Paolo Persichetti

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.

Scalp reconstruction with superficial temporal artery island flap: Clinical experience on 30 consecutive cases.

BACKGROUND Different techniques are available to reconstruct scalp defects; however, when the cranium is exposed or the hairline compromised, the procedure may become quite challenging. The use of superficial temporal artery fascio-cutaneous flaps has been described mainly to restore the hair-bearing surface of the upper lip or the eyebrow but only few applications in the scalp have been reported. The authors present their experience with the use of superficial temporal artery island flaps to obtain durable coverage and excellent contour in anterior scalp reconstruction. METHODS Thirty consecutive defects in the anterior scalp subunits (temporal = 14; parietal = 12; forehead = 4) were reconstructed with ipsilateral V-Y island flaps nourished by frontal and parietal branches of the superficial temporal artery. All defects resulted from skin cancer excision. Twenty-six flaps were based on the parietal branch. The frontal branch pedicle was used in only four cases to resurface defects in the forehead subunit. Glabrous skin flaps were harvested in six patients. Including a venous branch in the pedicle was not mandatory because the venous drainage of the flaps was provided by the perivascular fascial network. For this reason, a fascial pedicle around the artery, 2-3 cm in width, was maintained to minimise flap venous insufficiency. RESULTS Twenty-nine flaps healed uneventfully (96.7% flap survival rate), providing stable coverage with a mean follow-up of 12 months. In the early postoperative time (up to 48 h), slight venous stasis was observed in 14 flaps (46.6%), but it resolved spontaneously within 1 week. Two flaps showed severe venous stasis, but in only one case (3.3%) it progressed to distal necrosis requiring surgical revision. No cases of alopecia or hairline distortion were postoperatively registered. CONCLUSIONS The use of superficial temporal artery island flaps, mobilised in a V-Y fashion, proved to be an elegant and reliable solution to resurface defects in the anterior scalp subunits in both hairy and bald patients.

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

A locally aggressive solitary fibrous tumor of the leg: Case report and literature review

INTRODUCTION The solitary fibrous tumor (SFT) is a rare soft tissue tumor with a substantially benign clinical behavior. However, malignant neoplasms with local recurrence or distant metastases have been reported. PRESENTATION OF THE CASE The authors present a case of an aggressive SFT of the leg, in a 55 years old Caucasian man. Radiological, histological and molecular findings are reported. The differential diagnosis, therapy and outcome of this rare tumor are also discussed. DISCUSSION An extensive review of literature showed SFTs clinical behavior as substantially benign, anyway aggressive or malignant neoplasms have been described. The potential risk of local recurrence and distant metastasis thus suggests wide surgical resection and careful long-term follow-up. Differential diagnosis may be quite laborious as SFT can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin and bcl-2 is then mandatory. CONCLUSION Our clinical experience confirmed that SFT may have an aggressive behavior, however, conservative surgical treatment may be successful in the long term.

The Use of Acellular Dermal Matrix in Reconstruction of Complex Scalp Defects

Multi-focal basal or squamous cell carcinomas of the scalp, as well as recurrent tumors or previously irradiated lesions, always require large full thickness excision to achieve successful and complete healing. Loco-regional or micro-vascular flaps are the gold standard for closure of complex defects of the scalp but in some, especially older, patients, these techniques may be contraindicated. Over the last few years, the introduction of dermal substitutes has improved wound healing and modified surgical strategies in the treatment of complex tissue loss. Matriderm s (Eurosurgical Limited, Guildford, UK) is an acellular dermal substitute constituted by a matrix of type 1 bovine collagen and elastin, with a thickness of 1 to 2mm and pores of about 75mm. Since its introduction in clinical practice, it has been used in the reconstruction of tissue following burns or complex wounds, 1,2 but few studies have focused on its use in the craniofacial region and no studies appear to have evaluated its usefulness in scalp reconstruction. Herewith, we report our personal experience using this acellular dermal matrix in a complex scalp reconstruction, comparing the esthetic outcome to that of a previous full-thickness skin graft in the same region.

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.

Medial thigh lift in post-bariatric patients: Our encouraging experience

Abstract Background: A high rate of postoperative complications following inner thigh lift is reported in the medical literature. The authors present the results of a study on the validity of inner thigh contouring, with liposuction and concomitant skin excision, in postbariatric patients. Methods: This study examined the charts of 46 postbariatric female patients, who underwent medial thigh lift with a ‘T’ scar technique and concomitant liposuction, between February 2010 and February 2013. Complications were recorded. A questionnaire was administered to the patients at the 1-year follow-up visit. Preoperative and 1-year postoperative photographs were compared, superimposed, and analysed. Results: This study did not observe major systemic complications, haematoma, seroma, infection, skin necrosis, lymphoceles, or lymphoedema. Minor complications were three cases of wound dehiscence and two cases of deepithelialisation. At the 1-year follow-up visit, caudal scar migration, genital distortion, recurrent ptosis, or deformity of the inner thigh contour were not observed. Questionnaires and a comparison of pre- and 1-year postoperative pictures showed encouraging results. Conclusions: The medial thigh lift technique described and assessed in this article is a straightforward surgical procedure, with considerable functional and aesthetic results. Liposuction, early mobilisation, and appropriate postoperative management are pivotal to reduce postoperative downtime and complications.

How You Become Who You Are: A New Concept of Beauty for Plastic Surgery

The search for beauty and its value has been a discussion topic since the ancient Greeks composed their myths. The advent of safer and more advanced modern plastic surgery techniques and the spread of aesthetic medicine have renewed the search for beauty. Today, beauty seems possible, accessible, and more democratic than ever before [1]. To be beautiful is going to become an imperative, and from this standard, new and more subtle discriminations will arise: natural beauty will become more precious than artificial beauty, so that naturally beautiful bodies are privileged [2]. With regard to clinical practice, one of the most fundamental and interesting questions in aesthetic surgery is whether an objective indication exists for such procedures.