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Background: The coronavirus disease 2019 (COVID-19) pandemic required an unprecedented transformation of medical education, shifting from traditional, in-person learning to distanced, online learning. This study aimed to review changes to medical education and describe the advantages and disadvantages of virtual medical education experienced by medical students during the pandemic. Methods: An online survey study was conducted at two medical schools, University of Michigan Medical School in the United States and Koc University School of Medicine in Turkey. Medical students completed questionnaires regarding their educational experience before and during the pandemic. Survey instruments were designed to assess differences in the educational curriculum, study methods, clinical skills self-evaluations, perceptions of the quality of in-person and online learning, and overall satisfaction. Results: A total of 184 medical students completed the survey. There was an increase in the use of online study tools since the pandemic. There was no statistically significant difference in self-reported assessments of clinical preparedness and overall clinical competence during surgical clerkship. The percentage of students interested in pursuing a career in surgery has nearly doubled from 34% to 63%. A majority of students (83%) believed that the time available for self-study and research increased during the pandemic. Fifty-two percent of students believed that online education is less efficacious than in-person education, but 86% of students still preferred a blended approach. Conclusions: Medical schools have continued to update their curricula following the COVID-19 pandemic. This study illustrates the transformations in medical education to ensure that the most effective and suitable teaching is delivered.
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Background: Minimally invasive procedures have become increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. All U.S. Food and Drug Administration-approved neurotoxins are indicated for achieving similar effects, even though they are different in regard to structure, manufacturing technique, and storage requirements. It is agreed upon that each neurotoxin is unique and therefore not interchangeable. The aim of the author is to provide an approach for choosing the optimal toxin in different indications regarding the area of treatment, the age and characteristics of the patient, potential risks, and ultimate goals. Methods: As the country that the author practices carries onabotulinum (ONA), prabotulinum (PRA), and abobotulinum (ABO) toxin type-A, one of these three toxins was preferred for each category. ABO toxins were preferred in wide areas due to the broader action halo. Typical examples include hyperhidrosis treatment, wide forehead area, and calf slimming. In areas where very precise and targeted treatment is required, PRA and ONA toxins were preferred to limit potential side effects due to wider diffusion. First-time patients were typically treated with PRA toxins for a softer trial periods where as "repeat" patients were successfully treated with ABO toxins. Results: No toxin is superior to the other in terms of producing effects. Yet, small differences in their properties can allow the plastic surgeon to cater to each patient's needs while yielding the most optimal results. Conclusions: This study is meant to serve as a guideline for choosing the ideal toxin in different patient settings and indications.
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An intriguing observation that has recently found support through clinical and experimental studies is that wounds of the oral mucosa tend to display faster healing and result in less scarring than in the skin. We aimed to investigate the potential of heterotopic oral mucosal fibroblasts in cutaneous wounds while determining the main differences between wounds conditioned with either the oral mucosa or dermis-derived human fibroblasts. A total of 48 nude mice were divided into four groups: control, sham, dermal fibroblast (DF), and oral fibroblast (OF). Fibroblasts were isolated, cultured, and seeded onto fibrin scaffolds for transfer to full-thickness dorsal wounds. Cell viability, wound area, healing rate, vascularization, cellular proliferation, dermal thickness, collagen architecture, and subtypes were evaluated. Both cell groups had a viability of 95% in fibrin gel prior to transfer. None of the wounds fully epithelialized on day 10, while all were epithelialized by day 21, which resulted in scars of different sizes and quality. Healing rate and scars were similar between the control and sham groups, whereas fastest healing and least scarring were noted in the OF group. Dermal thickness was highest in the DF group, which was also supported by highest levels of collagen types I and III. Proliferative cells and vascular density were highest in the OF group. DF result in healing through a thick dermal component, while oral fibroblasts result in faster healing and less scarring through potentially privileged angiogenic and regenerative gene expression.
