Ulrich M. Rieger

Perioral aging – An anthropometric appraisal

To adequately perform perioral rejuvenation procedures, it is necessary to understand the morphologic changes caused by facial aging. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate such changes. Photographs of 346 male individuals were evaluated using 12 anthropometric indices. Data from two groups of health subjects, the first exhibiting a mean age of nearly 20 and the second of nearly 60 years, were compared. To evaluate the influence of combined nicotine and alcohol abuse, the data of the second group were compared to a third group exhibiting a similar mean age who were known alcohol and nicotine abusers. Comparison of the first to the second group showed significant decrease of the vertical height of upper and lower vermilion and relative enlargement of the cutaneous part of upper and lower lips. This effect was stronger in the upper vermilion and medial upper lips. The sagging of the upper lips led to the appearance of an increased mouth width. In the third group the effect of sagging of the upper lips, and especially its medial portion was significantly higher compared to the second group. The photo-assisted anthropometric measurements investigated gave reproducible results related to perioral aging.

Comparative Study of the Free Microvascular Groin Flap: Optimizing the Donor Site After Free Radial Forearm Flap Phalloplasty

OBJECTIVEnTo improve the donor-site morbidity of the radial forearm flap through coverage with a free vascularized groin flap and comparing this flap coverage to the current standard, a full-thickness skin graft (FTSG).nnnMATERIALS AND METHODSnA retrospective analysis of all free radial forearm flap phalloplasties for transgender surgery at our institution was performed. We examined patient characteristics, donor site defects, surgical procedure, and clinical courses.nnnRESULTSnBetween October 2013 and February 2016, 27 consecutive patients underwent phalloplasty for female-to-male reassignment surgery with free radial forearm flaps. A total of 7 free groin flaps (group A) and 20 full-thickness skin graft from the groin region (group B) for donor-site defect coverage of the forearm were performed. The mean age in group A was 28.4 years with a mean body mass index of 21.6u2009kg/m(2) and a mean follow-up time of 10.6 months. The mean surgery time was 724 minutes. The mean patients functional rating was 3.6 accompanied by the mean patients aesthetical rating of 3.7. The mean age in group B was 30.5 years with a mean body mass index of 23.7u2009kg/m(2) and a mean follow-up time of 13.4 months. The mean surgery time was 563 minutes. The mean patients functional rating was 3.1 accompanied by the mean patients aesthetical rating of 2.9.nnnCONCLUSIONnWe suggest that the free microvascular groin flap should be considered for immediate defect closure after phalloplasty with a radial forearm flap due to its beneficial functional and aesthetic results and the low rate of complications.

Quality of postoperative pain management after midfacial fracture repair—an outcome-oriented study

ObjectivesThere is a lack of literature regarding the procedure-specific quality of acute postoperative pain management after midfacial fracture repair. The purpose of the presented prospective clinical study was to evaluate postoperative pain management after surgical repair of midfacial fractures.Materials and methodsEighty-five adults were evaluated on the first postoperative day following midfacial repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. The main outcome measures were patients’ characteristics and clinical- and patient-reported outcome parameters.ResultsOverall, pain on the first postoperative day was moderate. A significant correlation between process and outcome parameters could be shown. Duration of surgery above the calculated median was significantly associated with higher maximum pain intensity (pu2009=u20090.017). Patients requiring opioids in the recovery room presented significantly higher pain on activity (pu2009=u20090.029) and maximum pain (pu2009=u20090.035). Sleeping impairment (pu2009=u20090.001) and mood disturbance (pu2009=u20090.008) were significantly more prevalent in patients undergoing repair of a centrolateral midfacial fracture.ConclusionsQUIPS is a simple and qualified tool to evaluate the procedure specific quality of acute postoperative pain management. Pain on the first postoperative day following midfacial fracture repair seems overall to be moderate. Nearly a third of the patients showed inadequate postoperative pain management. To prevent inadequate postoperative pain management, it is necessary to establish a continued procedure-specific outcome measurement.

Cheek rotation flap reconstruction—an anthropometric appraisal of surgical outcomes

ObjectivesCheek rotation flaps are an established surgical procedure for coverage of facial skin defects especially of the cheek and infraorbital region. A comparison of pre- and postoperative anthropometric measurements may help to objectify intraoperative estimations with regards to postoperative appearance.Materials and methodsWe present an evaluation of 31 patients undergoing periorbital reconstruction by a cheek rotation flap on standardized photographs based on reference anthropometric data. Analysis included intercanthal, binocular and eye fissure width, eye fissure, lid sulcus and upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, scleral show, ectropion, and canthal tilt. Furthermore, it was clearly differentiated whether the defect to cover included eyelid skin or not.ResultsEctropion showed a significant association to surgery (pu2009=u20090.03) and time (pu2009=u20090.03). If the defect to cover included lower eyelid skin, lower iris coverage values decreased significantly (pu2009=u20090.02), meanwhile the rate of scleral show increased significantly (pu2009<u20090.01), indicating pre- to postoperative lower eyelid retraction.ConclusionsIn all patients analyzed, indices were reproducible and reliable. An association between surgery and ectropion was detectable. Whenever lower eyelid skin is involved in the defect to be covered, the significantly decreased lower iris coverage and increased rate of scleral show indicate an increased risk of lower lid retraction.Clinical relevanceWhenever eyelid skin is involved in a defect to be covered by a cheek rotation flap, there is an increased risk of postoperative lower lid distortion. Special care has to be taken to perform techniques preventing lower lid retraction.

