Publications by authors named "Carlo M Oranges"

81 Publications

Reply: Adipose tissue grafts survival and bioactivity in relation to space and internal pressure of the recipient site: a transversal topic in plastic surgery.

Plast Reconstr Surg 2022 Jul 12. Epub 2022 Jul 12.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000009415DOI Listing
July 2022

Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies.

J Clin Med 2022 Jun 25;11(13). Epub 2022 Jun 25.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland.

Background: Free and pedicled flaps are both valuable surgical strategies for lower limb reconstruction. Evidence that compares both techniques is scarce. Our aim is to synthetise all the comparative studies by conducting a meta-analysis to identify post-operative outcomes.

Method: A systematic review of pubmed, EMBASE, Cochrane library, and Web of Science was conducted, aiming at articles comparing the outcomes of free versus pedicled flaps in lower limb reconstruction. A pooled analysis with the Mantel and Haenszel methods and random effect analysis provided results as a risk ratio with a 95% confidence interval.

Results: 10 retrospective studies were selected. While the flap necrosis rate did not differ significantly between techniques (RR 1.35, 95%CI 0.76-2.39, = 0.31), the partial flap necrosis rate was significantly lower in free flaps (RR 0.45, 95%CI 0.22-0.91, = 0.03). The overall complication rate (RR 0.83, 95%CI 0.64-1.07, = 0.16) and revision surgery rate (RR 1.38, 95%CI 0.55-3.50, = 0.49) did not differ significantly. No significant difference was found in the high aesthetic satisfaction rate (RR 1.76, 95%CI 0.57-5.41, = 0.32) and post-operative infection rate (RR 0.85, 95%CI 0.55-1.33, = 0.48).

Conclusion: Despite important variability in the choice of flaps and outcomes reported among studies, free and pedicled flaps appear to be reliable surgical strategies for lower limb reconstruction with similar surgical outcomes.
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http://dx.doi.org/10.3390/jcm11133672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267676PMC
June 2022

Sacral Defect Reconstruction Using Double Pedicled Gracilis Muscle Flap combined with Gluteal Fasciocutaneous Rotation Flap.

Plast Reconstr Surg Glob Open 2022 May 16;10(5):e4329. Epub 2022 May 16.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Several reconstructive approaches have been described for reconstruction after sacral chordomas, classically myocutaneous flaps. Recently, postural muscle preservation techniques are preferred whenever possible. We present the case of a 70-year-old man who underwent en-bloc resection of a sacral chordoma resulting in a large three-dimensional defect. To reconstruct the pelvic floor, an acellular dermal matrix and a double pedicled muscle gracilis flap were used to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with a unilateral gluteal fasciocutaneous rotation flap partially deepithelialized. No surgical complications were observed. Aesthetic and functional outcomes were both satisfying at 9-months postoperative follow-up. The ambulatory functions were not compromised. This combined flap reconstruction associated with a dermal matrix offers a reliable and effective option for sacral reconstruction while minimizing the morbidity.
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http://dx.doi.org/10.1097/GOX.0000000000004329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187201PMC
May 2022

Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques.

Ophthalmol Ther 2022 Aug 11;11(4):1383-1408. Epub 2022 Jun 11.

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.

Reconstruction of eyelid defects, especially the posterior lamella, remains challenging because of its anatomical complexity, functional considerations, and aesthetic concerns. The goals of eyelid reconstruction include restoring eyelid structure and function and achieving an aesthetically acceptable appearance. An in-depth understanding of the complex eyelid anatomy and several reconstructive principles are mandatory to achieve these goals. Currently, there are multiple surgical treatment options for eyelid reconstruction, including different flaps, grafts, and combinations of them. This comprehensive review outlines the principles of reconstruction and discusses the indications, advantages, and disadvantages of currently available surgical techniques. We also propose our clinical thinking for solving specific clinical questions in eyelid reconstruction and offer perspectives on new potential methodologies in the future.
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http://dx.doi.org/10.1007/s40123-022-00533-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253217PMC
August 2022

Rintala Flap and Posterior Perichondrial Cutaneous Graft: A Combined Approach for Nasal Tip Reconstruction.