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Dermis/citología , Fibroblastos/fisiología , Mucosa Bucal/citología , Repitelización , Animales , Proliferación Celular , Supervivencia Celular , Cicatriz/patología , Colágeno Tipo I/metabolismo , Colágeno Tipo III/metabolismo , Dermis/lesiones , Fibrina , Fibroblastos/trasplante , Geles , Humanos , Ratones , Neovascularización FisiológicaRESUMEN
Although the cancellation of elective procedures due to the COVID-19 outbreak has been a vital precaution, it has resulted in the suspension of aesthetic procedures and surgeries worldwide. Consequently, this postponement and other factors might have a negative impact on patients planning to undergo aesthetic procedures. Understanding the changes in patient motivation and perception in comparison to the prepandemic period is imperative for proper adjustment of plastic surgery clinics.A prospective questionnaire study was conducted on patients with cancelled aesthetic surgeries or procedures to determine the effects that coronavirus disease 2019 (COVID-19) had on patient motivation regarding cosmetic surgery and procedures and to establish a relationship between patient characteristics and the overall effect of pandemia on the perception of cosmetic surgery.Although most patients felt angry or frustrated due to the cancellation of their surgeries or procedures, the majority accepted that it was a necessary precaution. Patients with a history of previous minimally invasive procedures had a significantly higher ratio of acceptance for cancellations, whereas single patients were more likely to want to have their treatments done if the decision were left up to them. A subset of patients considered undergoing additional cosmetic procedures in the setting of self-isolation, and all patients stated that they would reschedule once the pandemia was under control.Patients with established motivation for plastic surgery and minimally invasive procedures ultimately plan to resume their normal treatments alongside others after the pandemia subsides. Plastic surgeons must actively communicate with their patient population during this time to properly educate, embrace, and direct them under scientific guidelines.
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COVID-19 , Cirugía Plástica , Estética Dental , Humanos , Motivación , Percepción , Estudios Prospectivos , SARS-CoV-2RESUMEN
BACKGROUND: Free fascial flaps are widely used for the reconstruction of defects located on the distal extremities as they provide thin yet durable soft tissue coverage. The serratus anterior fascia flap stands out from other fascial flap alternatives as it has optimal anatomical properties that can provide ideal coverage in a wide range of reconstructive challenges. The purpose of this study was to present our experience with the serratus anterior fascia flap in a variety of complex soft tissue defects. METHODS: A retrospective review was conducted on patients who underwent reconstruction with the free serratus anterior fascia flap for complex soft tissue defects involving the distal extremities. RESULTS: Complex soft tissue defects of 13 patients were reconstructed using the free serratus fascia flap. No major postoperative complications such as flap loss, dehiscence, infection, or hematoma were encountered in any of the patients. All of the patients demonstrated durable and harmonious long-term flap coverage that facilitated movement without any signs of scar contractures and tendon adhesions at the site of reconstruction. CONCLUSIONS: The serratus anterior fascia flap demonstrates versatility and stability for the closure of complex distal extremity defects. It creates thin yet durable coverage that facilitates underlying tendon gliding while providing harmony with the natural contours of these anatomic areas and has low donor site morbidity, making it a primary choice in the reconstruction complex soft tissue defects involving the hands and feet.
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Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Traumatismos de los Tejidos Blandos , Cicatriz , Fascia/trasplante , Humanos , Extremidad Inferior/cirugía , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/cirugíaRESUMEN
Kaposi sarcoma and cutaneous angiosarcoma are rare forms of skin malignancies that are vascular in nature and are frequently encountered in the immunosuppressed population. Although synchronous angiosarcoma and Kaposi sarcoma have been documented, to our knowledge, the coexistence of these vascular malignancies with underlying chronic lymphocytic leukemia has not been previously reported. A 51-year-old male patient with chronic lymphocytic leukemia presented with Kaposi sarcoma located on his left ankle. Shortly after, the patient presented with de novo lesions located on the plantar region of the right foot, reported as angiosarcoma. Following a multidisciplinary decision, treatment with adjuvant chemotherapy consisting of paclitaxel and carboplatin with consolidation radiotherapy was planned. The patient's Kaposi sarcoma has remained unchanged throughout this period. In such cases, the treatment is advised to be planned around the more aggressive malignancy. These patients should also be followed-up by dermatology due to the higher risk of secondary cutaneous malignancies.
