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Two-thirds of the world population do not have access to safe, affordable and timely surgery. This global surgical crisis largely affects low and middle-income countries, and it will surpass the challenges created by communicable diseases. The barriers of access to surgery range from cost of surgery and patient transportation to availability and quality of surgical infrastructure and providers. Mercy Ships is a Non-Governmental Organisation (NGO) providing free world-class life-saving and life-transforming surgery to the poorest of the poor in West Africa. In order to address barriers to access surgical assessment and care, Mercy Ships switched from centralised patient selection mainly in port cities or capitals to decentralised selection strategy staffed by experienced nursing teams travelling to remote locations nearer to patients' homes. In this way, the under-served rural population is given equal opportunity to access Mercy Ships’ free specialised surgical services. In each country served by the Mercy Ships, a 5 year country engagement program is created to focus on improving the quality of life for people living with disease, disfigurement and disability through free direct medical service to reduce the burden of unmet surgical needs. Moreover, our Medical Capacity Building teams concentrate in improving infrastructure and quality control, equipment donation and maintenance. Lastly, Mercy Ships partner with government and policy makers to improve and strengthen their local surgical care delivery system as an indispensable part of the healthcare system. In this vast sea of global surgical crisis, the vision of the Mercy Ships is to eradicate the ‘disease of poverty’ and effectively do itself out of a job. Mercy Ships' new and the world's largest (37,000 ton) purpose-built hospital ship, the Global Mercy, is joining our current ship, the Africa Mercy (16,500 ton) to save lives and to strengthen local surgical care service. This will more than double our capacity and impact in sub-Saharan Africa following COVID-19 pandemic. Moreover our state-of-art on-board simulation laboratories and traditional practical training of local healthcare providers will further enhance and build their medical capacity. The Global Mercy will become the largest floating and training platform to train next generation African medical and health care professionals so that they can save countless lives by training others in the future. We therefore invite you to partner with us in bringing hope and healing to the forgotten poor in West Africa.

Summary Facial nerve paralysis (FNP) is a debilitating condition that leaves those affected with disfigurement and loss of function. The most important function of the facial nerve is protecting the eye through eye closure and blinking. A series of reanimation techniques have been reported to restore dynamic function in FNP, but the lack of a universally accepted method that is reliable and reproducible with immediate effect has led to the introduction of several implantable devices. Most of these devices have been applied to assist blinking; however, the delicate anatomy and unique mechanics of eye closure are difficult to replicate. Lid loading is the most frequently used implant today, which is a passive device that can aid in volitional eye closure but has a limited effect on blinking. Dynamic action can be achieved with active prostheses but achieving successful long-term function remains elusive. Device action must also be coupled with a real-time feedback mechanism in order to capture the natural variation in facial muscle movements. This review discusses all prostheses used for restoring eye closure and blinking to date and explores their relative merits.

Background Persons with severe burns often develop long-term psychosocial difficulties such as posttraumatic stress disorder (PTSD) and depression. Significant appearance changes following burn injury (e.g., scarring and disfigurement) can lead to body image dissatisfaction (BID) that causes psychological problems. Using a two-wave longitudinal design, this study examined the association between burn severity and psychosocial adjustment after burns (symptoms of PTSD and depression), particularly through the mediating role of BID. Method Participants were 111 burn survivors of the 2015 Formosa Fun Coast Water Park explosion. The mean age was 24.23 years, and 62.2% were female. The average TBSA burned was 50.3%, and the mean length of stay (LOS) in hospital was 85.44 days. Data were collected two (Time 1, T1) and three years (Time 2, T2) after the 2015 explosion. A composite burn severity score (CBSS) was additionally created based on TBSA and LOS. Results Three main findings emerged: (1) burn severity (TBSA, LOS, and CBSS) were significantly associated with T1 BID and T2 depressive symptoms, but not with T2 PTSD symptoms; (2) T1 BID significantly mediated the relationship between burn severity (TBSA and CBSS) and T2 PTSD symptoms, after controlling for T1 PTSD symptoms; and (3) T1 BID significantly mediated the relationship between burn severity (TBSA, LOS, and CBSS) and T2 depressive symptoms, after controlling for T1 depressive symptoms. Conclusions The current findings highlight the importance of BID in the development and maintenance of psychosocial maladjustment long after burn injury.

There is a need for a systematic approach to evaluate patients for potential face transplantation (FT). Ten patients with severe facial defects treated between 1995 and 2017 formed the study group. Data was collected from patient charts and clinical, radiological and laboratory examinations. Facial deficiencies were subdivided into four different categories: anatomical region (10 facial subunits), facial function, aesthetic defect (range 0-9-worst), and impact on health-related quality of life (HRQoL) (15D questionnaire, range 0-1). Immunological status and possible contraindications were also evaluated. Defect aetiology consisted of burns (4), ballistic injury (3), blunt injury (1), blast injury (1), and neurofibromatosis type I (1). All patients had central facial deficiencies and 6 patients had 8 to 10 injured facial subunits. All patients had at least partial loss of facial function. The mean aesthetic disfigurement score was 6.4. The median lowering of 15D score was -0.107. None were significantly sensitized although four patients had relative contraindications and one patient had an absolute contraindication for FT. Three patients with a severe overall facial deficiency were considered as potential FT candidates. We herein propose a comprehensive and systematic tool to evaluate potential candidates for FT. This approach includes assessment of 4 key categories: anatomical regions affected, facial function, aesthetics, and HRQoL.