Plast Reconstr Surg Glob Open 2022 May 6;10(5):e4316. Epub 2022 May 6.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Nasal tip reconstruction requires a meticulous approach due to the complexity of the nasal anatomy and its aesthetic importance. Many procedures have been described to restore this aesthetic unit, including the paramedian forehead flap, which is one of the workhorse flaps. However, despite excellent final outcomes, this procedure may be refused by patients, due to its temporary conspicuous appearance possibly associated with serious psychological implications, and the need of multiple interventions. We aimed to present an approach combining the Rintala flap and the posterior perichondrial cutaneous graft as a valuable alternative to treat large nasal tip defects.
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http://dx.doi.org/10.1097/GOX.0000000000004316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9076444PMC
May 2022

Head and Neck Porocarcinoma: SEER Analysis of Epidemiology and Survival.

J Clin Med 2022 Apr 14;11(8). Epub 2022 Apr 14.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

Porocarcinoma is a rare malignant adnexal tumor. Little is known about the location of the disease in the head and neck. Our aim is to offer the largest analysis of demographic, pathological, and treatment patterns of head and neck porocarcinoma in comparison with other locations of the neoplasm from an epidemiologically representative cohort.

Method: The Surveillance, Epidemiology, and End Results program of the National Cancer Institute was searched for all cases of porocarcinomas diagnosed between 2000 and 2018. This database is considered representative of the US population. Demographic, pathological, and treatment variables were compared between the head and neck and other regions. Overall and disease-specific survival was calculated and compared between groups.

Results: 563 porocarcinomas were identified, with 172 in the head and neck. The mean age was 66.4 years. Males were more affected in the head and neck. Regional and distant invasion rates were low (2.9 and 2.3%, respectively). Local excision and Mohs surgery were the most frequent therapies. Five-year overall survival was 74.8%. Five-year disease-specific survival was 97%.

Conclusions: Head and neck porocarcinoma affects more males than females. Regional or distant metastatic rates are low and overestimated in previous literature. Disease-specific mortality is low. Surgery remains the mainstay of treatment.
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http://dx.doi.org/10.3390/jcm11082185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9024621PMC
April 2022

Muscle vs. Fasciocutaneous Microvascular Free Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies.

J Clin Med 2022 Mar 11;11(6). Epub 2022 Mar 11.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

(1) Background: Lower extremity microvascular reconstruction aims at restoring function and preventing infection while ensuring optimal cosmetic outcomes. Muscle (M) or fasciocutaneous (FC) free flaps are alternatively used to treat similar conditions. However, it is unclear whether one option might be considered superior in terms of clinical outcomes. We performed a meta-analysis of studies comparing M and FC flaps to evaluate this issue. (2) Methods: The PRISMA guidelines were followed to perform a systematic search of the English literature. We included all articles comparing M and FC flap reconstructions for lower limb soft tissue defects following trauma, infection, or tumor resection. We considered flap loss, postoperative infection, and donor site morbidity as primary outcomes. Secondary outcomes included minor recipient site complications and the need for revision surgery. (3) Results: A total of 10 articles involving 1340 patients receiving 1346 flaps were retrieved, corresponding to 782 M flaps and 564 FC flaps. The sizes of the studies ranged from 39 to 518 patients. We observed statistically significant differences ( < 0.05) in terms of donor site morbidity and total flap loss with better outcomes for FC free flaps. Moreover, the majority of authors preferred FC flaps because of the greater aesthetic satisfaction and lesser rates of postoperative infection. (4) Conclusion: Our data suggest that both M and FC free flaps are safe and effective options for lower limb reconstruction following trauma, infection, or tumor resection, although FC flaps tend to provide stronger clinical benefits. Further research should include larger randomized studies to confirm these data.
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http://dx.doi.org/10.3390/jcm11061557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951471PMC
March 2022

Survival outcomes and epidemiology of Merkel cell carcinoma of the lower limb and hip: A Surveillance, Epidemiology, and End Results analysis 2000-2018.