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Earlobe elongation is one of the signs of aging process and surgical correction is warranted for earlobe ptosis. Most of the earlobe reduction techniques result with scars on the anterior or inferior aspect of the earlobe or unnatural appearance. The authors present a modified technique for earlobe reduction and reshaping that results with an acceptable scar set on the natural groove of the anterior surface of the earlobe. Nine healthy female patients were operated for earlobe reduction. The postoperative and preoperative otobasion inferius (O)-subaurale (S) distances of these patients were evaluated. According to the measurements, the preoperative mean O-S distance of the right lobule was 13.1 ± 1.8 mm and the left lobule was 12.8 ± 1.9 mm, while the postoperative O-S distance of the right side was 3.4 ± 1 mm and the left side was 3.4 ± 0.7 mm (Table 2). This translated to an approximate pre- and postoperative O-S distance difference of 9 mm, a significant reduction that resulted with ideal O-S values. The presented approach has numerous advantages including inconspicuous scarring, smooth lateral earlobe contours, and undisturbed free borders. This was a Level IV therapeutic study.
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Pabellón Auricular , Procedimientos de Cirugía Plástica , Cicatriz , Estética Dental , Femenino , Humanos , Periodo PosoperatorioRESUMEN
BACKGROUND: Although columellar strut grafts (CSGs) are considered among the fundamental steps for providing nasal tip support, a downward rotation of the nasal tip in patients with strut grafts can still be encountered. Patient-related factors such as nasal skin thickness can allow the plastic surgeon to anticipate certain drawbacks that can be encountered in the healing phase, but patient-based differences of nasal cartilage and the resulting impact have yet to be investigated. The purpose of this study was to evaluate the effect of the biomechanical properties of CSGs on late postoperative nasal tip position and support. METHODS: The study was undertaken with the participation of 20 patients undergoing closed-technique primary rhinoplasty with CSGs. Each cartilage specimen was biomechanically analyzed to calculate the modulus of elasticity. Preoperative and postoperative images were obtained to determine nasal tip position and rotation with quantitative measurements. Postoperative 3- and 12-month measurements were evaluated according to their relationship with the elasticity modulus of the utilized cartilages. RESULTS: The evaluation demonstrated that the elasticity modulus can impact the long-term support of the nasolabial angle in which an increase in the coefficient of elasticity can result in a decrease in long-term nasal tip support. CONCLUSION: The results of the study reveal a new objective variable that can impact nasal tip dynamics and patient-related differences following rhinoplasty. This study not only brings forth a different perspective in the evaluation of nasal tip dynamics but can also provide data for determining ideal values for cartilage prefabrication.