The surgeon's role in modern cancer management has evolved beyond that of technician with a scalpel and now encompasses a wide ranging role in diagnosis, counselling, screening, prevention, resource management and palliative care as well as the traditional role of surgical excision. Many surgeons also have an active academic interest at teaching hospitals, conducting cancer research and teaching in associated medical schools. The UK has three established cancer screening programmes for breast, cervical and colorectal cancer, where surgeons are required to perform clinical assessment, diagnostic biopsies and plan surgical treatments. The multidisciplinary team remains the cornerstone of cancer treatment in the UK and each oncological subspecialty has regular meetings to discuss tailored cancer treatment for each individual. Alongside oncologists, radiologists, specialist nurses and pathologists, the surgeon is a key member of this team and in the decision making process. There are many different surgical techniques available for surgical treatment of cancer, many of which allow a minimally invasive approach including laparoscopic, endoscopic and robotic surgery. The progress of medical genetics and gene profiling now allows identification of ‘at-risk’ individuals for specific types of cancer where prophylactic or risk reducing surgery may be of benefit. Cancer treatment may result in disfigurement and loss of function, so reconstructive surgery is now an integral part of cancer management. Patients with advanced disease can often be helped by surgery to relieve symptoms and improve the quality of their remaining life and so the surgeon may play a key role in end-of-life care.

Plexiform neurofibromas (PNF) in neurofibromatosis type 1 (NF1) are usually diagnosed in childhood and can grow rapidly during this period. In 10% of patients, PNF involve the orbital-periorbital area and may cause visual problems including glaucoma, visual loss from amblyopia (deprivational, strabismic, or refractive), optic nerve compression, or keratopathy. Ptosis, proptosis, and facial disfigurement lead to social problems and decreased self-esteem. Complete surgical removal involves significant risks and mutilation, and regrowth after debulking is not uncommon. Inhibitors of the RAS/MAPK pathway have recently been investigated for their activity in PNF. We administered the oral MEK inhibitor trametinib to five young children with NF1 and PNF of the orbital area, with visual compromise and progressive tumor growth; and followed them clinically and by volumetric MRI. Treatment was initiated at a mean age of 26.8 months (SD ± 12.8) and continued for a median 28 months (range 16–51). Doses were 0.025 mg/kg/day for children aged > 6 years and 0.032 mg/kg/day for those aged < 6 years. Volumetric MRI measurements showed a reduction of 2.9–33% at 1 year after treatment initiation, with maximal reductions of 44% and 49% in two patients, at 44 and 36 months, respectively. No change in visual function was recorded during treatment. One child reported decreased orbital pain after 2 weeks; and another, with involvement of the masseters, had increased ability to chew food. Toxicities were mostly to skin and nails, grades 1–2. Trametinib can decrease tumor size in some young children with orbital PNF and may prevent progressive disfigurement.

Morbihan disease is a rare condition characterized by persistent erythema and solid edema of the upper two thirds of the face, leading to visual impairment and significant esthetic disfigurement. The underlying etiology of the disease remains uncertain, but its correlation with lymphoedema has been conjectured. Definitive treatment options are also lacking, and most current topical, systemic, and surgical interventions provide transient or partial results.In this report, we describe a case of Morbihan disease in a 32-year-old man. He suffered from erythema and swelling over the left periorbital region for 6 years, and was diagnosed with Morbihan disease. As the edema was unresponsive to drug therapy, he was referred to our department. Indocyanine green lymphography was performed, and the diagnosis of facial lymphoedema was confirmed. Manual lymphatic drainage was not effective, so we proceeded with surgical procedures. Lymphaticovenous anastomosis was performed to improve lymphatic drainage, and blepharoplasty was performed to debulk the enlarged tissue of lymphoedema. The visual field improved significantly, and the patient remains free from reexpansion of the lesion during the 1-year follow-up.The surgical approach for lymphoedema treatment can be a viable option for severe Morbihan disease unresponsive to nonsurgical therapies.

Burn injury can cause abnormal healing and pathologic scar formation that significantly impairs patients' ability to return to baseline levels of functioning. Quality of life can be significantly diminished due to pain, stiffness, contracture, and the psychological burden of disfigurement. Traditional scar therapies such as silicone sheeting and compression garments are highly reliant on patient compliance, and have not demonstrated satisfactory efficacy. Even more invasive therapies such as intralesional medication delivery or surgical contracture release have high recurrence rates. Recently, fractional CO2 laser therapy has emerged as a promising treatment modality for burn scars, but there is a lack of recent studies that aggregates extant data to demonstrate outcomes after laser therapy. To address this, we conducted a systematic review and meta-analysis to determine the efficacy of fractional CO2 lasers in treating burn scars, and found that laser therapy alone yielded statistically significant improvements in scar profiles. There were very few reports of adverse effects, most treatments were provided as outpatient, and both patient and burn practitioners reported high satisfaction. By sharing our findings, we hope that more burn practitioners will consider adopting laser therapy as a safe and cost-effective first-line therapy for burn scar management.

Background Despite controversy surrounding labiaplasty in adolescent girls, labiaplasty might be indicated in the case of recurrent labial hair thread tourniquet syndrome (HTTS). Case We describe a case of an 11-year-old girl with recurrent labial HTTS who underwent labiaplasty. Summary and Conclusion Recurrent labial HTTS can lead to disfigurement and partial loss of labium. Labiaplasty can restore normal anatomy of the labia and prevent further recurrence in select cases.

