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Aesthetic Plastic Surgery Dec 2023While autologous fat grafting of the face is considered a generally safe procedure, severe complications such as arterial embolism (AE) have been reported. (Review)
Review
BACKGROUND
While autologous fat grafting of the face is considered a generally safe procedure, severe complications such as arterial embolism (AE) have been reported.
OBJECTIVE
To summarize data on injection-related visual compromise, stroke, and death caused by arterial embolism after facial fat transplantation.
MATERIALS AND METHODS
Plastic surgery societies were contacted for reports on AE after autologous facial fat injection. In addition, a systematic literature review was performed. Data extracted included study design, injection site/technique, symptoms, management, outcome, and etiology.
RESULTS
61 patients with a mean age of 33.56 ± 11.45 years were reported. Injections targeted the glabella or multiple facial regions (both n = 16/61, 26.2%) most commonly, followed by injections in the temples (n = 10/61, 16.4%) and the forehead (n = 9/61, 14.8%). The mean volume injected was 21.5 ± 21.5 ml. Visual symptoms were described most frequently (n = 24/58, 41.4%) followed by neurological symptoms (n = 20/58, 34.5%), or both (n = 13/58, 22.4%). Ophthalmic artery (OA, n = 26/60, 43.3%), anterior or middle cerebral artery (CA, n = 11/60, 18.3%) or both (n = 14/60, 23.3%) were most frequently occluded. Outcome analysis revealed permanent vision loss in all patients with OA occlusion (n = 26/26, 100%), neurological impairment in most patients with CA occlusion (n = 8/10, 80%), and vision loss in most patients suffering from both OA and CA occlusion (n = 7/11, 63.6%). Six patients died following embolisms.
CONCLUSIONS
AE causes severe complications such as blindness, stroke, and death. Due to a lack of high-quality data, no evidence-based treatment algorithms exist. To increase patient safety, a database collecting cases and complications should be established.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Adult; Humans; Middle Aged; Young Adult; Adipose Tissue; Blindness; Embolism; Face; Forehead; Retrospective Studies; Stroke; Treatment Outcome; Tissue Transplantation
PubMed: 37563433
DOI: 10.1007/s00266-023-03511-y -
The Cochrane Database of Systematic... Apr 2015Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach. A systematic review was required to guide clinical practice.
OBJECTIVES
To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity.
SEARCH METHODS
For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 4th March 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid MEDLINE (2012 to 3rd March 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 2012 to 3rd March 2015); Ovid EMBASE (2012 to 3rd March 2015); and EBSCO CINAHL (2012 to 4th March 2015).
SELECTION CRITERIA
Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery. Ring drapes were excluded.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information.
MAIN RESULTS
We identified no new studies for this fourth update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.06 to 1.66, P = 0.89). Length of hospital stay was similar in the adhesive drape and non-adhesive drape groups.
AUTHORS' CONCLUSIONS
There was no evidence from the seven trials that plastic adhesive drapes reduce surgical site infection rates, and some evidence that they increase infection rates. Further trials may be justified, using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection, based on different wound classifications.
Topics: Adhesives; Humans; Iodine; Length of Stay; Plastics; Randomized Controlled Trials as Topic; Surgical Drapes; Surgical Wound Infection
PubMed: 25901509
DOI: 10.1002/14651858.CD006353.pub4 -
A Systematic Review and Meta-Analysis of Rhinoplasty Using the Rhinoplasty Outcome Evaluation Scale.Annals of Maxillofacial Surgery 2022The purpose was to evaluate the role and impact of the rhinoplasty outcome evaluation (ROE) in rhinoplasty. (Review)
Review
BACKGROUND
The purpose was to evaluate the role and impact of the rhinoplasty outcome evaluation (ROE) in rhinoplasty.
OBJECTIVES
To systematically review the ability of ROE to assess rhinoplasty outcome in the very recent surgical approaches.
DATA SOURCES
Searching MESH terms "rhinoplasty" and "rhinoplasty and ROE" on PubMed, Scopus, Embase, Google Scholar, and other major literature databases.
STUDY ELIGIBILITY CRITERIA
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses model was adopted for eligibility criteria.
