| 1. |
- Almeland, Stian, et al.
(författare)
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The effect of microsurgical training on novice medical students’ basic surgical skills—a randomized controlled trial
- 2020
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Ingår i: European journal of plastic surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 43, s. 459-466
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Tidskriftsartikel (refereegranskat)abstract
- Background It has been demonstrated that medical students are capable of learning microsurgical techniques. We hypothesize that microsurgical training might give insight into the importance of delicate tissue handling and correct knot tying that could have a positive influence on macrosurgical skills. The primary aim of this study was to evaluate the effect of microsurgical training on macrosurgical suturing skills in novice medical students. Subjects and methods In 2018, 46 novice medical students were enrolled and randomized into two groups. The intervention group received both macro- and microsurgical training and the control group received only microsurgical training. Both groups underwent an assessment test that consisted of macrosurgical tasks of three simple interrupted sutures with a square knot and continuous three-stitch long over-and-over sutures. These tests were individually filmed and assessed using the University of Bergen suturing skills assessment tool (UBAT) and the Objective Structured Assessment of Technical Skill global rating scale (OSATS). Questionnaires regarding future career ambitions and attitudes towards plastic surgery were also completed both prior to and following the tests. Results The intervention group needed a longer time to complete the tasks than the control group (12.2 min vs. 9.6 min, p>0.001), and scored lower on both the UBAT (5.6 vs. 9.0, p>0.001) and the OSATS (11.1 vs. 13.1, p>0.001) assessments. The microsurgery course tended to positively influence the students’ attitudes towards a career in plastic surgery (p=0.002). This study demonstrates poorer macrosurgical skills in the medical students group exposed to microsurgical training. The true effect of microsurgical training warrants further investigation.
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| 2. |
- Andreasson, My, et al.
(författare)
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Narrow neovaginal width in a transgender patient due to short interramic distance
- 2017
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 40:5, s. 487-488
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Tidskriftsartikel (refereegranskat)abstract
- Vaginoplasty is one of the core procedures for transgender patients. Aneovaginal cavity is created between the prostate and rectum. The width of the introitus is determined by the distance between the inferior pubic rami. A 32-year-old transgender patient underwent vaginoplasty. Surgery was uneventful. When starting the dilation regimen, insertion of the usual stent was impossible since the neovagina had restricted width. A CT scan of the pelvis showed that the interramic distance, at 3.0 cm below the lower border of bony structure of the symphysis pubis, was only 3.2 cm. If a transgender patient presents with short stature, a short interramic distance may be expected. Preoperative radiologicalimagingshouldbeconsidered. Surgeonsshouldbe equipped with adequate-size stents for postoperative dilation regimen.
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| 3. |
- Hallberg, Håkan, et al.
(författare)
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Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up
- 2019
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 42:1, s. 33-42
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Tidskriftsartikel (refereegranskat)abstract
- © 2018, The Author(s). Background: Matrices are now commonly used in breast reconstruction, but the scientific evidence is still scares. The main aim was to compare complications and the need for corrections in immediate breast reconstruction with the porcine-derived Surgisis®with the traditional muscle-covered technique. The secondary aim was to compare long-term quality of life and satisfaction. Methods: All consecutive patients who had their breast reconstructed with a Surgisis®or muscle-covered tissue expander/implant were included. Patients were followed clinically and with BREAST-Q. Results: During the study period, 116 reconstructions (71 patients) were operated in the Surgisis®group and 132 reconstructions (90 patients) in the control group. The median follow-up time was 74months (min 43–max 162). The total early complication rate was 37% in the Surgisis®group and 27% in the control group. There were no differences in implant loss (p = 0.68) or total number of complications (p = 0.24) between the two groups. Risk factors for complications were mainly patient characteristics and the use of a tissue expander. There was a slightly higher capsular contracture frequency in the Surgisis®patients (4.2% vs. 2.5%). The need for corrections and patient satisfaction and quality of life were similar in the two groups. Conclusions: The use of Surgisis®in implant-based reconstruction seems to result in an acceptable total early complication rate. The rate might be higher in tissue expander-based reconstruction. Risk factors are mainly patient characteristics. The capsular contracture rate and need for corrections, as well as patient satisfaction and quality of life, are similar in the Surgisis®patients and muscle-covered controls. Level of evidence: III.
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| 4. |
- Hansson, Emma, et al.