JAAD Int 2022 Jun 23;7:13-21. Epub 2022 Feb 23.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Background: Merkel cell carcinoma of lower limb and hip skin is a rare skin tumor that has a high recurrence rate.

Objective: To assess epidemiology and survival outcomes of the lower limb and hip Merkel cell carcinoma, which are less addressed in the literature.

Methods: The Surveillance, Epidemiology, and End Results database was searched for all cases of skin Merkel cell carcinoma between 2000 and 2018. Demographic and clinicopathologic features were compared between lower limb and other skin localizations using the test or χ test. The overall survival (OS) of lower limb Merkel cell carcinoma was calculated using the Kaplan-Meier method. Subgroups were compared using the log rank test. Multivariate cox regression was used to identify independent prognostic factors.

Results: In total, 976 patients were identified. The mean age was 72.7 years. The median OS was 68 months, better than that of other localizations. Older age, regional lymph node, and distant metastasis were associated with low OS. Surgery with >1-cm margins, when associated with radiotherapy, had the best OS. Age, tumor size, lymph node status, presence of metastasis, and treatment sequence were identified as independent prognostic factors.

Conclusion: Lower limb and hip Merkel cell carcinomas have better OS than tumors in other skin localizations. In this dataset, the best OS was ensured using surgery with >1-cm margins and adjuvant radiotherapy.
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http://dx.doi.org/10.1016/j.jdin.2021.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873923PMC
June 2022

Squamous Cell Carcinoma of the Vulva: A Survival and Epidemiologic Study with Focus on Surgery and Radiotherapy.

J Clin Med 2022 Feb 16;11(4). Epub 2022 Feb 16.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

Vulvar squamous cell carcinoma (SCC) is the most frequent vulvar neoplasia. While the primary role of surgery is widely accepted, large population studies are needed to compare survival between diverse treatment modalities and to identify independent prognostic factors to help council patients and guide oncological treatment. The U.S. National Cancer Index, Surveillance, Epidemiology and End Results (SEER) program data between 2000 and 2018 was screened for all squamous cell carcinoma affecting the vulva. Raw data was processed with IBM SPSS. Demographic, clinical-pathological and treatment data were studied. Overall survival (OS) was calculated using the Kaplan-Meier method and subgroups were compared using the log rank test. A multivariate cox regression was conducted to identify independent prognostic factors. A total of 11,360 patients were identified with a median age of 65. Median overall survival was 101 months. Surgery as a primary treatment is the therapeutic sequence associated with the best overall survival. Multivariate cox-regression did not meet proportional hazard assumption. Age, pathological grade, stage at diagnosis, treatment sequence and the use of chemotherapy were identified as independent prognostic factor. Surgery alone is the treatment sequence offering the best overall survival. Surgery should be offered to all eligible patients.
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http://dx.doi.org/10.3390/jcm11041025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880528PMC
February 2022

Sacral Chordoma: A Population-based Analysis of Epidemiology and Survival Outcomes.

Anticancer Res 2022 Feb;42(2):929-937

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland;

Background/aim: Sacral chordoma is a rare primary bone neoplasm associated with high morbidity. The aim of this study is to identify demographic and clinicopathological characteristics of this tumor and evaluate their impact on survival outcomes.

Patients And Methods: The Surveillance, Epidemiology and End Results (SEER) database collecting data between 2000 and 2018 was searched for all cases of sacral chordoma. We analyzed demographic aspects, cancer stage and treatment patterns. Overall survival was calculated using the Kaplan-Meier method and compared between subgroups using the log-rank test. A multivariate Cox hazard regression analysis was conducted to identify independent predictors of overall survival.

Results: Four hundred and forty-two patients were identified with a mean age of 62.7 years. Most tumors presented regional invasion at diagnosis (43.2%). Mean overall survival was 124.7 months. No significant difference in terms of overall survival was found between surgery alone and surgery associated with radiotherapy. Both options provided a significantly increased survival than radiotherapy alone. Age of less than 50 years or between 50 and 69 correlated significantly with improved survival.