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Cartílagos Nasales/cirugía , Rinoplastia/métodos , Resistencia a la Tracción , Trasplante de Tejidos/métodos , Adulto , Fenómenos Biomecánicos , Estudios de Cohortes , Estética , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tabique Nasal/cirugía , Nariz/cirugía , Estudios Prospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Although the excision of the buccal fat pad has become very popular for achieving a slimmer midface, not all patients are good candidates for this procedure. Unfortunately, studies that provide guidelines by emphasizing volumetric and technical details are limited. OBJECTIVES: The study compared preoperative and postoperative volumetric data to identify the amount of tissue that can safely be removed and important technical concepts involved in lower cheek contouring with buccal fat pad excision. METHODS: Patients complaining of cheek fullness were evaluated to determine if they were good candidates for the procedure. Eligible patients were screened with transbuccal ultrasound to determine tissue volumes and anatomical details. Intraoperative and postoperative, 6th-month volume measurements were undertaken and residual tissues and vascular pedicles reevaluated. RESULTS: Ultrasound imaging showed that the mean preoperative volume of the fat pads was 11.67 ± 1.44 mL, and the mean postoperative volume was 8.58 ± 1.07 mL. The mean volume of the excised tissues was 2.74 ± 0.69 mL. Postoperative buccal fat pad volume values correlated with the reported average in the literature for the same age group. CONCLUSIONS: Buccal fat pad removal is an effective technique for refining the facial silhouette that should be reserved for patients with increased buccal fat pad volume. Removal of only the excessive portion of the fat pad is important because this structure provides significant volume in the midface that can be difficult to restore once aging affects the surrounding soft and bony tissue.
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Tejido Adiposo/cirugía , Mejilla/cirugía , Procedimientos de Cirugía Plástica/métodos , Tejido Adiposo/diagnóstico por imagen , Adulto , Mejilla/diagnóstico por imagen , Músculos Faciales/diagnóstico por imagen , Femenino , Humanos , Estudios Prospectivos , Ultrasonografía , Adulto JovenRESUMEN
Background/aim: Even though new techniques are emerging to overcome the inconsistent long-term viability of fat grafts, current methods for increasing fat graft survival are not routinely adaptable to all clinical environments. The purpose of this study was to determine the efficacy of microneedling as an adjunct to fat grafting to the face. Materials and methods: Twenty-two patients that underwent fat grafting to the face with adjunctive microneedling were evaluated in terms of improvement in facial skin quality and facial volume and their results were compared to those in 18 patients that underwent fat grafting without microneedling. The evaluation was conducted with a modification of the Global Aesthetic Improvement Scale at the postoperative third month. Results: All patients that underwent fat grafting and microneedling demonstrated "much improvement" in skin quality and volume at the postoperative third month while "improvement" was noted in patients that underwent fat grafting alone. The difference between skin quality and volume improvement scores was found to be significantly in favor of the patients that received adjunctive microneedling. Conclusion: Fat grafting to the face with adjunctive microneedling is a practical and potentially mutual-acting technique that can be used both for its significant effect on increasing fat graft survival and improving skin quality.
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Treatment of hand deformities in epidermolysis bullosa patients represents a challenging field in hand surgery practice, thus a systematic approach by a team is mandatory for a successful result. A simple and practical algorithm for the surgical treatment of hand deformities in EB was employed by the authors where the deformities of each digit in EB patients was categorized according to pseudosyndactyly and interphalangeal joint contracture severity for guidance during the surgical treatment. The current study retrospectively reviewed the medical records and photographic data of 13 EB patients followed in our department, for whom a systematic approach to the management and treatment was used. Mild cases were treated by surgical release and secondary healing with non-adhesive dressing while moderate cases were treated with autologous dermal grafts harvested with a special technique that were fixed on denuded areas on the proximal interphalageal joints after release. The remaining areas were treated similarly to the mild group. Additional K-wires were applied for two weeks in severe cases. A total of 21 procedures were performed on 13 EB patients with hand deformities according to the proposed treatment strategy. Functional recovery was satisfactory for each patient and the outcomes were dependent upon the severity of deformity. A multidisciplinary and conscious approach followed by an algorithmic surgical treatment protocol described in the study has been beneficial in providing consistent and successful long-term results for these patients.