(författare)
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Designing and arranging an undergraduate elective course in plastic surgery—the experiences of a Scandinavian department
- 2016
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 39:3, s. 207-212
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Tidskriftsartikel (refereegranskat)abstract
- Background: In recent years, the medical curricula have become more crowded and the majority of medical students are no longer exposed to plastic surgery in medical school. Previous studies have revealed that most medical students are not aware of what the speciality entails.The aims of this paper were to describe the development of an elective course, as a method for including more plastic surgery in undergraduate medical training, and to investigate how many students were attracted to the course. Methods: The course was designed to build on knowledge the students had acquired previously in their training. The aims and learning objectives were chosen so that they would be potentially useful to all future doctors and were described according to the SOLO taxonomy and the levels of Miller’s pyramid of learning were applied. Results: The course attracted students who had not previously considered a career in plastic surgery. The number of students applying for the course exceeded the number of places on offer and the course was well received by the students taking it. Conclusions: The course has the potential to increase the knowledge about plastic surgery among future doctors, possibly leading to improvements in both referrals and recruitment of suitable young doctors to the speciality. Level of Evidence: Not ratable.
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| 5. |
- Holm, Sebastian, et al.
(författare)
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Cutaneous steam burns and steam inhalation injuries : a literature review and a case presentation
- 2022
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Ingår i: European journal of plastic surgery. - : Springer Nature. - 0930-343X .- 1435-0130. ; 45:6, s. 881-896
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Tidskriftsartikel (refereegranskat)abstract
- Scald is one type of burn that s often mentioned alone and occurs mostly in the paediatric population. Inhaled steam is mostly cooled off in the airways, why thermal damage is rarely seen. A sudden exposure to hot steam/inhalation can cause a thermal inhalation injury. A scoping review was performed, with the aim to summarize all published papers in English, about steam-related injuries. The search was conducted using the PubMed (R) and Cochrane libraries on 19th of May 2021, without a set time period. Out of a total of 1186 identified records, 31 were chosen for review. Burns related to the contact with steam are generally rare and can be both minor and severe. The more severe cases related to steam exposure are mostly workplace accidents and the minor injuries reported in the literature are often related to steam inhalation therapy, especially in the paediatric population. This review describes the challenges that can be found dealing with patients suffering from cutaneous steam burns and/or steam inhalation injuries. A steam injury to the airways or the skin can be directly life-threatening and should be treated with caution. This type of injury can lead to acute respiratory insufficiency and sometimes death. A case of a male patient with extensive cutaneous steam burns and a steam inhalation injury who passed away after 11 days of treatment is also presented to illustrate this review. Level of evidence: Level V, Therapeutic; Risk/Prognostic Study.
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| 6. |
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| 7. |
- Madura, Tomas, et al.
(författare)
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Circumoral complications in hereditary sensory and autonomic neuropathy - A case of simple lip reconstruction?
- 2013
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Ingår i: European journal of plastic surgery. - : Springer. - 0930-343X .- 1435-0130. ; 36:5, s. 319-321
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Tidskriftsartikel (refereegranskat)abstract
- We report a case of a 7-year-old Bangladeshi boy who caused himself oral incontinence by self-mutilation. The patient was known to suffer from hereditary sensory and autonomic neuropathy type V. As definitive management, a full dental clearance was performed along with reconstruction of the lower lip with a good functional and aesthetic outcome. He did not experience any adverse effects from the full dental clearance with regard to feeding, nutrition or development. We discuss the dilemma and challenges raised in the management of this patient and highlight the need for a multi-disciplinary specialist input for what appeared to be a simple case of lip reconstruction for a plastic surgeon.
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| 8. |
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| 9. |
- Ockell, Jonas, et al.
(författare)
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Physical measurements and patients' perception of excess skin on arms and thighs before and after bariatric surgery
- 2022
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 45:4, s. 631-640
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Tidskriftsartikel (refereegranskat)abstract
- Background Bariatric surgery is an effective weight loss method for patients with obesity. One side effect of bariatric surgery is uncomfortable excess skin. Much remains to be learned about physical measurements and patients' subjective perceptions of it. Here, we investigated the pre- to post-bariatric changes in patients' perception and physical measurements of the skin on the arms and thighs, in order to find possible subgroups especially affected by post-operative excess skin and to identify predicting factors. Methods One hundred forty-seven patients eligible for bariatric surgery completed the Sahlgrenska Excess Skin Questionnaire (SESQ) and underwent measurements of their skin before and 18 months after the procedure. Results Although most physical measurements decreased post-operatively, many patients reported increased discomfort. We identified one subgroup particularly prone to report excess skin on the arms post-operatively: women with high discomfort from excess skin on the arms and high body mass index (BMI), pre-operatively. Ptosis of the excess skin seems to be a feasible measurement for predicting post-operative discomfort. For every centimetre of ptosis pre-operatively, patients had 1.37- and 1.31-fold higher odds of achieving a score for post-operative discomfort from excess skin on the upper arms and thighs, respectively, of >= 6 (on a 0-10 scale). Conclusions We identified a subgroup especially affected by discomforting excess skin on arms and thighs after weight loss. Furthermore, we suggest a pre-operative pro-operative ptosis measuring to predict post-operative discomfort level. The result of this study further increases the knowledge of excess skin and should be useful in further improving patient education.