Conclusion: Age and stage at diagnosis impact significantly survival outcomes. Surgery remains the mainstay treatment with the highest overall survival. Its association with radiotherapy is currently questionable and needs further research.
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http://dx.doi.org/10.21873/anticanres.15552DOI Listing
February 2022

Sternocleidomastoid Muscle Transfer for Treatment of Longstanding Facial Paralysis: Long-term Outcomes and Complications.

In Vivo 2022 Jan-Feb;36(1):501-509

Plastic and Reconstructive Surgery Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China;

Background/aim: The use of sternocleidomastoid muscle (SCM) flap for facial reanimation was established in the 1980s by the senior author of this paper. We aimed to analyze long-term outcome and complications of this procedure.

Patients And Methods: We conducted a retrospective chart review of all patients undergoing SCM reanimation for longstanding facial palsy between January 2009 and December 2015. Patients with follow-up longer than 12 months (range=12-96) were included in the study. Facial muscle function was evaluated before and at each follow-up after the surgery with the House-Brackmann (HB) scale-facial nerve grading system and Facegram analysis. Donor site morbidity and overall complication rates were documented and analyzed.

Results: Forty-two patients aged 18-66 years (mean age=37) with a mean duration of facial palsy of 5 years (range=2-48) met the inclusion criteria. The HB score 2 years after surgery improved significantly (p<0.05) in comparison to the pre-operative condition (3.6 vs. 4.7). Twelve months after surgery, oral commissure excursion improved by mean 8.95 mm. No flap necrosis occurred, nor compromise of neck and shoulder function despite an obvious contour defect in the SCM donor site. None of the patients presented head posture or movement issues.

Conclusion: The SCM flap transfer is a reliable and effective procedure to achieve moderate improvement of the oral commissure excursion using a local method with moderate donor site morbidity. It can be regarded as a valuable option for dynamic facial reanimation in case of longstanding facial palsy.
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http://dx.doi.org/10.21873/invivo.12731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765154PMC
January 2022

Complications of Nonpermanent Facial Fillers: A Systematic Review.

Plast Reconstr Surg Glob Open 2021 Oct 22;9(10):e3851. Epub 2021 Oct 22.

Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.

Background: A variety of complications after injection of nonpermanent fillers for facial rejuvenation have been reported so far. However, to date, the overall complication rate is still a matter of debate. The aim of this study was to perform a systematic review of literature to assess the type and severity of associated complications following injections in different anatomical regions of the face.

Methods: The entire PubMed/Medline database was screened to identify case reports and clinical studies describing complications that have occurred after injection of nonpermanent fillers in the face. These complications have been reviewed and analyzed according to their occurrence in different anatomical regions of the face.

Results: Forty-six articles including a total of 164 patients reported on a total of 436 complications during the time period between January 2003 and February 2020. The majority of the complications were reported after injections to the nose and the nasolabial fold (n = 230), the forehead and the eyebrows (n = 53), and the glabellar region (n = 36). Out of 436 complications, 163 have been classified as severe or permanent including skin necrosis (n = 46), loss of vision (n = 35), or encephalitis (n = 1), whereas 273 complications were classified as mild or transient, such as local edema (n = 74), skin erythema (n = 69), and filler migration (n = 2). The most severe complications were observed in treatments of nose, glabella, and forehead.

Conclusions: Nonpermanent facial fillers are associated with rare but potentially severe complications. Severity and impact of complications depend on the anatomical region of the face and eventually require profound knowledge of facial anatomy.
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http://dx.doi.org/10.1097/GOX.0000000000003851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542164PMC
October 2021

Reduction Mammoplasty: A Ten-Year Retrospective Review of the Omega Resection Pattern Technique.

J Clin Med 2021 Sep 27;10(19). Epub 2021 Sep 27.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.