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Epidermólisis Ampollosa Distrófica/complicaciones , Deformidades Adquiridas de la Mano/cirugía , Procedimientos de Cirugía Plástica/métodos , Rango del Movimiento Articular/fisiología , Trasplante de Piel/métodos , Adolescente , Algoritmos , Niño , Preescolar , Estudios de Cohortes , Contractura/etiología , Contractura/cirugía , Manejo de la Enfermedad , Progresión de la Enfermedad , Epidermólisis Ampollosa Distrófica/diagnóstico , Femenino , Estudios de Seguimiento , Deformidades Adquiridas de la Mano/diagnóstico , Humanos , Masculino , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
It has been established that many chemotherapeutic agents are associated with a variety of ocular side effects. As an antineoplastic agent, 5-fluorouracil (5-FU) is the chemotherapeutic agent that is frequently linked with cicatricial ectropion. Capecitabine is a prodrug of 5-FU and has a more favorable side effect profile than 5-FU. Frequent side effects of capecitabine include gastrointestinal events and hand-foot-mouth syndrome; cicatricial ectropion is rather uncommon. Enzyme deficiencies affecting the capecitabine metabolism have been reported to be associated with exaggerated generalized systemic and cutaneous side effects; however, there are no cases in the literature reporting capecitabine-induced isolated bilateral-progressive ectropion. Although cessation of the agent is frequently sufficient for the treatment of ectropion, close follow-up is indicated in such patients as permanent damage may occur if the problem is left untreated. We report a case of capecitabine-induced bilateral cicatricial ectropion refractory to treatment cessation, ultimately requiring surgical treatment.
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Background: Lip augmentation procedures have increased drastically in the last years as patients seek to enhance the shape and size of their lips with dermal fillers. One of the main concerns faced with these procedures is the pain inflicted through injections. On the other hand, many different techniques have been introduced for the reduction of pain while performing office-based minimal invasive procedures. Objectives: This study aims to determine the analgesic effect of vibration anesthesia during lip augmentation procedures and to evaluate its overall effect on the comfort of patients. Methods: A split-lip study was designed in a randomized fashion for 25 lip augmentation patients who received hyaluronic acid fillers with or without with a concurrent vibration stimulus on either half of their lips. Patients were asked to score the pain that they felt during lip injections on a scale from 0 to 10 (0 being no pain and 10 being the worst pain ever felt) for either lip half. The pain scores were then analyzed for significance. Results: The overall pain score on the vibration-assisted side was 3.82 ± 1.73 while the pain score for the side with no vibration was 5.6 ± 1.76 (P < 0.001). Twenty-three patients (92%) felt less pain with the addition of vibration while, interestingly, 2 patients (8%) stated that they felt an increase in pain levels on the vibration-treated side. Conclusions: Vibration devices can be a safe and effective tool for lowering pain levels in patients undergoing lip augmentation with hyaluronic acid fillers. Level of Evidence: 2.
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Anestesia/métodos , Técnicas Cosméticas , Dolor/prevención & control , Vibración , Adulto , Rellenos Dérmicos/administración & dosificación , Femenino , Humanos , Ácido Hialurónico/administración & dosificación , Labio , Persona de Mediana Edad , Dimensión del Dolor , Adulto JovenAsunto(s)
Circuncisión Masculina/efectos adversos , Necrosis/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Úlcera por Presión/diagnóstico , Úlcera por Presión/terapia , Estómago/cirugía , Adulto , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Necrosis/diagnóstico , Arteria Poplítea/patología , Arteria Poplítea/cirugía , Úlcera por Presión/fisiopatología , Resultado del TratamientoRESUMEN
Uncertainty in the management of animal-inflicted injuries, especially in rural settings, usually results in a general approach to leave all wounds to heal with secondary intention, which can lead to unsightly scarring and functional loss. This study focusus on different circumstances dealt with by plastic surgeons in a rural setting in Turkey and aims to configure what the general approach should be through an analysis of a wide spectrum of patients. Between June 2013 and December 2014, 205 patients who presented to the emergency department for animal-inflicted injuries were retrospectively analysed. Patients who consulted for plastic surgery were included in the analysis to determine which wounds require further attention. Patients with past animal-inflicted injuries who presented to the outpatient plastic surgery clinic with concerns such as non-healing open wounds or cosmetic or functional impairment were also evaluated. Statistical analysis demostrated a significantly lower rate of infection encountered in animal-inflicted open wounds (AIOWs) of patients who consulted for plastic surgery from the emergency department than those who presented to the outpatient clinic (P < 0·05). The main concern in the management of animal-inflicted wounds is their potential for infection, but this does not mean that every wound will be infected. The most important factor is being able to distinguish wounds that have a higher potential for infection and to select the type of wound management accordingly. An algorithm has been proposed as a guidance for the management of AIOWs, which covers the approach towards both domestic and stray animal-inflicted injuries.