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| 10. |
- Olofsson, K, et al.
(författare)
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Self-perception after hypospadias repair in young men's perspective
- 2003
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 26:6, s. 294-297
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Tidskriftsartikel (refereegranskat)abstract
- Twenty-one males underwent an interview, clinical investigation, and measurement of urine flow and residual volume 15-25 years after surgery. Although surgical techniques have been improved during recent decades, the results of hypospadias repair made 20 years ago are nethertheless acceptable and most patients regard the outcome as satisfactory.
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| 11. |
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| 12. |
- Reilly, Frank O. F., et al.
(författare)
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Implementation of robot-assisted lymphaticovenous anastomoses in a microsurgical unit
- 2024
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Ingår i: European journal of plastic surgery. - : Springer. - 0930-343X .- 1435-0130. ; 47
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Tidskriftsartikel (refereegranskat)abstract
- Background: Numerous papers have been published evaluating the clinical benefits of robot-assisted microsurgery. In this study, we describe the incorporation of the MUSA-2 robot (Microsure, Eindhoven, The Netherlands) into a plastic surgery unit outside of its development centre. We aimed to assess robot implementation timeframes, areas of future development, and key learning points for centres considering the establishment of a robot-assisted microsurgery service.Methods: We identified 12 female patients with upper limb lymphoedema secondary to breast cancer treatment, who consented to have a robotic-assisted lymphaticovenous anastomosis (LVA) from September 2022 to March 2023. All patients had at least one robot-assisted LVA. Post operatively, a surgical evaluation of the robot's performance and of the surgeon's intraoperative workload was measured. Each patient completed a postoperative Likert scale, which measured their surgical experience.Results: The mean robot time per case was 60.25 min. The mean time taken for the first robot-assisted anastomosis was 32 min. The second robot anastomoses was 30% faster than the first, taking a mean of 22.5 min. The average anastomosis had 4.5 sutures placed robotically. Initial mean scores in the workload survey completed by the surgeon were highest for frustration and effort, both reduced with increasing volume of cases. In 91% of cases, physical intraoperative discomfort was reported by the surgeon but completely resolved following repositioning.Conclusions: The current technology can be readily incorporated into a microsurgical unit. We developed four key learning points from the implementation of robot-assisted LVA in our microsurgical unit.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
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| 17. |
- Smeele, Hansje P., et al.
(författare)
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Breast reconstruction timing and modality in context : A cross-sectional study in Uppsala, Maastricht, and Rome
- 2023
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Ingår i: European journal of plastic surgery. - : Springer. - 0930-343X .- 1435-0130. ; 47:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWith the development and refinement of techniques most mastectomy patients nowadays are candidates for breast reconstruction. No one surgical technique fits all, however. Treatment choices are driven by patient characteristics and preferences, alongside policy and operational factors. These, in turn, might be expected to differ on several levels of aggregation, for example, countries, regions, and hospitals. The aim of this study was to compare choices for breast reconstruction timing and modality in Uppsala (Sweden), Maastricht (the Netherlands), and Rome (Italy).MethodsIn this cross-sectional study, patients presenting for first-time post-mastectomy breast reconstruction in three teaching hospitals were included. The primary study outcomes were breast reconstruction timing and modality. Covariables were body habitus (i.e., body mass index, waist circumference, and mastectomy weight), health-related quality of life assessed with the BREAST-Q Reconstruction module, patient preferences assessed with a self-constructed questionnaire, and shared decision making assessed with the CollaboRATE questionnaire. Statistical tests were used to compare data across study sites.ResultsSixty-six participants were included. The most common choices for breast reconstruction timing and modality were delayed DIEP flaps in Uppsala (53%), immediate DIEP flaps in Maastricht (44%), and immediate prepectoral implants in Rome (92%). Participants in Rome were much slenderer than participants in Uppsala and Maastricht (mean body mass index 21.6, 26.2, and 26.3 kg/m2, respectively; p < 0.05). Participants in Uppsala and Maastricht highly valued material used for the reconstruction; participants in Rome were significantly more concerned with complications, scars, and recovery duration associated with the reconstruction.ConclusionsThis study shows large differences in choices for breast reconstruction timing and modality in Uppsala, Maastricht, and Rome. Possible reasons for the observed variation include differences in patient characteristics, patient preferences, reconstructive techniques available, and reimbursement.Level of evidenceLevel IV, Therapeutic study.