Reduction mammoplasty is the gold standard procedure for symptomatic breast hypertrophy and it is also used for contralateral breast symmetrisation following breast cancer surgery. We aim at introducing a new procedure, which uses an omega resection pattern to simplify the inferior pedicle breast resection technique. A retrospective review of all patients who underwent the omega resection reduction mammoplasty at the University Hospital of Basel between 2010 and 2020 was carried out. We collected patient demographics, surgical outcomes, operation time, type and frequency of complications at 12 months follow-up. Outcomes were compared with the most commonly used techniques. Additionally, we assessed if patients' and clinical characteristics augmented/diminished the complication rate. During the study period, 67 reduction mammaplasties were performed by a senior plastic surgeon (M = 42.5, SD = 15.6; M = 27.28, SD = 3.4; 20% smokers). The average tissue removed was 826 g (ranging from 15 to 2307 g). In 10 breasts (15%) occurred minor complications. No major complications were reported. Operation time (M = 149 min; ranging from 87 to 270 min) was significantly shorter than the inferior, superomedial, and superior pedicle techniques. Univariate Odd Ratios showed that no-smoker status, a BMI in a normal range, resection weight between 500 g to 1500 g, NTN distance < 30 cm, removal of drains one day after the operation, ASA index of 2, inpatient clinic hospitalisation, and not undergoing other concomitant surgical operations were protective factors against the risk to develop complications. The omega resection pattern technique demonstrated to be an effective, safe, and fast mammoplasty reduction procedure for bilateral macromastia and unilateral symmetrizing procedures, even for large breasts, able to be adopted as a new valid alternative to the existing ones.
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http://dx.doi.org/10.3390/jcm10194418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509280PMC
September 2021

The Butterfly Technique: A Retrospective Study for Labia Minora Reduction Using an Integrated Approach.

Plast Reconstr Surg Glob Open 2021 Sep 13;9(9):e3810. Epub 2021 Sep 13.

Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals (HUG), University of Geneva, Geneva, Switzerland.

In recent years, the demand for genital plastic procedures has increased. Of those, the reduction of the labia minora has become very popular. Several techniques are described, with all its advantages and disadvantages. The aim of this study is to introduce a novel approach combining de-epithelialization with wedge resection.

Methods: In this retrospective study, we included patients seen between September 2011 and April 2014 with hypertrophic labia minora. The surgical technique consisted in an integrated approach of de-epithelialization and wedge excision. Patients were examined for early and late postoperative complications. Furthermore, patient satisfaction was evaluated at the final follow-up.

Results: A total of 17 labioplasties (Franco type II-IV) in 10 patients with a mean age of 29 ± 12 years (range 20-62 y) were performed. Three patients experienced wound-healing problems, requiring surgical revision. After a median follow-up of 39 ± 6 months (range 28-48 mo), a high overall patient satisfaction has been achieved (8.6 ± 1.1). No dyspareunia, hypertrophic scarring, or micturition problems have been reported.

Conclusions: By using our integrated approach, hereby called the "butterfly technique," the neurovascular supply remains preserved, and an efficient volume reduction can be achieved with a concealed scar. Nevertheless, suture techniques and suture materials have to be tested to reduce the incidence of wound dehiscence rate.
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http://dx.doi.org/10.1097/GOX.0000000000003810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432638PMC
September 2021

[Management of symptomatic breast hypertrophy and reduction mammaplasty].

Rev Med Suisse 2021 Jun;17(743):1177-1181

Service de chirurgie plastique, reconstructive et esthétique, Département de chirurgie, HUG, 1211 Genève 14.

Breast hypertrophy (macromastia) can cause various symptoms correlated with excessive breast volume and is usually associated with breast ptosis. Symptomatic macromastia can constitute a heavy burden on patient's global health. While conservative therapy does not allow for long term relief, breast reduction mammaplasty is an effective and safe treatment. Multiple techniques have been described, but all rely on common principles. Measures can be taken to lower surgical complications rates and implemented by primary care physicians in collaboration with the plastic surgery approach.
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June 2021

Rhinosurgery during and after the COVID-19 Pandemic: International Consensus Conference Statement on Preliminary Perioperative Safety Measures.