PARTICIPANTS AND INTERVENTIONS
A first large screening on 1,660 papers allowed the final retrieval of 896 reports, of which only 101 were eligible for all the inclusion criteria, which allowed finally to select a group of 12 reports published in the time range 2018-2021.
STUDY APPRAISAL AND SYNTHESIS METHODS
Meta-regression with Durbin-Watson test, checking of meta-analysis bias with Rosenthal's estimator, and heterogeneity through the statistics were performed. The analysis included a Mantel-Haenszel test and associated or meta-analysis.
RESULTS
Twelve eligible and qualified papers were included in the meta-analysis, out of 1,263 patients, from 1,660 papers. ROE confirmed previous reports about its ability to discriminate preoperative from postoperative outcome (50/100), as from the different rhinoplasty approaches, a value very close to the functional Nasal Obstruction Symptom Evaluation scale. This study strengthens the role of ROE in the evaluation of rhinoplasty outcomes encouraging further research to improve ROE scale on different cultural habits and geographical areas.
LIMITATIONS
The main limitations were due to the weak inclusion and exclusion criteria, methodological flaws with the statistical analysis, and poor data synthesis and evaluation in many papers about ROE.
PubMed: 36199467
DOI: 10.4103/ams.ams_244_21 -
Oxidative Medicine and Cellular... 2022Scarring, which develops due to fibroblast activation and excessive extracellular matrix deposition, can cause physical, psychological, and cosmetic problems.... (Review)
Review
Scarring, which develops due to fibroblast activation and excessive extracellular matrix deposition, can cause physical, psychological, and cosmetic problems. Fibroblasts are the main type of connective tissue cells and play important roles in wound healing. However, the underlying mechanisms of fibroblast in reaching scarless wound healing require more exploration. Herein, we systematically reviewed how fibroblasts behave in response to skin injuries, as well as their functions in regeneration and scar formation. Several biocompatible materials, including hydrogels and nanoparticles, were also suggested. Moreover, factors that concern transformation from fibroblasts into cancer-associated fibroblasts are mentioned due to a tight association between scar formation and primary skin cancers. These findings will help us better understand skin fibrotic pathogenesis, as well as provide potential targets for scarless wound healing therapies.
Topics: Biology; Cicatrix; Fibroblasts; Humans; Skin; Wound Healing
PubMed: 35602101
DOI: 10.1155/2022/4586569 -
International Journal of Surgery... Dec 2014The purpose of this study was to investigate the use of antibiotic prophylaxis for plastic surgical procedures at our hospital, and to perform a systematic literature... (Review)
Review
The purpose of this study was to investigate the use of antibiotic prophylaxis for plastic surgical procedures at our hospital, and to perform a systematic literature review of randomized controlled trials evaluating the use of prophylactic antibiotics in plastic surgery. The records of patients who received plastic surgical procedures with Class I surgical incisions between 2009 and 2010 were retrospectively reviewed. A systematic literature review was conducted for studies examining the use of prophylactic antibiotics for Class I surgical wounds. A total of 13,997 cases with Class I surgical incisions were included. Prophylactic antibiotics were given in 13,865 cases (99.1%). The antibiotics used were primarily cefuroxime, clindamycin, metronidazole, cefoxitin sodium, and gentamicin. The average duration of administration was 4.84 ± 3.07 (range, 1-51) days. Antibiotics were administered postoperatively in >99% of cases while preoperative antibiotic administration was only given in 32 cases (0.23%). Wound infections occurred in 21 cases for an overall infection rate of 0.15%. Fourteen studies met the inclusion criteria of the systematic review. There was marked variation in the timing of antibiotic administration with antibiotics given pre-, peri-, and postoperatively. Of studies that compared the use of prophylactic antibiotics with placebo, a reduction in wound infections was noted in 4 trials and no difference was noted in 6 trials. No significant difference in infection rates was shown between the prophylactic and postoperative arms. In conclusion, prophylactic antibiotics are overused in plastic surgical procedures. Evidence-based guidelines for the use of prophylactic antibiotics in plastic surgical procedures are needed.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefoxitin; Cefuroxime; China; Clindamycin; Female; Gentamicins; Humans; Male; Metronidazole; Middle Aged; Plastic Surgery Procedures; Retrospective Studies; Surgery, Plastic
PubMed: 25448649
DOI: 10.1016/j.ijsu.2014.10.029 -
Plastic and Reconstructive Surgery Apr 2016Nonsteroidal antiinflammatory drugs such as ibuprofen are common medications with multiple useful effects, including pain relief and reduction of inflammation. However,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nonsteroidal antiinflammatory drugs such as ibuprofen are common medications with multiple useful effects, including pain relief and reduction of inflammation. However, surgeons commonly withhold all nonsteroidal antiinflammatory drugs perioperatively because of bleeding concerns. However, not all nonsteroidal antiinflammatory drugs irreversibly block platelet function. The authors hypothesized that the use of ibuprofen would have no effect on postoperative bleeding in plastic surgery patients.
