Annalisa Cogliandro

Pelvic and perineal reconstruction following abdominoperineal resection: the role of gracilis flap.

Pelvic and perineal cancer can arise from different structures: genitourinary system, bowel, or skin. The optimal approach to these patients, to ameliorate their immediate and long-term prognosis, implies a multidisciplinary team of specialists, such as oncologic surgeons, plastic surgeons, oncologists, and radiotherapists, working together to tailor an individualized treatment planning for each patient. Nowadays, sphincter-preserving operations are the treatment of choice for rectal cancer in the majority of patients, and seldom an abdominoperineal resection (APR) is necessary, mainly because of early diagnosis and the widespread use of neoadjuvant treatments. Conversely, APR is mandatory when cancer sphincter involvement is demonstrated either from rectal or anal cancer or in case of recurrent rectal carcinoma with sphincteral muscle invasion. APR was first performed by Miles in 1908; it consists of resection of the rectum and of the anal canal, incorporating a variable tract of sigmoid colon and en bloc removal of perianal skin. Radiation therapy, often delivered in the neoadjuvant setting to reduce tumor bulk to achieve safer margins, causes important and irreversible alterations to irradiated tissues. These procedures lead to wide loss of substance, with surgical scars and postactinic sclerosis. Following oncologic surgery, reconstruction is accomplished either through direct closure, or, if this is not feasible, by means of advance, rotation, transposition, or free flaps. In our experience, gracilis flap (GF) is the first choice for pelvic-perineal reconstruction. It was one of the first flaps used in perineal reconstruction, described by Bartholdson and Hulten in 1975, even though in 1972, Orticochea had already used the musculocutaneous version of this flap for penile reconstruction. In 1976, McCraw et al used it as a musculocutaneous flap for vaginal reconstruction. Its localization in the vicinity of the defect and easy elevation account for its common use. No functional impairment follows as other adductor muscles of the thigh supersede its function. Moreover, the gracilis donor site is commonly outside the field of irradiation and thus provides healthy tissues for reconstruction. Gracilis muscle can be used to perform unilateral or bilateral, muscular, or musculocutaneous flap reconstruction. The aim of the present study is to compare retrospectively the outcomes of 2 homogeneous groups of patients with rectal carcinomas, undergoing APR, in whom the perineal wound was closed either directly or with a GF.

Implant Breast Reconstruction After Salvage Mastectomy in Previously Irradiated Patients

The most common surgical approach in case of local tumor recurrence after quadrantectomy and radiotherapy is salvage mastectomy. Breast reconstruction is the subsequent phase of the treatment and the plastic surgeon has to operate on previously irradiated and manipulated tissues. The medical literature highlights that breast reconstruction with tissue expanders is not a pursuable option, considering previous radiotherapy a contraindication. The purpose of this retrospective study is to evaluate the influence of previous radiotherapy on 2-stage breast reconstruction (tissue expander/implant). Only patients with analogous timing of radiation therapy and the same demolitive and reconstructive procedures were recruited. The results of this study prove that, after salvage mastectomy in previously irradiated patients, implant reconstruction is still possible. Further comparative studies are, of course, advisable to draw any conclusion on the possibility to perform implant reconstruction in previously irradiated patients.

A systematic review of patient-reported outcome measures after rhinoplasty

The literature still lacks a review regarding PROs applied for rhinoplasty. Thus, we performed a systematic review of the literature to identify PROMs that assess patient satisfaction and quality of life after rhinoplasty. The aim of our study was to identify existing questionnaires and to summarize their development, psychometric properties, and content. A multi-step search of the web-based PubMed database from the National Library of Medicine was performed to identify PROMs that are designed to evaluate satisfaction and quality of life following rhinoplasty. Each potential PROM was examined by three independent reviewers for adherence to inclusion/exclusion criteria. Questionnaires included in the analysis were appraised for their adherence to international guidelines for the development and validation of health outcome questionnaires, as outlined by the Scientific Advisory Committee of the Medical Outcome Trust and the U.S. Food and Drug Administration. Our search generated a total of 457 articles, 351 that were retrieved in the primary search, and 106 that were found in the references of the first set of articles. The process of development and validation of each of the included PROMs was examined. Only ten of these were identified as surgery-specific questionnaires about rhinoplasty. These were divided into three categories: (1) functional self-assessment (Nasal Surgical Questionnaire, Nasal Obstruction Symptoms Evaluation Scale, and Nasal Obstruction Septoplasty Effectiveness); (2) aesthetic self-assessment (Utrecht Questionnaire, FACE-Q rhinoplasty module, Glasgow Benefit Inventory); and (3) aesthetic and functional self-assessment (Rhinoplasty Outcomes Evaluation), Functional Rhinoplasty Outcome Inventory 17, RHINO Scale, and Evaluation of Aesthetic Rhinoplasty Scale).