Plast Reconstr Surg 2021 05;147(5):1087-1095

From the Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, University of Basel; the Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven Campus Gasthuisberg; the Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute; private practice; the Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital; the Department of Otorhinolaryngology, University College Hospital; the Clinic for Plastic Surgery; the Department of Facial Plastic Surgery, Marienhospital; the Department of Otorhinolaryngology, Head and Neck Surgery, Facial Plastic Surgery, Klinikum Karlsruhe; the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine; Klinik für Hals-, Nasen-, Ohren- und Gesichtschirurgie, Kantonsspital Luzern; the Dallas Plastic Surgery Institute; and the Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII.

Background: The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society.

Methods: A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel's recommendations were based on current evidence and expert opinions. The resulting report was circulated in an iterative open e-mail process until consensus was obtained.

Results: Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures.

Conclusion: The implementation of the panel's recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.
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http://dx.doi.org/10.1097/PRS.0000000000007868DOI Listing
May 2021

Increasing Fat Graft Retention in Irradiated Tissue after Preconditioning with External Volume Expansion.

Plast Reconstr Surg 2021 01;147(1):158e-159e

Department of Plastic, Reconstructive, and Aesthetic Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000007445DOI Listing
January 2021

Arteriovenous Loops Enable Free Tissue Transfer With Otherwise Inadequate Local Donor and Recipient Vessels.

In Vivo 2020 Sep-Oct;34(5):2543-2548

Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.

Background/aim: Free flap reconstruction with damaged or diseased vessels is a challenging problem. We describe our case series using an arteriovenous loop or bypass surgery with free flaps for complex defect reconstructions at the lower extremity and the pelvic region.

Patients And Methods: In this single-center retrospective cohort study 11 consecutive patients (mean age=73 years, range=53-88 years) were operated on, between June 2016 and August 2018. Patients were reconstructed with free gracilis flaps (n=8), free latissimus dorsi flap (n=1) and chimeric scapular flap (n=1), respectively.

Results: The mean loop length was 30 cm (range=12-40 cm). The loop/bypass revision rate was 27% (3/11), and the overall flap loss rate was 20% (2/10). After a mean follow-up time of 17 months (range=12-24 months), the limb salvage rate was 75% (6/8).

Conclusion: We successfully reconstructed complex defects with poor recipient vessels using arteriovenous loops or bypass surgery and free flaps.
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http://dx.doi.org/10.21873/invivo.12071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652518PMC
June 2021

Discussion: Comparison of Patient Symptomatology before and after Labiaplasty.

Plast Reconstr Surg 2020 09;146(3):537-538

From the Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, University of Basel; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Lausanne University Hospital; and the Department of Plastic and General Surgery, Turku University Hospital, University of Turku.

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http://dx.doi.org/10.1097/PRS.0000000000007142DOI Listing
September 2020

A Changing Paradigm: The Brazilian Butt Lift Is Neither Brazilian Nor a Lift-Why It Needs to Be Called Safe Subcutaneous Buttock Augmentation.

Plast Reconstr Surg 2020 10;146(4):502e-503e

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000007200DOI Listing
October 2020

Recipient-Site Preconditioning with Deferoxamine Increases Fat Graft Survival by Inducing VEGF and Neovascularization in a Rat Model.

Plast Reconstr Surg 2020 07;146(1):101e-102e

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000006929DOI Listing
July 2020

Human platelet lysate stimulated adipose stem cells exhibit strong neurotrophic potency for nerve tissue engineering applications.

Regen Med 2020 03 20;15(3):1399-1408. Epub 2020 Apr 20.

Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.

We investigated a potential strategy involving human platelet lysate (HPL) as a media additive for enhancing the neurotrophic potency of human adipose stem cells (ASC). Dorsal root ganglion explants, ASC and Schwann cells were used for axonal outgrowth experiments. Remarkably, HPL-supplemented ASC promoted robust axonal outgrowth, in other words, four-times higher than fetal bovine serum-supplemented ASC and even matched to the level of Schwann cells. Further, analysis of regime of growth medium additive supplementation revealed the critical play of HPL in dorsal root ganglion and stem cells co-culture system for mounting effective axonal growth response. HPL supplementation significantly improved the neurotrophic potency of ASC as evidenced by the robust axonal outgrowth; these findings hold significance for nerve tissue engineering applications.
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http://dx.doi.org/10.2217/rme-2020-0031DOI Listing
March 2020

Sensory assessment of meshed skin grafts over free gracilis muscle flaps without nerve coaptation for lower extremity reconstruction.