Comparison of fasciocutaneous V-Y and rotational flaps for defect coverage of sacral pressure sores: a critical single-centre appraisal

Pressure sore rates remain high in both nursing homes as well as in hospitals. Numerous surgical options are available for defect coverage in the sacral region. However, objective data is scarce as to whether a specific flap design is superior to another. Here, we aim to compare two fasciocutaneous flap designs for sacral defect coverage: the gluteal rotation flap and the gluteal V‐Y flap. All primary sacral pressure sores of grades III–IV that were being covered with gluteal fasciocutaneous rotational or V‐Y flaps between January 2008 and December 2014 at our institution were analysed. A total of 41 patients received a total of 52 flaps. Of these, 18 patients received 20 gluteal rotational flaps, and 23 patients received 32 V‐Y flaps. Both groups were comparable with regards to demographics, comorbidities and complications. Significantly more V‐Y flaps were needed to cover smaller defects. Mean length of hospital stay was significantly prolonged when surgical revision had to be carried out. Both flap designs have proven safe and reliable for defect coverage after sacral pressure sores. Gluteal rotational flaps appear to be more useful for larger defects. Both flap designs facilitate their reuse in case of pressure sore recurrence. Complication rates appear to be comparable in both designs and to the current literature.

Poly Implant Prothèse and Rofil Substandard Breast Implant Explantations from a Large German Single Centre from 2011 to 2014: A Comparative Study.

BackgroundFollowing a Europe-wide scandal, substandard breast implants containing silicone for industry purposes produced by Poly Implant Prothèse (PIP&Rofil) were explanted due to its potential health risks.ObjectiveWe investigated whether these implants actually imposed a threat to patients’ health.MethodsIn this retrospective single-centre case–control study, we compared patients with breast augmentation receiving implant explantation (01/2011–01/2015). Data were collected retrospectively from the patients’ records. Patients were split into two groups: PIP&Rofil and implants of other manufacturers.ResultsA total of 307 patients with 495 breast implants met the inclusion criteria, 64 patients with 115 PIP&Rofil implants and 243 patients with 380 implants of other manufacturers. Comparison of descriptive statistics between the two groups revealed that for a variety of indicators (e.g. patient age, breast cancer, aesthetic vs. reconstructive indication, implant volume, submuscular vs. subglandular implant position) PIP implants differ from non-PIP implant patients. Raw mean comparison showed higher rupture rates for non-PIP implants, 28.42xa0% (PIP 23.48xa0%). However, when controlling for implant indwelling time, PIP implants had shown higher rupture rates. Both groups had similar rates of capsular contracture (PIP: 71.30xa0%, Others: 72.63xa0%) with different distribution of Baker Scores (Baker 2/3/4: PIP 5/8/13 and non-PIP 3/24/135).ConclusionConcerning patient symptoms, we did not find any objective reason to justify implant explantation of PIP&Rofil implants as a solely precautionary measure. As PIP&Rofil implants showed shorter retention periods until rupture and ruptured implants can cause symptoms or health problems, PIP&Rofil implants should be regularly monitored and explanted if there is evidence of rupture.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

Reduction Mammaplasty: Outcome Analysis Based on Bodyweight

This retrospective study aimed to evaluate how reduction mammaplasty influences the bodyweight of patients 5xa0years after the procedure. The literature shows controversy regarding the effect of breast reduction on the progression of bodyweight. Between 1 January 2006 and 31 July 2007, 249 reduction mammaplasties were performed in the Department of Plastic, Reconstructive, and Aesthetic Surgery at the University Hospital Innsbruck. The exclusion criteria ruled out patients with oncoplastic breast reduction plasties, unilateral reduction mammaplasty, no documented preoperative weight, and bariatric procedures. The study finally included 50 women with a mean age of 44xa0±xa012xa0years. Of these 50 women, 26 (52xa0%) gained weight, 18 (36xa0%) lost weight, and 6 (12xa0%) remained stable during a 5-year follow-up period after the procedure. The mean weight gain was 4.50xa0±xa03.5xa0kg, and the mean weight loss was 3.44xa0±xa02.20xa0kg. The results of the study suggest that reduction mammaplasty is not a stimulus for weight loss. Although a tendency to gain weight was discovered, the weight gain compared with that of the standard population did not reach statistical significance.Level of Evidence IVThis 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.

Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management

ObjectivesPostoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy.Materials and methodsIn a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients’ characteristics, pain parameters, outcome, and pain therapy process parameters.ResultsPain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (pxa0=xa0.037). Significantly lower satisfaction with postoperative pain intensity (pxa0>xa0.001) and significantly higher desire for additional pain medication (pxa0=xa0.023) were detected, when duration of surgery was above the median of 107.5xa0min.ConclusionsInadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand.Clinical relevanceOnly the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.

The posterior thigh flap for defect coverage of ischial pressure sores – a critical single-centre analysis

The development of pressure sores is still not only an enormous economical but also a medical burden. Especially in the ischial region, the local defect coverage remains demanding as it is the main weight‐bearing area in wheelchair‐mobilised patients and is prone to high mobility. The purpose of our study was to report our long‐time experience with the reconstruction of ischial pressure ulcers with the medially based posterior thigh flap.

The versatility of the medial thigh lift for defect coverage in the genito-perineal region.

Soft tissue defects in the genito‐perineal region are predominantly because of trauma, infections, neoplasms or iatrogenic causes. As a result of the regions urological, reproductive and gastrointestinal function, defects in this area may cause devastating physical and psychological consequences as well as diminished sexual functioning. The purpose of this study was to examine the efficacy of implementing a medial thigh lift for defect coverage in the perineal region.