Transfeminine patients facing barriers to gender confirming surgery sometimes pursue illicit feminization procedures such as "street" hormones and silicone injections. These procedures often yield complications and disfigurement, making surgeons and insurance companies wary of secondary breast reconstruction. This clinical series assesses illicit treatment among our transfeminine breast surgery patients and describes the presentation, surgical approaches, and outcomes of each patient. A retrospective review of transfeminine patients who underwent chest feminization surgery with a single provider between March 2018 and March 2020 identified patients with a history of illicit hormones or silicone injections. Demographics, comorbidities, preoperative diagnoses and symptoms, surgical details, and postoperative outcomes were collected. Patients were contacted for a follow-up survey concerning outcomes and satisfaction. Of the 41 transfeminine patients reviewed, eight (19.5%) had previous illicit treatment. Seven (17.1%) used non-prescribed hormones, and three (7.3%) received silicone breast injections. Two patients presented with symptoms from silicone injections; the remaining were asymptomatic. Six patients underwent subglandular breast augmentation, one had a reduction mammoplasty, and one underwent an implant exchange. Only one patient had postoperative complications that healed without surgical intervention. This series emphasizes the need to assess the prevalence of silicone injections and illicit hormone use among transgender chest feminization patients. The use of these substances was relatively high in our population compared to national averages; however, there is a low risk of postoperative complications. Providers may perform breast surgery in patients with a history of illicit augmentation practices after careful evaluation and surgical planning.

Importance: The difficulty associated with concealing keloids located in the face and neck regions often results in disfigurement and psychological stress for patients. Objective: The purpose of this review is to determine if specific regions on the head and neck have a greater propensity to develop keloids to alert the facial plastic surgeon of regional keloid risk. Evidence Review: PubMed, Ovid, Cochrane, and Embase computerized searches were performed through January 2020. Two independent reviewers conducted data extraction following a predetermined protocol identifying 1445 keloid studies. Findings: The prevalence of keloids in different regions of the head and neck was evaluated among 1598 head and neck keloids in the final analysis. Three of nine studies evaluated keloids specific to the ear and described a combined 1194 ear keloids locations (53.0% lobule, 22.9% cartilaginous region, 0.3% both, and 23.7% unspecified). One study reported exclusively on 82 neck keloids 72% of which were located in the submental or submandibular region. The remaining five studies evaluated 322 head and neck keloids more generally and showed 70.2% ear, 9.6% unspecified, 6.5% peri-/postauricular, 5.6% beard area, 2.2% scalp/forehead, 2.2% chin, 1.6% lateral face, 1.6% neck, and 0.3% central face keloids. Conclusions and Relevance: The ear, periauricular regions, bearded facial regions, and submandibular and submental sites show the highest propensity for keloid development in the head and neck region. The lowest keloid risk occurred in the central face region. Risk factors in relation to facial and neck regions associated with the formation of keloids should be taken into consideration before performing elective procedures in keloid susceptible individuals.

© 2020Rhinophyma is a progressive disease of the nose, which is characterised by skin thickening and sebaceous hyperplasia. Patients with rhinophyma are often stigmatised due to worsening disfigurement of their nose. This can also result in functional impairment such as reduced nasal patency. Severe cases of rhinophyma are best managed with varied surgical interventions, as there is no clear ‘gold standard’ treatment that has been described. We present our experiences in the management of rhinophyma and the evolution of treatment modalities that have been employed over a nine-year period.

Background: Arteriovenous malformations (AVMs) of the brain and face present unique challenges for clinicians. Cerebral AVMs may induce hemorrhage or form aneurysms, while facial AVMs can cause significant disfigurement and pain. Moreover, facial AVMs often draw blood supply from arteries providing critical blood flow to other important structures of the head which may make them impossible to treat curatively. Medical adjuvants may be an important consideration in the management of these patients. Summary: We conducted a systematic review of the literature to identify other instances of molecular target of rapamycin (mTOR) inhibitors used as medical adjuvants for the treatment of cranial and facial AVMs. We also present 2 cases from our own institution where patients were treated with partial embolization, followed by adjuvant therapy with rapamycin. After screening a total of 75 articles, 7 were identified which described use of rapamycin in the treatment of inoperable cranial or facial AVM. In total, 21 cases were reviewed. The median treatment duration was 12 months (3–24.5 months), and the highest recorded dose was 3.5 mg/m2. 76.2% of patients demonstrated at least a partial response to rapamycin therapy. In 2 patients treated at our institution, symptomatic and radiographic improvement were noted 6 months after initiation of therapy. Key Messages: Early results have been encouraging in a small number of patients with inoperable AVM of the head and face treated with mTOR inhibitors. Further study of medical adjuvants such as rapamycin may be worthwhile.

Introduction: Organ transplantation is the therapeutic modality available for people with end-organ failure. However, only 10% of the need for transplantation is met globally. There are different factors that influence organ donation by people. Objective: This study was planned with an aim to understand the beliefs and knowledge of a rural community toward organ donation and the identification of barriers for organ donation. Materials and Methods: A qualitative community-based cross-sectional study was carried out among the adults of a rural area of Ballabgarh block of district Faridabad, Haryana. There were four groups of participants based on age and gender. Data collection was done through focused group discussion. Results: Several themes emerged and various reasons that were facilitators/barriers for donation of organ by people were listed: unawareness on what organs can be donated, misuse of donated organs by black marketing, organ donation by people having any comorbidity, no religious prohibition on organ donation, and disfigurement of body after organ donation. Conclusion: People consider organ donation a noble act. However, there are various myths and misconceptions as well as unawareness of procedure regarding organ donation that leads to lower rate of organ donation. Awareness campaigns should be organized to take care of such issues.

We report a case of third-degree burn involving 5% of the total body surface area caused by off-label use of Hanautherm®, an infrared radiant heat lamp for bed-warming, in a patient with severe accidental hypothermia. This iatrogenic burn required repeated surgical interventions and long-term hospitalization and caused subsequent cosmetic disfigurement and functional disability. To our knowledge, this is the first reported adult case of iatrogenic burn occurring during treatment for hypothermia. Radiant heat lamps should never be used for rewarming of patients with hypothermia without careful observation.