Arch Plast Surg 2021 Mar 10;48(2):224-230. Epub 2020 Apr 10.

Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.

Background: Little is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation.

Methods: Thirteen consecutive patients with a median age of 55 years (range, 21-70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed.

Results: All flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10-51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5°C and 25% at 25°C).

Conclusions: Finer sensation could be partially restored. However, thermal sensation remained poor.
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http://dx.doi.org/10.5999/aps.2019.00584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007463PMC
March 2021

Fat Grafting into Younger Recipients Improves Volume Retention in an Animal Model.

Plast Reconstr Surg 2020 03;145(3):657e-658e

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000006574DOI Listing
March 2020

Clostridial Infection After Open Fractures of the Lower Extremity - Report of Two Cases and Discussion of Pathomechanism and Treatment.

In Vivo 2020 Jan-Feb;34(1):291-298

Department of Orthopedic Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.

Background: Management of post-traumatic open fractures resulting from severe injuries of the lower extremity continues to challenge orthopedic and reconstructive surgeons. Moreover, post-traumatic osteoarticular infections due to Clostridium species are rare, with few reports in the literature. We describe possible pathomechanisms and propose treatment options for cases of delayed diagnosis of osteoarticular infections with Clostridium spp.

Case Reports: Two patients sustained severe osteoarticular infection due to Clostridium spp. after open epi- and metaphyseal fractures of the lower extremity. In combination with radical debridement, ankle arthrodesis and long-term antibiotic treatment, satisfactory results were achieved after a follow-up of 18 months and 24 years.

Conclusion: Clostridium species are difficult to identify, treatment is usually delayed and most patients have unfavourable outcomes.
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http://dx.doi.org/10.21873/invivo.11773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984111PMC
June 2020

Local anesthetic pain catheters to reduce opioid use in massive weight loss patients undergoing abdominoplasty: A comparative study.

J Plast Reconstr Aesthet Surg 2020 Apr 28;73(4):770-776. Epub 2019 Nov 28.

Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland.

Background: Abdominoplasty is a common procedure for anatomical restoration of the lower abdominal skin, with a continuously increasing annual number of procedures performed. The significance of postoperative pain management is of crucial importance from a patient's perspective and to ensure the achievement of the aimed clinical outcome. We evaluated the efficacy of local pain pump catheters (PPCs) on massive weight loss patients undergoing body-contouring abdominoplasty.

Methods: Primary abdominoplasty procedures after massive weight loss performed from 2009 to 2014 were retrospectively reviewed. The patients were divided into two groups according to the use of the PPC. The primary outcome measure was the amount of opioid use calculated as morphine equivalents. The secondary outcome measures were the length of hospital stay (LOS) and early postoperative complications within 30 days of surgery.

Results: A total of 61 patients were included in the study: 24 patients in the PPC group and 37 patients in the conventional abdominoplasty analgesia (CAA) group. No significant differences between the study groups were found with regard to demographics, operative time, and resection weight. A significantly decreased use of opioids was observed after using PPC versus control (14.0 ± 13.9 mg vs. 74.6 ± 73.3 mg, p < 0.001). Similarly, the LOS was shorter in the PPC group (3.1 ± 1.1 days vs. 3.8 ± 1.0 days, p = 0.023). There was a similar rate of complications in both groups (45.8% vs. 40.5%, p = 0.622). The most common complication was seroma formation (25.0% vs. 18.5%, p = 0.315).

