Category: National Laser Institute

An Effective Simulator for Intraoral Facial Skeletal Contour Surgeries

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imageBackground
In East Asia, intraoral facial skeletal contour surgeries (intraoral FSCSs), including reduction gonioplasty, reduction malarplasty, and genioplasty, have become increasingly popular. Nonetheless, intraoral FSCSs are technically difficult and have a steep learning curve. An effective simulator could be beneficial for intraoral FSCS training. However, there is no intraoral FSCS simulator available. We introduced an intraoral FSCS simulator and assessed its effectiveness.
Methods
An intraoral FSCS simulator was established by covering a 3-dimensional printed skull with elastic cloth. Twenty residents were enrolled and randomly divided into experimental group A and control group B. Group A performed the intraoral FSCS on the simulator for 3 times. Group B performed the intraoral FSCS on skull model for 3 times. The intraoral FSCS simulator and trainees’ performance were evaluated by a trainee-reported questionnaire before and after training, the surgical outcomes were graded by 3 senior attending physicians. All questions and the surgical outcome were scored based on a 5-point Likert scale (1 = very poor, 5 = very good). The surgical times were recorded.
Results
The intraoral FSCS simulator (4.13 ± 0.64) simulated the surgical reality significantly better than the skull (2.6 ± 0.63). In intraoral FSCS simulator training, the restriction and compliance of the facial soft tissue were vividly mimicked (4.4 ± 0.51); the intraoral approach was vividly mimicked (4.07 ± 0.59). The intraoral FSCS simulator is significantly superior to the skull in improving participants’ confidence in performing intraoral FSCS, power system control, and intraoral approach adoption (<0.001). The average surgical outcome score was 3.11 ± 0.45 in group A and 3.91 ± 0.24 in group B. The average surgical time was 177.78 ± 28.38 minutes in group A and 65.26 ± 15.38 minutes in group B.
Conclusions
We developed the first intraoral FSCS simulator and proved its effectiveness preliminarily. Randomized controlled study with clinical cases is needed to further test its effectiveness.

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Linea Arcuate Hernia Following Transversus Abdominis Release Incisional Hernia Repair

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imageOpen abdominal surgery continues to be most commonly complicated by postoperative herniation at the incision line. In 2012, Novitsky et al described a novel hernia repair technique that utilized a transversus abdominis release coupled with a posterior (retrorectus) component separation (TAR-PCS) of the ventral abdominal wall. Early reports attest to the versatility and low recurrence rate of this technique, particularly when repairing large and complex defects. We present a rare case of herniation below the linea arcuate (LAH) following repair via TAR-PCS. Given its novelty compared with more widely utilized techniques, literature review revealed less discussion regarding potential pitfalls associated with this type of reconstruction, in particular the potential for LAH. To date, only 9 cases of symptomatic LAH have been described, although 2 previously described “suprapubic” herniations following TAR-PCS may represent previously mischaracterized cases of this type of complication. Nonetheless, none of these reports were in the setting of ventral hernia repair.

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Impact on Breastfeeding According to Implant Features in Breast Augmentation: A Multicentric Retrospective Study

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imageBackground
Exclusive breastfeeding is highly recommended by the World Health Organization during the first 6 months of life. In parallel, breast augmentation with implants is one of the most performed operations in aesthetic surgery.
Objective
The goal of our study was therefore to analyze the potential impact of aesthetic breast implants on breastfeeding.
Study Design
A retrospective study was carried out in 3 French university hospitals. The main inclusion criterion was adult women of childbearing age (18–50 years old) with bilateral breast hypoplasia. Some features of the surgery, such as the operative indication, the surgical approach, the implant position against the pectoral muscle, and implants features (material, volume, profile), were collected. We conducted a survey by phone about childbirth after the procedure. If the women had children after surgery, we asked them if they breastfed and the characteristics of breastfeeding.
Results
In total, 1316 patients received breast implants in the 3 centers from January 2011 to October 2016 and met our inclusion criteria. We included 1073 patients; 998 women had breast implants with no pregnancy. Among the 75 patients (7%) who gave birth after the surgery, 51 wanted to breastfeed (68%). The patients with a retroglandular implant were significantly less able to breastfeed compared with the patients with retromuscular implants (P = 0.0005). No difference was found for age, the type of surgery, the surgical approach, and the shape or type of implant between the successful breastfeeding group and failed breastfeeding group.
Conclusion
A woman with aesthetic breast implants has a 75% chance of breastfeeding if desired, regardless of the type and the volume of the implant and the surgical approach. She has an 82% probability of breastfeeding with retromuscular implants and 17% with retroglandular implants.

