing RIM from similar-looking diseases, such as chronic radiation dermatitis, cancer recurrence, radiation, recall dermatitis, new carcinoma or cellulitis. There is no clear treatment regimen for this condition. Clinical outcome after therapy is often unsatisfactory. The commonly used methods and agents include: topical and systemic steroids, calcineurin inhibitors, systemic immunosuppressants including methotrexate, tacrolimus, heparin, hyaluronidase, phototherapy (UVA, UVA1, UVB, PUVA), systemic antibiotics, imiquimod, mycophenolate mofetil, photophoresis. The differential diagnosis is challenging and requires a multidisciplinary approach to avoid misdiagnosis and to plan appropriate treatment.
Topics: Female; Humans; Male; Neoplasms; Radiation Pneumonitis; Radiotherapy; Scleroderma, Localized; Skin Diseases
PubMed: 25174551
DOI: 10.1111/jdv.12704 -
Journal of Cutaneous and Aesthetic... 2023Pyogenic granuloma is a benign vascular tumor, with a tendency to bleed on manipulation. A young female presented to us with a disfiguring facial pyogenic granuloma. We...
Pyogenic granuloma is a benign vascular tumor, with a tendency to bleed on manipulation. A young female presented to us with a disfiguring facial pyogenic granuloma. We adopted a novel approach using pressure therapy to treat the same. The use of an elastic adhesive bandage reduced the size and vascularity of the lesion, following which laser ablation was done with minimal bleeding and scarring. This is a simple, inexpensive method to approach large and disfiguring pyogenic granulomas.
PubMed: 37383971
DOI: 10.4103/JCAS.JCAS_97_21 -
Biochimica Et Biophysica Acta Apr 2015Organisms have to be sufficiently robust to environmental and genetic perturbations, yet plastic enough to cope with stressful scenarios to which they are not fully... (Review)
Review
Organisms have to be sufficiently robust to environmental and genetic perturbations, yet plastic enough to cope with stressful scenarios to which they are not fully adapted. How this apparent conflict between robustness and plasticity is resolved at the cellular and whole organism levels is not clear. Here we review and discuss evidence in flies suggesting that the environment can modulate the balance between robustness and plasticity. The outcomes of this modulation can vary from mild sensitizations that are hardly noticeable, to overt qualitative changes in phenotype. The effects could be at both the cellular and whole organism levels and can include cellular de-/trans-differentiation ('Cellular reprogramming') and gross disfigurements such as homeotic transformations ('Tissue/whole organism reprogramming'). When the stress is mild enough, plastic changes in some processes may prevent drastic changes in more robust traits such as cell identity and tissue integrity. However, when the stress is sufficiently severe, this buffering may no longer be able to prevent such overt changes, and the resulting phenotypic variability could be subjected to selection and might assist survival at the population level. This article is part of a Special Issue entitled: Stress as a fundamental theme in cell plasticity.
Topics: Animals; Body Patterning; Cell Dedifferentiation; Diptera; Drosophila; Environment; MicroRNAs; Selection, Genetic; Stress, Physiological
PubMed: 25134463
DOI: 10.1016/j.bbagrm.2014.08.004 -
Frontiers in Bioengineering and... 2020Each year, congenital defects, trauma or cancer often results in considerable physical disfigurement for many people worldwide. This adversely impacts their... (Review)
Review
Each year, congenital defects, trauma or cancer often results in considerable physical disfigurement for many people worldwide. This adversely impacts their psychological, social and economic outlook, leading to poor life experiences and negative health outcomes. In many cases of soft tissue disfigurement, highly personalized prostheses are available to restore both aesthetics and function. As discussed in part A of this review, key to the success of any soft tissue prosthetic is the fundamental properties of the materials. This determines the maximum attainable level of aesthetics, attachment mechanisms, fabrication complexity, cost, and robustness. Since the early-mid 20th century, polymers have completely replaced natural materials in prosthetics, with advances in both material properties and fabrication techniques leading to significantly improved capabilities. In part A, we discussed the history of polymers in prosthetics, their ideal properties, and the application of polymers in prostheses for the ear, nose, eye, breast and finger. We also reviewed the latest developments in advanced manufacturing and 3D printing, including different fabrication technologies and new and upcoming materials. In this review, Part B, we detail the chemistry of the most commonly used synthetic polymers in soft tissue prosthetics; silicone, acrylic resin, vinyl polymer, and polyurethane elastomer. For each polymer, we briefly discuss their history before detailing their chemistry and fabrication processes. We also discuss degradation of the polymer in the context of their application in prosthetics, including time and weathering, the impact of skin secretions, microbial growth and cleaning and disinfecting. Although advanced manufacturing promises new fabrication capabilities using exotic synthetic polymers with programmable material properties, silicones and acrylics remain the most commonly used materials in prosthetics today. As research in this field progresses, development of new variations and fabrication techniques based on these synthetic polymers will lead to even better and more robust soft tissue prosthetics, with improved life-like aesthetics and lower cost manufacturing.
PubMed: 32391336
DOI: 10.3389/fbioe.2020.00147 -
Trauma, Violence & Abuse Apr 2023Violence against women and girls by burning is a serious and confronting form of gender-based violence. Often, perpetrators aim to disfigure their victims or cause great... (Review)
Review
Violence against women and girls by burning is a serious and confronting form of gender-based violence. Often, perpetrators aim to disfigure their victims or cause great pain, rather than kill them. Little is known about the characteristics of females who are subjected to violence by burning. This study aimed to review the literature concerning the prevalence, demographic profile, injury event, contributing factors and health outcomes for women and girls who have experienced burn-related violence. A search across five databases (PubMed, CINAHL, PsycINFO, Scopus and LILACS) was conducted up to April 2021 to identify original peer-review research, with a focus on violence by burning against women and girls. The review was guided by the five-stage approach to integrative reviews developed by Whittemore and Knafl (2005). Fifteen studies were identified. Victims were predominantly married, with low socio-economic status, limited education, and high emotional and financial dependency on their partners or families. Burn injuries were mostly caused by flame or acid, with significant morbidity or high mortality. Motives included family/marital issues or property/financial disputes. This review identified the limited evidence available in the peer-reviewed literature related to burn-related violence against women and girls worldwide. Findings suggest the need for further research to provide a clearer understanding of the complex issues involved.
Topics: Humans; Female; Violence; Prevalence; Gender-Based Violence; Burns
PubMed: 34624204
DOI: 10.1177/15248380211048445