Background: Fibrous dysplasia mainly presents in its monostotic form in the cranio-facial region with serious cosmetic disfigurement and functional derangement of the affected and adjacent structures putting both patient and the attending surgeon in great dilemma. Surgical treatment is the only rewarding and generally accepted treatment option, however, controversy over the surgical technique to be adopted still exists. While in the past, surgeons generally adopted conservative shaving or contouring technique, over the recent years, advocates of radical surgery are winning more disciples. Objective: To highlight the locally destructive, functionally degrading nature of a neglected or poorly excised (shaved) lesion in patients and highlight the outcome of total excision and surgical technique adopted to obviate the need for autologous bone grafting and two-staged surgery. Subjects and Method: We present case series of three patients with giant monostotic fibrous dysplasia of the maxilla, surgically treated in our Centre, who were part of a total of eight cases managed over the past fifteen years in our department of Ear, Nose and Throat-Head and Neck Surgery. The pre-operative clinical assessment, relevant investigations and post-operative outcome are presented. Our surgical technique is highlighted. All the patients had unilateral lesion of the maxilla with gross cosmetic and functional defects. Two of the patients had ischaemic (pressure) atrophy of the cheek soft tissue and skin leading to skin metaplastic changes including leukoplakia, hyperpigmentation. Post-operative follow-up showed satisfactory cosmetic outcome and significant reversal of malocclusion and dental anarchy. There was no recorded recurrence throughout the follow-up period ranging from four to eleven years. Nasal airway was re-established bilaterally in all the cases. Conclusion: Total or near total excision surgical technique with periosteal preservation is our treatment of choice in the management of monostotic cranio-facial fibrous dysplasia. Given the fact that the growth of the tumours often does not cease after puberty against general belief, shaving or contouring technique should be relegated to the background. Our technique of no grafting which reduced cost and morbidity to the patient should be encouraged.

Background When complications following rhinoplasty occur or when the desired outcome is not achieved, patients may seek litigation on the premise that there was a violation in the standard of care. Knowledge of malpractice claims can inform rhinoplasty surgeons on how to minimize risk of future litigation as well as improve patient satisfaction. Objectives The aims of this study were to identify motives for seeking medical malpractice litigation after rhinoplasty, and to examine outcomes of malpractice litigation after rhinoplasty in the United States Methods The Westlaw legal database was reviewed for all available court decisions related to malpractice after rhinoplasty. Data collected and analyzed included plaintiff gender, location, specialty of defendant(s), plaintiff allegation, and adjudicated case outcomes. Results Twenty-three cases were identified between 1960 and 2018, located in 12 US states; 70% of the plaintiffs were female. Otolaryngologists were cited in 11 cases, whereas 12 cases involved a plastic surgeon. All cases alleged negligence. Cases involved “technical” errors (69.6%), “unsatisfactory” outcomes (39.1%), inadequate follow-up or aftercare (30.4%), issues with the informed consent process (21.7%), unexpectedly extensive surgery (8.7%), improper medication administration (4.3%), and failure to recognize symptoms (4.3%). Twenty of the 23 adjudicated cases (86.9%) were ruled in favor of the surgeon. The main contributing factor in cases alleging malpractice was poor aesthetic outcome/disfigurement (60.7%). Conclusions Malpractice litigation after rhinoplasty favored the surgeon in the majority of the adjudicated cases reviewed. The principal reason for litigating was dissatisfaction with aesthetic outcomes. Rhinoplasty surgeons may mitigate possible litigation by developing a positive doctor-patient relationship, clearly understanding the patient’s surgical expectations, and obtaining detailed informed consent while maintaining frequent and caring communication with the patient.

Neurofibromatosis type I is a common genetic disease that can lead to disfigurement, neurological and functional disorders. However, it is rare to meet the case which a huge mass is formed rapidly after neurofibroma ruptures. This case report describes a rare case of a 52-year-old female with a rapidly expanding mass on her back and mild anemia as the main symptoms. Physical examination showed a huge mass on the back and a surface ulceration with the diameter of 6 cm. Imaging examination revealed the abundant blood supply to the lesion. We performed preoperative arterial embolization, and surgical resection on the fifth day after embolization. After operation, proper blood transfusion and vacuum sealing drainage (VSD) were given. Through 9-months follow-up study, the incision of the patient recovered well and there was no sign of tumor recurrence. Therefore, this case report provides clinicians with valuable experience in the treatment for rapidly expanding neurofibroma.

Periorbital necrotizing fasciitis is a very rare condition with a UK incidence of 0.24 cases per million per annum. Outcomes can range from disfigurement to sight loss and even death. Debridement is crucial when sight or life is threatened and the subsequent reconstructive stages can be challenging. We describe two cases of periocular necrotizing fasciitis demonstrating the progression of the disease as well as the surgical debridement for both pre-septal and post-septal disease and the reconstructive steps leading to outcome. Level of evidence: Level V, therapeutic study.

Background: Face is the index of the mind, through which we express our various emotions. Defect of eyes can be congenital or acquired, due to carcinoma or trauma, which can lead to severe facial asymmetry and disfigurement. It results in several functional, esthetic and psychological disturbances to the patient. Restoring form and function in such patients is a very challenging task and requires an individualized design and technique for each patient. Case Report: This case report showcases rehabilitation of a patient who was diagnosed with exenterated left eye secondary to squamous cell carcinoma and maxillary sinus. Various steps for fabrication of a custom silicone orbital prosthesis have been elaborated in this article which improved the patient’s psychological, social and emotional well-being. Conclusion: The customized silicone orbital prosthesis does not only provide a life like-appearance but also has the advantage of being light in weight. Apart from being comfortable, economical and non-invasive use of the orbital prosthesis for a disfigured face undoubtedly improves the quality of life and the overall well-being of the patient. Keywords: Custom silicone orbital prosthesis, Exenteration, Squamous cell carcinoma.