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Cicatriz/prevención & control , Cicatrización de Heridas/fisiología , Heridas y Lesiones/etiología , Heridas y Lesiones/terapia , Adolescente , Adulto , Anciano , Algoritmos , Animales , Antibacterianos/uso terapéutico , Mordeduras y Picaduras , Bovinos , Niño , Preescolar , Cicatriz/epidemiología , Perros , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales de Enseñanza , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Medición de Riesgo , Población Rural , Trasplante de Piel/métodos , Técnicas de Sutura , Resultado del Tratamiento , Turquía , Infección de Heridas/epidemiología , Infección de Heridas/prevención & control , Heridas y Lesiones/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: The orbital floor is one of the most frequently injured areas of the maxillofacial skeleton during facial trauma. A retrospective analysis of patients who have undergone treatment of orbital floor fractures with heterologous cortical bone is presented. METHODS: This retrospective study was carried out with 21 patients over a period of 4 years between 2010 and 2014. All patients with a traumatic orbital floor defect who underwent reconstruction with heterologous cortical bone were included. The operations were carried out under general anesthesia for all patients. A subciliary incision was used in 20 patients and an infraorbital approach was used in one patient. All patients underwent follow-up examinations clinically as well as radiologically, at 1, 3, 6 and 12 months postoperatively. Computed tomographic scans were taken at the postoperative 6th month, and at the first postoperative year if needed. RESULTS: Preoperatively, the physical examination revealed diplopia in 17 patients (80.9%), gaze restriction in 14 patients (66.6%), enophthalmos in six patients (28.5%), and infraorbital nerve paresthesia in two patients (9.5%). None of the patients showed impaired visual acuity preoperatively or postoperatively. Diplopia and gaze restriction resolved postoperatively in all of the patients. All patients had a negative intraoperative forced duction test demonstrating free globe movement. Enophthalmos showed complete resolution in the postoperative period. In one of the two patients with preoperative infraorbital nerve paresthesia, this resolved at the postoperative fifth month. Scleral show appeared in six patients but resolved completely within 3-8 weeks with massage. There was no graft extrusion, resorption or displacement during the follow-up period. CONCLUSIONS: Tecnoss Semi Soft Lamina is a good alternative for the reconstruction of blowout fractures due to its plasticity and biocompatible structure. Without donor site morbidity, it is a safe and appropriate heterologous bone graft material for maxillofacial applications such as orbital floor reconstruction. We cannot recommend its use for near-total, wide orbital floor defects as it may not provide enough support in such circumstances.
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Hueso Cortical/trasplante , Xenoinjertos/trasplante , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Adolescente , Adulto , Animales , Niño , Diplopía/cirugía , Enoftalmia/cirugía , Femenino , Estudios de Seguimiento , Caballos , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/cirugía , Órbita/inervación , Parestesia/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
Elastofibroma is a benign and slow-growing soft tissue tumor that classically presents as an ill-defined solitary mass at the inferior pole of the scapula in the fifth and sixth decades of life for women. This tumor can be rarely seen in childhood, but it has not been reported in the infantile age group to date. To our knowledge, this case represents the first report of elastofibroma in the infantile age group. The aim of this report is to present a paravertebral elastofibroma in a 14-month-old patient and discuss the clinical features and treatment modalities.