Conclusion: The use of local anesthetic pain catheters in abdominoplasty may be associated with a decreased use of opioids and might result in a shorter hospital stay on massive weight loss patients. Further studies are needed to validate this treatment modality.
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http://dx.doi.org/10.1016/j.bjps.2019.11.003DOI Listing
April 2020

Delayed Postconditioning with External Volume Expansion Improves Survival of Adipose Tissue Grafts in a Murine Model.

Plast Reconstr Surg 2020 01;145(1):203e-204e

Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, University of Basel, Basel, Switzerland.

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http://dx.doi.org/10.1097/PRS.0000000000006338DOI Listing
January 2020

Free Pedicled Anterolateral Thigh Flap for Abdominal Wall Reconstruction.

Anticancer Res 2019 Dec;39(12):6759-6768

Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Background/aim: Large full thickness abdominal wall defects following malignancies can be a reconstructive challenge. The purpose of this study was to analyze long-term outcomes and complications following abdominal wall reconstruction using composite antero-lateral thigh (ALT) flaps.

Patients And Methods: The study retrospectively investigated 16 consecutive patients who underwent abdominal wall reconstruction with autologous flap between May 2003 and March 2018. Volumetric flap analysis was used to assess flap atrophy over time, evaluating the role of denervation and reinnervation. The long-term outcome was assessed to compare the two groups (free vs. pedicled ALT flap reconstructions).

Results: All flaps successfully covered the defects. We found a significant increase in flap resorption in free flaps when compared to pedicled ones. Abdominal bulging was seen in 3 out of 16 (19%) patients after more than 12 months follow-up, in close correlation with mesh absence.

Conclusion: Free flaps were shown to be equally effective as their pedicled counterparts, without significant increase in complication rate.
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http://dx.doi.org/10.21873/anticanres.13891DOI Listing
December 2019

Immediate versus Delayed Contralateral Breast Symmetrisation in Breast Reconstruction with Latissimus dorsi Flap: A Comparative Study.

Breast Care (Basel) 2019 Oct 17;14(5):272-276. Epub 2019 Sep 17.

Department of Plastic and General Surgery, Turku University Hospital and the University of Turku, Turku, Finland.

To achieve symmetry in unilateral free flap breast reconstruction often requires a contralateral procedure. There is no evidence in the literature to support the benefit of immediate contralateral breast symmetrisation concomitant to breast reconstruction. We hypothesized that performing a simultaneous contralateral balancing operation at the time as the initial reconstruction might provide immediate symmetry and minimize the frequency of secondary procedures. Thus, we performed a comparative study on this issue. A comparative retrospective study was conducted on 78 consecutive patients who underwent unilateral breast reconstruction surgery with latissimus dorsi (LD) flap and contralateral breast symmetrisation from January 2014 to June 2016 at Turku University Hospital. Exclusion criteria included other breast reconstruction techniques and no contralateral symmetrisation at follow-up. The patients were divided according to the timing of contralateral breast balancing operation into an immediate versus a delayed group. Postoperative complications, outcomes, and re-operations were compared. Baseline characteristics were well balanced between the groups except for comorbidity, which was significantly higher in the immediate group. Mastectomy weights (735.6 vs. 390.7 g, = 0.015), contralateral breast reduction weights (268.3 vs. 105.8 g, = 0.014), and implant size (218.9 vs. 138.9 g, = 0.001) were significantly larger in the immediate group. No significant differences in any kind of complications were detected. Similarly, the rates of re-operations were similar among the groups (24.0 vs. 43.3%, = 0.134). Performing immediate symmetrisation at the time of breast reconstruction is safe and feasible in autologous LD breast reconstructions, where 76% did not require a second operation for symmetry. There were no differences in the rate of any re-operation and, therefore, performance of simultaneous contralateral reduction is a reasonable option.
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http://dx.doi.org/10.1159/000502769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883469PMC
October 2019

Augmentation Gluteoplasty: A Brazilian Perspective.

Plast Reconstr Surg 2019 10;144(4):711e-712e

Department of Plastic and General Surgery, Turku University Hospital, University of Turku, Turku, Finland.

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http://dx.doi.org/10.1097/PRS.0000000000006038DOI Listing
October 2019
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