Pathological scars can result in functional impairment, disfigurement, a psychological burden, itch, and even chronic pain. We conducted a systematic review to investigate the influence of incisional Negative Pressure Wound Therapy (iNPWT) on scarring. PubMed, EMBASE and CINAHL were searched for preclinical and clinical comparative studies that investigated the influence of iNPWT on scarring‐related outcomes. Individual studies were assessed using the OHAT Risk of Bias Rating Tool for Human and Animal studies. The body of evidence was rated using OHAT methodology. Six preclinical studies and nine clinical studies (377 patients) were identified. Preclinical studies suggested that iNPWT reduced lateral tension on incisions, increased wound strength, and reduced scar width upon histological assessment. Two clinical studies reported improved patient‐reported scar satisfaction as measured with the PSAS (1 year after surgery), POSAS, and a VAS (both 42, 90, and 180 days after surgery). Five clinical studies reported improved observer‐reported scar satisfaction as measured with the VSS, SBSES, OSAS, MSS, VAS, and POSAS (7, 15, 30, 42, 90, 180, and 365 days after surgery). Three clinical studies did not detect significant differences at any point in time (POSAS, VAS, and NRS). Because of imprecision concerns, a moderate level of evidence was identified using OHAT methodology. Preclinical as well as clinical evidence indicates a beneficial influence of iNPWT on scarring. Moderate level evidence indicates that iNPWT decreases scar width and improves patient and observer‐reported scar satisfaction.

INTRODUCTION Patients with factitious disorder (FD) or "Munchausen syndrome" intentionally fabricate or induce medical problems for psychological gratification. They may deceive plastic surgeons into performing multiple unnecessary procedures. We undertook the first systematic review of FD case reports in plastic surgery. Our aims were 2-fold: (1) describe the adverse outcomes associated with these cases and (2) identify strategies for their prevention by surgeons. METHODS MEDLINE, EMBASE, and SCOPUS databases were searched. We included cases in which an adult with FD presented to a plastic surgeon. Our search returned a total of 42 eligible cases reported from North America (43%), Europe (37%), and Asia (20%). RESULTS Seventy-six percent of patients were women, and 62% worked in health care. Sixty percent had a comorbid psychiatric disorder, the most common (50%) being depression. Ninety-three percent of our sample presented with self-induced lesions. The average delay in diagnosis of FD was 54 months, with 46% of patients receiving multiple surgical procedures in this time, including debridement (36%) and skin grafts (39%). Surgical wounds were frequently exploited by patients to remain in, or return to, hospital: 50% contaminated or manipulated their wounds to prevent healing. Thirty-six percent of cases resulted in significant long-term disability (24%) or disfigurement (12%). Ten percent of patients received an amputation. Outcomes were improved when patients were confronted by surgeons, however, and 62% were willing to see a psychiatrist. Surgeons were able to support recovery in 33% of cases-for example, by using occlusive wound dressings. CONCLUSIONS Patients with FD who present to plastic surgeons are high risk: the majority require surgical intervention for severe self-injury, and many engage in harmful behaviors, such as "doctor-shopping." Early recognition of FD in plastic surgery is, therefore, crucial and may be achieved via careful examination of lesions for unusual morphology. Medical records may reveal extensive health care service use and negative investigations. Finally, plastic surgeons may play an important role in managing such patients. Management strategies include direct observation by nursing staff in the postoperative period and use of strict occlusive dressings to prevent access to surgical wounds.

Distress with self-perceived changes in appearance and function can result in body image disturbance (BID), which is common in head and neck cancer (HNC) survivors and a major source of psychosocial morbidity. To address the lack of psychometrically sound patient-reported outcome measures (PROMs) of HNC-related BID, we aim to create and validate the Inventory to Measure and Assess imaGe disturbancE-HeadNeck (IMAGE-HN).Survey study.Multiple academic centers.Following item development, HNC survivors from 4 academic centers completed the IMAGE-HN. Item responses were psychometrically analyzed using confirmatory factor analysis (CFA) and Rasch analysis.Item development resulted in a 31-item PROM consisting of 5 individual domains and a global domain. In total, 305 HNC survivors of diverse ages, HNC subsites, and reconstructive paradigms completed the initial items. After removal of 3 items for local dependence, CFA confirmed the unidimensionality and local independence (item residual correlations|0.20|) for each domain. Rasch analysis indicated acceptable fit (infit and outfit mean squares2.0), monotonicity of all rating scale categories, and low person misfit (4%). Person separation indices and person reliability were adequate for each domain except appearance concealment, which was removed (4 items). This resulted in the IMAGE-HN, a psychometrically acceptable 24-item PROM of HNC-related BID consisting of a global scale and 4 subscales measuring unique constructs and comprised independent items.IMAGE-HN is a novel, psychometrically sound, multidomain PROM of HNC-related BID for use in clinical and research settings.

Double lip is an unusual clinical finding, considered to be a developmental anomaly, and usually involving the upper lip more frequently than the lower lip. It may be seen in isolation or in association with Ascher's syndrome. It is caused by excessive areolar tissue and noninflammatory labial mucosa gland hyperplasia of pars villosa. During smiling, the lip is retracted, and the mucosa is positioned over the maxillary teeth, resulting in "cupid's bow" appearance. The incidence of this anomaly is not known. It has been reported in cleft patients, following lip trauma, and as a consequence of lip-biting habits. It might pose esthetic or functional problems and may be a reason for psychological stress to the affected individual because of over shown hyperplastic lip tissue. Surgical treatment is indicated for the correction of this disfigurement. Various surgical techniques have been suggested to address the double upper lip anomaly. All of these involve the excision of excessive mucosa and the underlying tissue. This case series puts forward the surgical management of this rare anomaly in a relatively simple manner. Double lip is a subject of interest to the dental clinicians because they usually are the first professionals to detect, identify, and treat this uncommon condition.