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Lacrimal Injury After Rhinoplasty: Two Case Reports

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Skin Care news and information found at www.SpaTreatmentTraining.com brought to you by National Laser Institute. Are you interested in a career that can train you to be a Med Spa technician? Want to become a certified Laser Hair Removal Specialist, Laser Tattoo Removal Specialist, Botox Injections or many more exciting Medical Spa courses? Enroll in the National Laser Institute and find yourself on the fast track to success.

imageLacrimal injury is very uncommon after osteotomy in rhinoplasty. We present 2 cases of lacrimal injury after osteotomy in rhinoplasty and present the steps to managing such an injury. These cases were finally treated with endoscopic dacryocystorhinostomy. We concluded that osteotomies must be at least 3 mm from the medial canthus or medial to the line from the medial canthus to the alar base. Also, it is recommended that osteotome blades be sharpened before each osteotomy.

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Nipple-sparing Mastectomy and Immediate Breast Reconstruction After Recurrence From Previous Breast Conservation Therapy

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Skin Care news and information found at www.SpaTreatmentTraining.com brought to you by National Laser Institute. Are you interested in a career that can train you to be a Med Spa technician? Want to become a certified Laser Hair Removal Specialist, Laser Tattoo Removal Specialist, Botox Injections or many more exciting Medical Spa courses? Enroll in the National Laser Institute and find yourself on the fast track to success.

imagePurpose
Breast conservation therapy (BCT) is widely accepted for breast cancer treatment. Nipple-sparing mastectomy has been newly developed to preserve the nipple-areolar complex and enhance aesthetic results. The purpose of this study was to evaluate the oncological safety and results of nipple-sparing mastectomy (NSM) after previous BCT.
Methods
Eighteen patients who received NSM and immediate breast reconstruction for local recurrence after BCT were identified. An additional 127 affected breasts with NSM and immediate breast reconstruction for primary breast cancer were selected as the control group. The patient disease status, reconstructive method, postoperative complications, and oncological outcome were investigated.
Results
No apparent significant differences between the 2 groups were found regarding patient demographic data, tumor stage, reconstructive method, surgical complication, or tumor recurrence rate (all P values >0.05), except preoperative radiotherapy was higher in secondary NSM group (0% vs 77.8%, P < 0.001). The further nipple and secondary deep inferior epigastric artery perforator flap reconstruction rate was higher in the secondary NSM group (11.1% vs 0.8%, P = 0.041 and 16.7% vs 2.4%, P = 0.026, respectively).
Conclusions
Prior BCT did not contribute to higher surgical complications in patients who received NSM and immediate reconstruction as a salvage procedure after tumor local recurrence. The oncological safety, general surgical result, and postoperative patient-reported satisfaction remain safe and reliable despite prior ipsilateral surgery and radiation. Care should be taken for possible higher nipple necrosis in the secondary NSM patients.