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| 18. |
- Stiernman, Mia, et al.
(författare)
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Parental and health care professional views on psychosocial and educational outcomes in patients with cleft lip and/or cleft palate
- 2019
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 42:4, s. 325-336
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Tidskriftsartikel (refereegranskat)abstract
- Background: Earlier research has investigated psychosocial and educational issues in populations of patients with cleft identifying several areas of concern. The objective of this study was to investigate current beliefs and knowledge about psychosocial and educational issues in parents and health care professionals (HCP) of children with cleft lip and/or palate (CL/P). Method: Parents were interviewed concerning the view of society on people with visible differences, their child’s social life, educational progress, and information regarding psychosocial care. Interviews with HCPs concerned characteristics related with educational achievement, behavior, and social relationships. Fifteen parents of children 9 to 13 years of age with CL/P and 10 HCPs and were interviewed. Data from interviews was analyzed with thematic analysis. Results: Eight children were reported to have emotional issues related to their cleft. Eleven parents, however, did not perceive that their child was treated differently in society. HCPs expressed concerns regarding for example coping with being different, low self-esteem, shyness, disadvantage on first impression, and acceptance of themselves. A majority of the HCPs did not think patient cognition and behavioral or physical development were specifically affected. Conclusions: The results revealed that parent experience and views were diverse—from no specific problems related to the cleft, to both emotional and educational issues. The beliefs and level of knowledge in HCPs also varied. All HCPs, however, wished for more information and training regarding psychosocial issues. Level of Evidence: Level VI, Diagnostic/Qualitative study.
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| 19. |
- Stiernman, Mia, et al.
(författare)
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Translation and pilot study of the Cleft Hearing Appearance and Speech Questionnaire (CHASQ)
- 2019
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 42:6, s. 583-592
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Tidskriftsartikel (refereegranskat)abstract
- Background: There has been a lack of a standardized protocol for collection of patient reported outcomes (PRO) and detection of and indication for psychological treatment in cleft care. The objectives of this paper was to translate Cleft Hearing Appearance and Speech Questionnaire (CHASQ) into eight European languages, to investigate whether levels of PRO in patients with cleft lip and/or cleft palate (CL/P) were comparable across countries and to investigate clinician experience of the instrument. Methods: The PRO measure—CHASQ—was translated into Bulgarian, Estonian, Greek, Latvian, Macedonian, Romanian, Serbian and Swedish and implemented with patients in the respective countries. A focus group discussion was conducted to investigate health care professional experience on the use of CHASQ in their clinics. Data was analysed in accordance with the principles of thematic analysis. Results: Analysis showed statistically significant differences between countries and groups of diagnosis in CHASQ scores. CHASQ helped clinicians gain patient information and informed on treatment decisions, broadened the clinicians’ role as caregivers and was perceived as short and easy to use. Limited time and resources in clinics were limitations in implementing the instrument. Conclusions: Translation and utilization of CHASQ facilitated international comparison and cooperation. Linguistically, valid replicas of CHASQ are now available in many European languages. Results from this study show that CHASQ may be used for collection of PRO on patient satisfaction and to spark conversation between clinicians, patients and families. Level of evidence: Not rateable.
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| 20. |
- Sundhagen, Henriette Pisani, et al.
(författare)
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Development and validation of a new assessment tool for suturing skills in medical students
- 2018
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 41:2, s. 207-216
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Tidskriftsartikel (refereegranskat)abstract
- Background: In recent years, emphasis has been put on that medical student should demonstrate pre-practice/pre-registration core procedural skills to ensure patient safety. Nonetheless, the formal teaching and training of basic suturing skills to medical students have received relatively little attention and there is no standard for what should be tested and how. The aim of this study was to develop and validate, using scientific methods, a tool for assessment of medical students’ suturing skills, measuring both micro- and macrosurgical qualities. Methods: A tool was constructed and content, construct, concurrent validity, and inter-rater, inter-item, inter-test reliability were tested. Three groups were included: students with no training in suturing skills, students who have had training, plastic surgery. Results: The results show promising reliability and validity when assessing novice medical students’ suturing skills. Conclusions: Further studies are needed on implementation of the instrument. Moreover, how the instrument can be used to give formative feedback, evaluate if a required standard is met and for curriculum development needs further investigation. Level of Evidence: Not ratable.