Penile adhesions may cause pain, bleeding, disfigurement and distress. In the setting of lichen sclerosus (LS), they often recur but current treatment options are limited. We present a novel surgical technique for treatment of recurrent penile adhesions using sub-coronal buccal mucosal graft (BMG) resurfacing. A retrospective, international multi-institutional study was conducted to include patients with refractory penile adhesions who were treated with this technique. Patients with > 12-month follow-up were included in analysis. The procedure involved circumferential excision of the diseased skin and replacement with a BMG. The primary outcomes were recurrence and surgical complications. Secondary outcomes were patient-reported outcome measures (PROMs) including Sexual Health Inventory for Men (SHIM) questionnaire and Global Response Assessment (GRA) questionnaire measuring functional and esthetic outcomes. Twenty-five men underwent the procedure across six institutions between 3/2014 and 11/2019. Twenty-one men met inclusion criteria. Mean operative time and hospital stay for sub-coronal resurfacing were 40 min (25–50) and 0.76 days (1–2), respectively. At the mean follow-up of 18 months (12–61), no patients developed recurrence. All patients who presented with pain and postcoital bleeding saw improvement on follow-up (18/18). There was a significant improvement in SHIM scores after the operation (14.4 pre-op, 17.0 post-op; p = 0.003). Overall improvement of symptoms was reported by all patients: 57% GRA + 3; 29% GRA + 2; 14% GRA + 1. Baseline penile sensation was preserved in 17/21 (81%) patients. Recurrent penile adhesions in the setting of LS are notoriously difficult to treat. A sub-coronal BMG resurfacing is feasible. This initial patient cohort demonstrated no recurrence and overall high satisfaction.

Burst fractures are relatively common injuries in the thoracolumbar spine. However, treatment of AO type (A3) unstable thoracolumbar fractures is still controversial, especially for patients with no neurological deficits. to evaluate the efficacy and safety of percutaneous pedicle fixation using a minimally invasive technique for AO type (A.3) thoracolumbar fractures. This study was done on ten patients complaining of thoracolumbar spine fractures grade A3 at ages ranged from twenty to sixtyfive years old. Those patients were treated bypercutaneuos fixationThose effects of the surgical methodology were gathered instantly after surgery, et cetera during, Also after those catch up time. Every last one of effects might have been statistically investigated with get sure information Furthermore relationship the middle of them, difficulties might have been talked about if then afterward surgery alternately during the catch up period. The percutaneous pedicle obsession system displays radiological, clinical, Furthermore utilitarian comes about that need aid altogether superior to the distributed outcomes with preservationist medication. This intervention, helped Eventually Tom's perusing fluoroscopy, demonstrated should make An technobabble for An helter skelter correctness and reliability, with effects comparable on the individuals news person On investigations for the established transpedicular obsession in regards to the disfigurement correction, Yet predominant for respect to blood loss, postoperative rehabilitation, What's more return of the exercises for Every day living. The outcomes of this investigation demonstrate that this may be An valid, safe, Furthermore compelling medicine for (A3) thoracolumbar blast fractures without neurological deficits.

Highlights • Lymphangiomas are benign swellings most commonly seen in paediatric population. • MRI is the superior imaging technique to diagnose lymphangiomas. • Surgical excision is the mainstay of treatment., Introduction Lymphangiomas are benign swellings most commonly seen in paediatric population. Head and neck are the common sites of presentation rarely can also been seen other sites as axilla, chest, abdomen, liver, spleen. Even though many different modalities have come up surgical excision remains the main stay of treatment. Case report A 24 year male patient presented with complaints of a swelling the neck since 2 months, which was 8 × 5 cms, soft, cystic and transilluminant in the anterior triangle of the neck. MRI study showed features suggestive of a para pharyngeal lymphangioma. Patient had undergone surgical excision through trans mandibular trans cervical approach for extra cranial part and for intra cranial part has got OK-432 sclerosant therapy. Discussion Lymphangiomas are benign, hamartamatous swellings. They are mostly noticed due to their large size causing disfigurement, dyspnoea or dysphagia. They are diagnosed prenatally by using ultrasound scanning. MRI is the superior imaging technique to diagnose lymphangiomas. Surgical excision is the mainstay of treatment, other treatment modalities as scelerotherapy, laser excision, radiotherapy, unroofing, aspiration or steroids are also used.

Oral cancer is the second most common disease affecting Indian population. Though better surgical, reconstruction and effective chemo/radiation protocols available these days improving the disease related outcomes, the debilitating effect of such therapeutic intervention on long term has negative impact on the quality of life of such patients. It has been drastically affected in many ways such as pain, disfigurement, social activity, health and functional impairment of speech and deglutition. For these reasons, the measurements of quality of life of patients are emerging trend nowadays. This study aims to evaluate the health related quality of life of patients affected with oral cancer and treated by surgery.

Introduction. Pyoderma gangrenosum (PG) is a multifactorial neutrophilic dermatosis of unknown etiology. It can occur in isolation; in association with different inflammatory, autoimmune, or malignant diseases; or as part of various syndromes. Because of its low incidence and the difficulty in distinguishing it from other possible lesions, PG is usually misdiagnosed. As a result, patients may be subjected to unnecessary treatments and surgical interventions that exacerbate the development of PG, as pathergy phenomenon is observed with this skin disorder. Surgical trauma can also lead to the formation of PG with the same mechanism. The occurrence of PG lesions has been reported after plastic surgery as well. In most cases, however, the diagnosis is delayed, resulting in disfigurement, additional surgeries, and extended hospital stay. Case Report. In this article, a case of early detected bilateral PG after reduction mammoplasty in a patient with no personal or family history of autoimmune disorders is presented. Careful examination of the wound and analysis of the clinical picture resulted in the diagnosis of PG. Conclusions. The authors believe that the description of the diagnostic clues considered in this case will aid the plastic surgeon in prompt recognition and management of postoperative PG, with the aim of decreasing patient morbidity and the duration of hospital stay while preventing additional complications.