METHODS
A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for primary research articles on ibuprofen and bleeding. Inclusion criteria were primary journal articles examining treatment of acute postoperative pain based on any modality. Data related to pain assessment, postoperative recovery, and complications were extracted. Bias assessment and meta-analysis were performed.
RESULTS
A total of 881 publications were reviewed. Four primary randomized controlled trials were selected for full analysis. Articles were of high quality by bias assessment. No significant difference was noted regarding bleeding events (p = 0.32), and pain control was noted to be equivalent.
CONCLUSIONS
Ibuprofen is a useful medication in the setting of surgery, with multiple beneficial effects. This meta-analysis represents a small set of high-quality studies suggesting that ibuprofen provides pain control equivalent to narcotics. Importantly, ibuprofen was not associated with an increased risk of bleeding. Further large studies will be necessary to elucidate this issue further, but ibuprofen is a safe postoperative analgesic in patients undergoing common plastic surgery soft-tissue procedures.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, II.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Humans; Ibuprofen; Models, Statistical; Pain, Postoperative; Postoperative Hemorrhage; Plastic Surgery Procedures
PubMed: 27018685
DOI: 10.1097/PRS.0000000000002027 -
JPRAS Open Jun 2024Plastic, reconstructive and aesthetic surgery (PRAS) is a significant yet often overlooked specialty in medical school curricula. The impact of social media and... (Review)
Review
INTRODUCTION
Plastic, reconstructive and aesthetic surgery (PRAS) is a significant yet often overlooked specialty in medical school curricula. The impact of social media and unregulated information sources can distort the perceptions of medical specialties, including PRAS, leading to a decline in student interest, inappropriate referrals and strain on healthcare services. This systematic review aimed to understand the perceptions of medical students towards PRAS, identify influencing factors and explore strategies to address these influences.
METHODS
The review followed the PRISMA 2020 guidelines. Four databases were searched, and the inclusion and exclusion criteria were applied. Data from 17 relevant studies were analysed in Microsoft Excel using descriptive statistics. The risk of bias was assessed using a modified Newcastle-Ottawa Scale.
RESULTS
Medical students generally held positive perceptions about PRAS, particularly regarding career opportunities, specialised skills and the nature of the specialty. However, their awareness of the full scope of plastic surgery is limited, with a focus on cosmetic and aesthetic procedures. Social media and the internet significantly influenced the students' perceptions, whereas personal experiences had a minor impact. Education and training in plastic surgery positively affected the students' perceptions. Nevertheless, there is a need for improved representation of PRAS in medical school curricula and promotion of accurate information through reliable sources.
CONCLUSION
Students exhibited a favourable attitude towards plastic surgery, but their knowledge of the specialty can be enhanced. Strengthening PRAS teaching in medical schools and ensuring accurate information dissemination can foster a deeper understanding and interest in this field. Large-scale studies with standardised protocols should be conducted in different countries to gain comprehensive insights tailored to specific educational contexts.
PubMed: 38726047
DOI: 10.1016/j.jpra.2024.04.003 -
Annals of the Royal College of Surgeons... Feb 2024Plastic surgery is an important specialty that involves widespread medical knowledge, some of which is taught in undergraduate curricula. The General Medical Council...
INTRODUCTION
Plastic surgery is an important specialty that involves widespread medical knowledge, some of which is taught in undergraduate curricula. The General Medical Council provides a well-defined plastic surgery curriculum for postgraduate training. However, there is no consensus on the provision for undergraduates in this specialty, potentially giving rise to a deficit in undergraduate medical education and a suboptimal basis for plastic surgery postgraduate training. Our aim was to identify the gap in undergraduate plastic surgery teaching and to understand student perceptions of the specialty as well as any trialled interventions.