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Free Latissimus Dorsi Myocutaneous Flap in a 6-Month-Old Child for Reconstruction of a Temporal Fossa Defect After Teratoma Resection

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Although free flap reconstruction has already gained widespread acceptance in pediatric patients, little is known about the outcome of free tissue transfer in head and neck reconstruction in pediatric patients. We present a case of a 6-month-old boy with a large volume deficit in the right temporal fossa after resection of a teratoma. This led to a large volume deficit with widely undermined skin margins. Therefore, we provided volume augmentation by microsurgical free latissimus dorsi myocutaneous flap transplantation. Intraoperative use of laser-assisted indocyanine green angiography indicated excellent flap perfusion. Postoperative magnetic resonance imaging showed adequate flap perfusion with no signs of flap necrosis. To our best knowledge, this case presents the youngest patient who underwent free flap transplantation in the head and neck region. Our case demonstrates that microvascular surgery can play an important role in particular cases in pediatric oncology, even in very young patients.

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Temporary Ectopic Implantation of an Amputated Leg Using the Distal Runoff Vessel of the Anterolateral Thigh Flap Followed by Subsequent Prefabricated Chimeric Replantation

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imageAim
Infrapopliteal replantation is indicated in selected patients. When the patient is hemodynamically unstable or the amputation site is severely contaminated, temporary ectopic implantation of the amputated limb is an option. To the best of our knowledge, this is the first case report using the distal runoff vessel of the anterolateral thigh flap for temporary ectopic implantation of an amputated leg followed by replantation with the prefabricated anterolateral thigh flap.
Patient and Methods
A 28-year-old male driver had left leg avulsion amputation after a car accident. Because of concerns about the high-energy trauma mechanism and extensive trauma zone, temporary ectopic implantation was planned to avoid a lengthy replantation procedure and to enable future replantation. The amputated leg was implanted to the thigh using the distal runoff vessel of the descending branch of the lateral circumflex femoral system in the preservation of proximal cutaneous perforator. When the patient became hemodynamically stable and the amputated stump was relatively clean and healthy, we replanted the amputated leg with the prefabricated anterolateral thigh flap on day 7.
Results
The replanted leg and anterolateral thigh flap survived well after the procedure. At the 15-month follow-up, the patient could walk independently. There was no need for custom-made shoes because there was no obvious leg length discrepancy and the flap was not bulky.
Conclusions
We believe that the distal runoff vessel of the descending branch of the lateral circumflex femoral system can not only serve as a recipient site for temporary ectopic implantation but also enable the harvest of a prefabricated anterolateral thigh flap with the amputated part at the replantation stage. This prefabricated tissue containing the anterolateral thigh flap and the amputated part needs only 1 set of vascular anastomosis to accomplish replantation and simultaneous revascularization of the anterolateral thigh flap. Most importantly, this ectopically prefabricated chimeric tissue minimizes the need for extensive bone shortening after radial debridement by providing sufficient soft tissue coverage at the replantation stage.

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Reconstruction of Large Soft Tissue Defects of the Extremities in Children Using the Kiss Deep Inferior Epigastric Artery Perforator Flap to Achieve Primary Closure of Donor Site

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imageBackground
The closure of massive skin defects remains challenging, particularly in children. In this report, we describe a technique to achieve primary donor site closure using the kiss deep inferior epigastric perforator (DIEP) flap for the reconstruction of large soft tissue defects located in the extremities of children.
Methods
From May 2011 to May 2016, a retrospective analysis was conducted on 10 pediatric patients with extensive soft tissue defects and reconstruction with double-skin paddle DIEP flap. After harvesting the flap, the skin paddle was divided into 2 separate paddles with a common vascular supply, and then the 2 paddles were sutured side by side through translating 2 paddles or rotating one of the paddles by 90 or 180 degrees, effectively doubling the width of the flap and rejoining it at the recipient site. Data on patient age, medical history, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow-up were reviewed retrospectively.
Results
Nine children had major soft tissue defects of the lower limb, and the remaining one had an upper limb defect. Only 1 case was complicated by partial necrosis of 1 paddle. Primary donor site closure was accomplished in all cases. The flaps were well matched on texture and contour, except that the 2 flaps were bulky at postoperative follow-up. There was no donor site breakdown, with only a slightly noticeable linear scar.
Conclusion
The kiss DIEP flap could be an alternative for reconstruction of large soft tissue defects of the extremities in children, with lower morbidity and improved cosmetic of the donor site.