INTRODUCTION AND OBJECTIVE:Recurrent penile adhesions often cause pain, post-coital bleeding, disfigurement and patient distress. Treatment options are limited and include topical steroids, lysis o...

Background The kyphotic deformity is more than just a cosmetic disfigurement. It is potentially life-threatening and disturbs the quality of life by causing cardiopulmonary dysfunction, spinal imbalance, and other associated problems. Corrective surgery is challenging but it is needed to bring the spinal balance back thus halting the progressiveness of the deformity. The cantilever technique is a gold standard to correct the sagittal plane deformity. Methods This is a review article with some case illustrations from Author's experience. Objective We aim to review the cantilever technique for kyphotic correction in spondylitis tuberculosis patients. Conclusion The cantilever technique is the standard for sagittal plane deformity correction that can be applied for kyphotic deformity correction in spondylitis tuberculosis cases. Developing the safest techniques and instrumentation is crucial to achieving spinal balance with minimal risk of morbidities., Highlights • Kyphotic deformity is more than just a cosmetic problem. • Kyphotic deformity is potentially life-threatening and disturbs quality of life. • Deformity correction surgery is challenging. • Cantilever technique is a gold standard to correct sagittal plane deformity.

Patients undergoing nail surgery frequently experience anxiety. Nail procedures generally are performed under local anesthesia; common concerns include the sight of blood, the procedure itself, procedural-associated disfigurement, and pain. Wearing a sleep mask diverts attention from the surgical field, thus reducing perioperative anxiety. Sleep masks are widely available and inexpensive.

Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.

There are patients with craniofacial deformity that can lead to extensive bone loss and severe disfigurement. Autologous reconstruction may be challenging in these patients, and it is usually associated with flap donor area morbidity and unfavorable aesthetic and functional results. A 51-year-old patient with human immunodeficiency virus infection, developed in the context of immunosuppression a fulminant fungal rhino-sinusitis with the need for surgical debridement, and in consequence extensive destruction of the nasal cavity and upper jaw, resulting in severe disfigurement due to nasal deformity and maxillary collapse. Human immunodeficiency virus disease was controlled and the complex craniofacial defect was posteriorly reconstructed with direct 3-dimensional (3D) printing combined with microsurgical free tissue transfer. The 3D facial implant, in titanium, was individualized and fabricated based on computed tomography images of the patient. A radial forearm free flap was used since a soft-tissue defect was anticipated after scar release and implant placement. It allowed simultaneous coverage of the palate, the anterior surface of maxilla and intranasal lining. The flap survived despite flap venous congestion in the postoperative period probably facilitated because of the complex 3D flap configuration and pedicle tunneling into the neck. After 9 months, the patient showed a tremendous aesthetic and functional improvement. The 3D printing was useful in our patient with craniofacial reconstruction. Its combination with free tissue transfer may improve the surgeon's armamentarium when dealing with complex patients.

As the number of patients seeking surgical and nonsurgical rhinoplasty continues to increase, the risk of nasal skin compromise after surgery also has risen. Vascular insult to the nasal skin envelope can lead to permanent disfigurement that is nearly impossible to correct. Tissue loss often requires major reconstruction that yields suboptimal cosmetic results. This article discusses prevention, early recognition, and effective treatment that aim to mitigate skin necrosis and the resulting soft tissue destruction.

Facial disfigurement due to any congenital or acquired condition is a social disability that can impede communication, contribute to awkward social interactions, and cause individuals with differences to be isolated and rejected. Yet, few interventions have been developed to address the psychosocial consequences of living with a visible difference, despite research indicating that the more visible the disfigurement is to others, the greater the social implication and challenge for the affected individual. This article reviews the impact of the “What to Do When People Stare” social and communication workshop, including its theoretical basis (drawn from anthropological research and theory pertaining to disfigurement), the phenomenon of staring, and the experience of being the target of a stare. The review highlights feedback from 46 individuals with disfiguring conditions caused by burns, dermatological conditions, and craniofacial conditions who completed a Workshop Evaluation Survey. The instructor, who has a facial difference, reviewed the science of staring, the role and influence of the media and beauty in society, myths associated with disfigurement, social and communication skills, and asked specific questions to elicit feelings and beliefs about why people stare, and how it feels to be the object of a stare. After completing the workshop, 80% of participants reported that they felt better prepared to cope with staring, and 83% reported a better understanding about the motives of staring. The workshop demonstrates the need to increase awareness of visible differences and to teach individuals with visible differences and the general public appropriate social skills for engaging with one another. The workshop’s success to date highlights the need for similar programs addressing the psychosocial communicative dimensions related to staring. Collaborations with burn centers and other nonprofit organizations that treat and assist individuals with psychosocial issues related to visible difference could strengthen content and assessment data.

The nose is considered an important structure in the facefrom both the cosmetic and functional point of view. It is themost projecting part in the face; hence any disfigurement isobvious and cannot be hidden. Skin defects may occur dueto many reasons including post traumatic and post ablativefollowing excision of skin cancer. There are various methodsfor coverage according to the reconstructive ladder. However,due to its importance, local flaps are always preferable to skingrafts as this produces like with like replacement includinggood padding with well vascularized tissue, pliable coverage,sensate tissue with better contouring, texture and color matchingwhen compared to skin grafting. In this paper, althoughmany flaps are described in literature, but most defects of thenose can be best closed by three common flaps used in thisarea. These flaps are reviewed including forehead flap, nasolabialflap and bilobed flap with the authors' personalexperience in this field. Ten cases were operated upon by theauthors in Kasr Al-Aini Hospital between February 2016 toJuly 2016 and followed-up for the following six months. Allthese flaps survived with a satisfactory patient outcome inmost patients