METHODS
A prospectively registered systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE, Embase™, PubMed and Google Scholar™ databases were searched for literature relating to undergraduate exposure to plastic surgery and relevant teaching interventions. Ten studies were included in this review, categorised into three main themes: exposure during medical school, determining factors and perceptions for pursuing a plastic surgery career, and teaching interventions.
RESULTS
Surveys assessing medical student perceptions indicate a significant deficit in exposure to plastic surgery in the undergraduate curriculum. Medical students' interest in the specialty is affected by multiple factors, including the amount of surgical exposure in medical school. Interventions to address the deficit mostly involve one-day courses.
CONCLUSIONS
Although the literature is currently limited, studies are needed to effectively assess the outcomes of plastic surgery teaching methods in undergraduate training. Moreover, there is a need for consensus around the provision of undergraduate teaching in plastic surgery. This should be reflected in the latest undergraduate curricula in medical education.
PubMed: 38362746
DOI: 10.1308/rcsann.2023.0099 -
Plastic and Reconstructive Surgery.... Sep 2016Quality of life (QoL) is an important outcome in plastic surgery. However, authors use different scales to address this subject, making it difficult to compare the...
UNLABELLED
Quality of life (QoL) is an important outcome in plastic surgery. However, authors use different scales to address this subject, making it difficult to compare the outcomes. To address this discrepancy, the aim of this study was to perform a systematic review and a random effect meta-analysis.
METHODS
The search was made in two electronic databases (LILACS and PUBMED) using Mesh and non-Mesh terms related to aesthetic plastic surgery and QoL. We performed qualitative and quantitative analyses of the gathered data. We calculated a random effect meta-analysis with Der Simonian and Laird as variance estimator to compare pre- and postoperative QoL standardized mean difference. To check if there is difference between aesthetic surgeries, we compared reduction mammoplasty to other aesthetic surgeries.
RESULTS
Of 1,715 identified, 20 studies were included in the qualitative analysis and 16 went through quantitative analysis. The random effect of all aesthetic surgeries shows that QoL improved after surgery. Reduction mammoplasty has improved QoL more than other procedures in social functioning and physical functioning domains.
CONCLUSIONS
Aesthetic plastic surgery increases QoL. Reduction mammoplasty seems to have better improvement compared with other aesthetic surgeries.
PubMed: 27757327
DOI: 10.1097/GOX.0000000000000833 -
JPRAS Open Mar 2019The objective of this study was to evaluate the safety and efficacy of fat grafting to the facial region for the reconstruction and aesthetic enhancement of facial... (Review)
Review
INTRODUCTION
The objective of this study was to evaluate the safety and efficacy of fat grafting to the facial region for the reconstruction and aesthetic enhancement of facial contour.
METHODS
A systematic literature review of the National Library of Medicine (PubMed), MEDLINE and Cochrane databases was performed. Studies involving the outcomes of autologous fat grafting to correct or enhance contour defects of the face were included. Extracted data included patient demographics, harvest and injection sites, graft harvesting and injection technique, mean injected volume, retained volume percentage and complications.
RESULTS
Forty-three articles met the inclusion criteria, resulting in 4577 patients with various facial contour defects treated with autologous fat grafting. Injection sites were categorized by anatomic facial regions as upper (32.5%), middle (53%) and lower face (14.5%). The mean volume of injected fat was 16.9 ml. The mean weighted volume retention of non-enriched grafts was 41.63% at the time of follow up (mean 13.9 months). A total of 104 (2.27%) complications were reported including asymmetry (74), skin irregularities (14), prolonged edema (4), graft hypertrophy (4), fat necrosis (3), infection (2), erythema (1), telangiectasia (1), and activation of acne (1).
CONCLUSION
The present study represents the first systematic review of fat grafting in the facial region, a widely-performed procedure within plastic surgery practice. Importantly, it presents pooled important data such as retained grafting volume and complication rates in this anatomical region, providing clinicians with more accurate information with which to guide their decision-making and patient education.
PubMed: 32158860
DOI: 10.1016/j.jpra.2018.12.004