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| 21. |
- Tallroth, Linda, et al.
(författare)
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Breast softness in patients randomised to postmastectomy breast reconstruction with an expander prosthesis or DIEP flap
- 2021
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; , s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Background Objectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfactionwith breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 yearfollowing delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) fap,using objective and subjective methods.Methods Seventy-three patients were randomised to breast reconstruction with an EP or DIEP fap between 2012 and 2018.Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary folddistance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluationwas performed using the BREAST-Q questionnaire.Results Objectively, DIEP faps were signifcantly softer than EP breast reconstructions. Non-operated contralateral breastswere signifcantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question(labelled 1.h) “How satisfed or dissatisfed have you been with the softness of your reconstructed breast (s)?” was higher inthe DIEP fap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanationtonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs=0.37).Conclusions In terms of breast softness, breast reconstructions with DIEP faps result in more satisfed patients. Concerningapplanation tonometry as an objective tool for
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| 22. |
- Tsangaris, Elena, et al.
(författare)
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Translation and cultural adaptation of the CLEFT-Q into Arabic, Dutch, Hindi, Swedish, and Turkish
- 2018
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 41:6, s. 643-652
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment for cleft lip and/or palate (CL/P) involves a multidisciplinary team of experts who aim to improve ones’ appearance, health-related quality of life, and speech function. To appropriately measure outcomes in CL/P from the patient perspective, a CL/P-specific patient-reported outcome (PRO) instrument is needed. The CLEFT-Q is a self-report PRO instrument developed to evaluate treatment outcomes in patients with CL/P. The aim of this study was to translate and culturally adapt the CLEFT-Q. Methods: The CLEFT-Q was translated and culturally adapted from English into Arabic, Dutch, Hindi, Swedish, and Turkish using guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research. For each language, two forward translations, one back translation, and cognitive debriefing interviews with patients were conducted. Results: The field test version of the CLEFT-Q consisted of 154 items across 13 scales. Forward translations for each language revealed few items that were difficult to translate into the various languages. Comparison of each back translation to the English version identified that a change in the meaning of an item was more common in the Turkish (n = 40, 26%) and Arabic (n = 17, 11%) translations, and required re-translation. Cognitive debriefing interviews involved 41 participants from plastic surgery centers in India, Qatar, Sweden, the Netherlands, and Turkey. Participants reported few difficulties in understanding the items, instructions, and response options in each CLEFT-Q translation. Conclusions: Semantic, idiomatic, experiential, and conceptual equivalence of the CLEFT-Q was achieved for all language versions, thus providing evidence of the CLEFT-Q’s transferability to other languages and cultures. Level of Evidence: Not ratable
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| 23. |
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| 24. |
- Ringberg, Anita
(författare)
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Subcutaneous mastectomy – surgical techniques and complications in 176 women
- 1990
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Ingår i: European Journal of Plastic Surgery. - 0930-343X. ; 13:1, s. 7-15
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Tidskriftsartikel (refereegranskat)abstract
- Since the 1960's, subcutaneous mastectomy (SCM) and reconstruction with an implant has been used to treat recurrent benign breast tumors and in situ breast carcinomas. It has also been used as a prophylactic operation in women with a high risk of developing breast carcinoma and to achieve symmetry following breast reconstruction. Reports on surgical complications have been discordant. Recent prospective studies have revealed negative psychosocial effects. Therefore, a retrospective analysis of the techniques used and early and late complications in the first 176 SCM performed from 1968 to 1981 was performed. Necrosis of the skin or nipple-areolar complex left persistent scar deformities in most patients. Necrosis over a submuscular implant never led to implant loss, in contrast to several subcutaneous implants. Smoking was associated with an increased frequency of necrosis. Infection of the implant pocket resulted in removal of 75% of the implants. The most common complication was capsular contracture (CC), this was less frequent with submuscular implants — no causative factor was found in this study. Indentation tonometry was found to be a useful means to quantify CC. Although results have improved and complications decreased during the period studied, SCM is still an operation that should be performed only with well defined indications.
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