A Systematic Review of Patient-Reported Outcome Measures Following Transsexual Surgery

BackgroundThe aims of our study were to identify studies that evaluated patient satisfaction after transsexual surgery, analyze existing questionnaires, and summarize their development, psychometric properties, and content.MethodsA systematic review of the English-language literature was performed. Patient-reported outcome measures designed to assess patient satisfaction and quality of life following transsexual surgery were identified. Qualifying instruments were assessed for content and adherence to international guidelines for development and validation.ResultsFrom 796 articles, 19 studies had sufficient data and met the inclusion criteria. Included were a total of 2299 patients and 17 patient-reported outcome measures: 10 generic instruments that assessed quality of life, 4 specific for female genital or sexual satisfaction, 2 specific for transsexual body image or gender dysphoria, and 1 specific for plastic surgery. The questionnaires were analyzed by reviewers to assess the adherence to the rules of the US FDA and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 17 individual questionnaires that were included. All measures were limited by either their development, their validation, or their content.ConclusionsThere is a need for a new self-assessment tool, which should include functional, psychorelational, and cosmetic components, to measure satisfaction and quality of life of patients who have undergone transsexual surgery.Level of Evidence IIIThis 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.

Combined use of fractional CO2 laser and radiofrequency waves to treat acne scars: A pilot study on 15 patients

Abstract Fractional laser resurfacing has become an important technique in the management of a number of skin conditions, such as photoaging and scars. A variety of laser wavelengths and delivery systems have been introduced to improve immediate and long-term therapeutic results. The simultaneous emission of CO2 laser and radiofrequency waves combines epidermal coagulation for a resurfacing effect and dermal denaturization for deeper remodelling. The authors present this new machine together with a preclinical histological study and pilot study on 15 patients suffering from acne scars.

Patient Satisfaction and Clinical Outcomes Following 414 Breast Reductions: Application of BREAST-Q

AbstractBackgroundThe aim of this study was to measure breast satisfaction and quality of life using the BREAST-Q Reduction Module in a large sample of postoperative patients having breast reduction using the inverted T technique.MethodsWith due approval from the ethics committee of our university, 414 patients who were seen in consultation for breast reduction surgery between 2005 and 2015 performed by the same team were asked to fill out BREAST-Q surveys. The patient factors collected for all those undergoing breast reduction included age, body mass index, incision pattern, areola complex pedicle used, amount of tissue resected, concurrent procedures, and complications.ResultsAt our Department of plastic, reconstructive, and aesthetic surgery, 414 women underwent reduction mammoplasty with the inverted T technique from 2005 to 2015. All patients answered the BREAST-Q reduction mammoplasty postoperative module. Postoperative patients who presented with severe hypertrophy and asymmetry Grade C were more satisfied than others.ConclusionsOur study represents the largest number of patients who answered the BREAST-Q reduction mammoplasty module. The goal of breast surgery should be the attainment of patient satisfaction with good breast volume, shape, and symmetry.Level of evidence IVThis journal requires that authors assign a level of evidence to each submission to which Evidence Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. http://www.springer.com/00266

Plastic surgery and smoking: a prospective analysis of incidence, compliance, and complications.

1. Rohrich RJ, Coberly DM, Krueger JK, Brown SA. Planning elective operations on patients who smoke: Survey of North American plastic surgeons. Plast Reconstr Surg. 2002;109:350– 355; discussion 356. 2. Rayatt S, White N, Jennings S, Matthews RN. Smoking and elective surgery: A survey of United Kingdom plastic surgery consultants. Plast Reconstr Surg. 2004;114:605–606; author reply 606. 3. Knobloch K, Gohritz A, Reuss E, Vogt PM. Nicotine in plastic surgery: A review (in German). Chirurg 2008;79:956–962. 4. Chang DW, Reece GP, Wang B, et al. Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg. 2000;105:2374–2380. 5. Padubidri AN, Yetman R, Browne E, et al. Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers. Plast Reconstr Surg. 2001;107:342–349; discussion 350.