Objectives: Lymphatic malformations (LM) are uncommon expansile lesions that may lead to aesthetic or functional impairment requiring intervention. Although recurrence and treatment-related complications are often reported for a subset of patients with extensive cervical LM, primary excision with a selective neck dissection approach is safe and effective. Study design: Case series at a single academic tertiary care center. Methods: Retrospective chart review was performed of clinical presentation, radiographic characteristics, operative notes, and pathology reports of three patients with large cervical LM who underwent complete surgical excision between July 2012 and December 2017. Results: Two-thirds were female with a median age of 39 years (range 34–49 years) All patients had left-sided lesions ranging in size from 6 to 20 cm. Presenting symptoms included increasing neck discomfort and disfigurement. All patients had lesions that were mobile to palpation, macrocystic and well-circumscribed on preoperative imaging without invasion of the upper aerodigestive tract, and without cranial neuropathy. There were no postsurgical cranial nerve issues, complications, or recurrence at a median follow up of 14.7 months (range 10.0–74.9 months). Conclusion: Adult patients with mobile, primarily macrocystic, and well-circumscribed cervical LM with no preoperative cranial nerve deficits are excellent candidates for primary surgical excision, even in cases of exceptionally large multicompartment lesions. If patients are carefully selected, surgery offers the distinct advantage of definitive treatment with a single modality in a single stage and minimal post-treatment morbidity. Keywords: Cervical lymphatic malformation, Congenital malformation, Primary surgical excision, Selective neck dissection

Breast augmentation is one of the most popular and safe cosmetic procedures performed by plastic surgeons worldwide. Although breast implants are available in a number of different materials, silicone-filled implants remain the most common type. However, prior to the development of breast implants, various materials were injected into the soft tissues of the breasts to increase breast volume, which caused cutaneous complications and disfigurement. This review details the history of breast augmentation, the current methods used in augmentation surgery, and associated cutaneous complications. Keywords: Plastic surgery, reconstructive surgery

Lymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels. When physiologic procedures fail or when faced with a delayed presentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.

IMPORTANCE Study of the association of regional facial dysfunction with quality of life will lead to a better understanding of quality of life in facial palsy.OBJECTIVE To determine the association of regional facial dysfunction with facial palsy-related quality of life.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis included patients with flaccid and nonflaccid (synkinetic) facial palsy treated at a tertiary care facial nerve center; the flaccid facial palsy group included 529 patients, and the nonflaccid facial palsy group included 391 patients. Data were included from all patients with facial palsy who had an eFACE score and Facial Clinimetric Evaluation (FaCE) scale total score acquired at the same time from February 1, 2014, through October 31, 2017. Linear regression analysis was performed to calculate the amount of variance in quality of life explained by the severity of facial palsy (eFACE). A relative weight analysis was performed for the contribution of each individual eFACE item in estimating quality of life.MAIN OUTCOMES AND MEASURES Facial palsy severity was measured using all 15 individual eFACE items (rated on a scale of 0 to 200, where 0 represents complete flaccidity, 100 represents a balanced aesthetic appearance, and 200 represents the worst imaginable hypertonia of a patient with synkinesis, with a transformation used for values from 101 to 200), and facial palsy-related quality of life was measured using the FaCE scale total score (range, 0 [worst] to 100 [best]).RESULTS Data of 920 individual patients (59.5% female; mean [SD] age, 48.6 [16.6] years) were available. The eFACE composite score accounted for 21.2% of the quality-of-life variance in the flaccid group and 13.9% in the nonflaccid group. With the use of all 15 individual eFACE items, these proportions increased to 29.7% and 16.8%, respectively. In both groups, oral commissure movement with smile was found to be the most important contributing item (relative weight, 0.108 [95% CI, 0.075-0.148] for the flaccid group and 0.025 [95% CI, 0.005-0.052] for the nonflaccid group). Items related to the function of periocular muscles were found to be of low importance.CONCLUSIONS AND RELEVANCE The present study suggests that the function of individual facial regions is not equally important for estimating facial palsy-related quality of life. The ability to smile is of greatest importance among patients with flaccid and nonflaccid facial palsy. The true importance of periocular function in the estimation of quality of life should be studied further in future research.

Background The shortage of organ donation is the key rate-limiting factor for organ transplantation in Iran. Many strategies have been proposed to increase donation; one strategy aims to improve awareness of organ donation and transplantation among medical students. Medical students may play an important role in the acceptance of organ donation in the population. This requires both a positive attitude and an appropriate knowledge about the concept of organ donation and transplantation. The objective of this study was to determine the knowledge and attitude of the medical students of the largest medical university in northwestern Iran. Methods Four hundred medical students in the 5th and 6th years of their education were enrolled in this study. They completed a self-administered 3-section questionnaire. Section 1 gathered demographic characteristics, section 2 covered attitude, and section 3 assessed knowledge regarding organ donation. Results The concept of brain death and criteria involved in organ transplant was understood by 57% of the students. Most of the students thought that there is a need to increase awareness regarding brain death and organ donation transplantation (ODT). Eighty-five percent of the students said that they would donate their organs, but 15% did not, most likely because of religion and body disfigurement. Seventy-eight percent of students would donate their organs to their family, relatives, or friends. Sixty-four percent thought that the family can decide regarding ODT. Seventy percent were willing to donate the organs of their family members after brain death. Religion and source of information regarding ODT has a significant effect on knowledge and attitude of students. Conclusions Students had a high level of attitude, but a low level of basic understanding about organ donation that lacked detailed knowledge. They accept its importance and desire further teaching to supplement their current knowledge to be able to understand the issues related to organ donation. The results of this study supported a greater emphasis on revising the curricula in medical schools to improve the knowledge of future health care workers. This strategy may be part of the solution to the chronic shortage of donor organs for transplantation.