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Readability, Suitability, and Complexity of Online Resources for Lower Extremity Reconstruction

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Skin Care news and information found at www.SpaTreatmentTraining.com brought to you by National Laser Institute. Are you interested in a career that can train you to be a Med Spa technician? Want to become a certified Laser Hair Removal Specialist, Laser Tattoo Removal Specialist, Botox Injections or many more exciting Medical Spa courses? Enroll in the National Laser Institute and find yourself on the fast track to success.

imageBackground
Surgical options for lower extremity reconstruction frequently include a decision between autologous free flap reconstruction and amputation. Patients rely on health education materials for information before making treatment decisions. This study evaluates the quality of online health information for lower extremity reconstruction.
Methods
We identified the top 10 Web sites for “leg amputation” and “leg free flap reconstruction.” Three validated tools were used to evaluate literacy demand of materials, including (1) the Simple Measure of Gobbledygook for readability; (2) the Peter Mosenthal and Irwin Kirsch readability formula for complexity of nonprose materials such as list, graphs, charts; and (3) the Centers for Disease Control and Prevention’s Clear Communication Index (Index). Differences in mean between the 2 groups were compared using Student t test.
Results
Average Simple Measure of Gobbledygook reading grades approximated 12th-grade level and were similar between the 2 groups. This is above the recommended level of sixth-grade health literature. Complexity scores for nonprose materials of these groups were within recommended range and corresponded to very low complexity at a fourth- to seventh-grade level. The Centers for Disease Control and Prevention index was higher for amputation literature compared with free flap reconstruction (70% vs 54%), but the difference was not statistically significant.
Conclusions
Overall, online health resources for lower extremity amputation and free flap reconstruction do not meet the standard for quality and accessible health information. Free flap reconstruction resources are scarce and complex. Patients facing decisions about extremity reconstruction may not have appropriate online health resources available to them to make informed decisions.

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The Use of Microplates for Internal Fixation of Comminuted Mandibular Fractures

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Skin Care news and information found at www.SpaTreatmentTraining.com brought to you by National Laser Institute. Are you interested in a career that can train you to be a Med Spa technician? Want to become a certified Laser Hair Removal Specialist, Laser Tattoo Removal Specialist, Botox Injections or many more exciting Medical Spa courses? Enroll in the National Laser Institute and find yourself on the fast track to success.

imageBackground
Although clinical trials have successfully applied microplates for the internal fixation of single or double isolated mandibular fractures, the use of microplate systems in comminuted mandibular fractures is not widely accepted. This study aimed to evaluate the use of microplates for internal fixation of comminuted mandible fractures and to discuss their applicability.
Methods
Fourteen patients with comminuted mandibular fractures (10 at a single region, 3 at 2 regions, and 1 at 4 regions) were treated with open reduction and internal fixation using 0.5- or 0.6-mm-thick titanium microplates and 1.0-, 1.2-, or 1.3-mm monocortical microscrews. Three-level fixation at the lower border, upper border (as interdental wiring), and middle of the mandible was performed. Maxillomandibular fixation was applied only when premature occlusal contact was observed after fracture fixation.
Results
During the follow-up period (3–55 months), all fractures showed favorable and complete bone healing. Six patients experienced minor complications, including minimal malocclusion (n = 5) and a localized infection (n = 1). Most of these complications were managed with conservative treatment. No major complications that required further orthodontic treatment or reoperation occurred.
Conclusions
These results suggest that 3-level fixation using microplates is appropriate for the reconstruction of comminuted mandibular fractures without bony defects. The small size and malleability of these devices facilitate accurate anatomical reduction for complete contact of the comminuted bony segments by multiple fixation. Furthermore, microplates allow for preservation of sufficient periosteal blood supply and restoration of premorbid occlusion (by occlusal self-adjustment) while providing sufficient stability.

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