Linguistic validation of the “FACE-Q Rhinoplasty Module” in Italian

Sir, We read with great interest the paper entitled ‘‘Quality of life in functional rhinoplasty: rhinoplasty outcomes evaluation German version (ROE-D)’’ published on September 2016 by Olcay Cem Bulut et al. on your journal, and we are not agree with the author to say that there are only two validated instruments to measure HRQL after rhinoplasty: ROE and FROI-17. It is a very interesting paper, but we think that the translation process they used is not described clearly. As Klassen et al. affirmed [1] United Kingdom Department of Health, systematic review of PRO measures for cosmetic surgery identified only nine specific instruments that demonstrated adequate psychometric properties and were developed with patient input. The widely used Rhinoplasty Outcomes Evaluation questionnaire was excluded from the United Kingdom review, because it was developed without patient input. The frequently used Derriford Appearance Scale, eight which is one of the nine measures in the United Kingdom Department of Health review, does not measure specific rhinoplasty concerns. In medical research, a rigorous translation and linguistic validation study is considered an essential step prior to using a PRO instrument in another language and/or culture. Following a rigorous linguistic validation, methodology helps to ensure the best possible translation which is produced. We translated FACE-Q Rhinoplasty Module following international guidelines. As the implementation of evidence-based medicine grows in everyday practice, there is increasing pressure to adopt validated survey instruments to demonstrate patientreported outcomes [2]. Surgical interventions on the face are most popular in cosmetic surgery, with nose reshaping being one of the most common procedures performed [3]. The only patient-reported outcome (PRO) instrument that we are aware of that measures how patients perceive the appearance of their nose is the FACE-Q [4]. This PRO instrument is composed of more than 40 independently functioning scales, including a 10-item scale called ‘‘Satisfaction with Nose’’ [4]. We translated and performed a linguistic validation of the FACE-Q Satisfaction with Nose scale for use in Italian patients. The translation was performed in accordance with the MAPI Research Trust [5] and the World Health Organization (WHO) recommendations. Our goal was to create a simple and clear translation understandable to all Italian patients. The steps we followed included performing two independent forward translations followed by a reconciliation process. A backward translation of the Italian version into English was then produced by a third translator. The final step involved qualitative cognitive interviews with patients to test understanding of the scale. At each step of the process, a project manager overviewed progress, coordinated committee meetings, and compiled reports. The entire translation process took approximately 3 months. This comment refers to the article available at doi:10.1007/s00405016-3920-x.

Patient-Reported Satisfaction Following Post-bariatric Surgery: A Systematic Review

AbstractIntroductionThe aims of our study were to identify studies that evaluated patient satisfaction following post-bariatric surgery, analyse existing questionnaires, and summarise their development, psychometric properties, and content.Patients and MethodsA multistep search was undertaken on the web-based PubMed database from the National Library of Medicine to identify studies on patient satisfaction and quality of life following post-bariatric surgery. The authors summarised all the questionnaires used in every study and categorised them as generic, surgery specific, or ad hoc, and whether they contained either validated or unvalidated measures.ResultsOur search generated a total of 1754 articles. We performed a systematic review of the 12 remaining studies, because these had sufficient data and met the inclusion criteria. All the studies identified from the literature review were assessed to determine the type of surgery used, and whether or not the questionnaire used to analyse patient satisfaction had been validated. The questionnaires were analysed by reviewers to assess adherence to the rules of the US Food and Drug Administration and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 20 individual questionnaires that included 10 generic instruments that assessed quality of life, six instruments specific for post-bariatric surgery, three instruments specific for breast surgery.ConclusionsIn post-bariatric patients, the BODY-Q was shown to be a more objective and confident measure for evaluating the quality of life of patients following post-bariatric surgery.Level of Evidence IIIFor 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.

Ethics and Plastic Surgery/What is Plastic Surgery?

Cosmetic surgery is a surgical expertise that aims at correcting or improving body imperfections. These may be congenital, acquired, due to illness, or due to traumatic or para-physiological events such as aging. Cosmetic surgery also includes surgical procedures requested by patients to improve their appearance. In this regard, cosmetic surgery differs from reconstructive surgery, which deals with the treatment of morphological alterations that can be related to pathological conditions; in the specific nature of their respective areas, cosmetic surgery and reconstructive surgery both belong to plastic surgery. The aim of this discipline must be to keep the same aesthetic and scientific approach both in the resolution of body imperfections or in voluntary modifications to appearance [1]. If, on one hand, the aesthetic dimension cannot be ignored in reconstructive surgery, then on the other hand, reconstructive surgery is strictly required in any cosmetic surgery [2]. In the last few years we have witnessed the use of medical treatment and cosmetic surgery more and more frequently in line with the continuous evolution of modern society, where individuals’ wellbeing also depends on the attractiveness of their physical appearance, according to the various standards imposed by society [3].