Scientific Abstract Presentations: Global Partners 2 (Non-CME) Saturday, October 28 Sat, Oct 28 10:30 a.m.-12:30 p.m. CDT

1.- INTRODUCTION. Body contouring in plastic surgery encompasses a range of procedures, including abdominal wall reconstruction for hernias, pedicled flaps in breast reconstruction, and aesthetic uses in abdominoplasties and lipoabdominoplasties. Although body contouring is often employed to enhance abdominal aesthetics, post-surgical edema management remains a challenge. Kinesiotherapy, in the form of continuous abdominal bandages, has been shown to be effective in this regard.

2.- METHODOLOGY This prospective clinical study involved a sample of 50 patients who underwent surgery at the General Hospital of Mexico plastic surgery department between March 2022 and March 2023. The patients were divided into two groups, experimental and control, each comprising 25 patients. The study included patients with similar characteristics: ages between 18 and 65 years, any sex, no comorbidities, BMI < 30 kg/m², and no abdominal hernia.

3.- ANALYSIS A total of 50 patients were analyzed, divided into two groups of 25. The experimental group included 20 females and 5 males, with an average age of 36 years. All patients in this group had a BMI < 28, indicating they were suitable candidates for the procedure. Kinesiotape was introduced as a treatment for controlling post-surgical edema in abdominal liposuction, with varying application patterns. Pattern 1 proved more challenging to apply and maintain, whereas pattern 2 was easier to use and preferred by the plastic surgery team in 64% of cases. MRI was an invaluable tool in this study, revealing significant information even when seromas were not visible . Statistical analyses, including Chi-square and Pearson correlation tests, were conducted to compare edema in both groups, as measured by MRI .

4.- RESULTS. The study's hypothesis considered the uncertain outcomes regarding edema control, seroma, ecchymosis, and pain. Edema was analyzed in both groups after surgery, at 7 and 21 days post-operation .

The study showed a decrease in edema measured by cm2 in MRI, with an average reduction of 373 cm2 in the control group compared to 635 cm2 in the experimental group, leading to decreased edema, ecchymosis, pain, and seroma.

5.- DISCUSSION: Liposuction is a widely used surgical technique for removing fat to improve body contour. However, some patients may experience an excessively flat abdomen. Kinesotherapy, a daily-use intervention, has shown proactive benefits in managing post-surgical complications related to body contouring.

6.- CONCLUSIONS. In conclusion, kinesiotherapy is an effective option for postoperative management of abdominoplasty. This adjunctive therapy improves recovery, reduces swelling, decreases pain, and enhances the patient's quality of life. Medical and kinesiotherapy professionals should collaborate to provide the best possible care for patients after abdominal liposuction surgery. Kinesiotherapy may also offer psychological benefits, such as reducing stress and anxiety related to the surgical procedure.

Our study demonstrates that with proper knowledge of tape placement and two types of patterns, edema can be decreased, resulting in mild edema if present. Additionally, the more practical pattern (number 2) was preferred by surgeons, fellows, and residents, making it easier to teach other surgeons.

The use of kinesiotherapy as a complementary treatment for patients undergoing abdominoplasty may be a valuable addition to post-surgical management, potentially improving patient outcomes and overall satisfaction with the procedure. Further research is needed to fully understand kinesiotherapy's effectiveness in this context and to identify specific protocols and techniques that are most beneficial.

This study concludes that using kinesiotherapy, with the appropriate pattern and correct application, can decrease edema and post-surgical complications such as pain, ecchymosis, and seroma by more than 35%. It is a safe option for patients, even when used alongside a girdle.

1.- INTRODUCTION.

An incisional hernia of the abdominal wall is any defect with or without an increase in volume in an area of a postoperative scar that is perceptible or palpable by clinical or imaging examination. The current incidence of incisional hernia is up to 11% . Repairing an incisional hernia has a probability of recurrence of 33%, the third and fourth attempts are associated with even greater recurrence , up to 64% after tension plasty and 32% after mesh plasty. Due to the high recurrence rate associated with the closure of hernial defects of the abdominal wall, novel techniques such as the use of pneumoperitoneum have been tried. This paper explores the use of preoperatively applied botulinum toxin to improve abdominal wall reconstruction and achieve tension-free midline wall coping.

2.- METHODOLOGY.

A Universe of 59 patients operated by the set of two services, Plastic and General Surgery in the General Hospital of Mexico, during 1 year ( from March 2022 to March 2023 ), in a clinical essay, prospective study. The patients were divided by 2 groups, the experimental and the control, with 26 and 33 patients. In the study we analyzed patients with a very similar characteristics; age between 18 to 65 years, any sex, no comorbidities, BMI < 30 m/k2, with midline hernia > 12 cm2 visualized by a CT Scan. Relative contraindications where patients with intestinal stomas, ( if they where young, no comorbidities, and BMI < 30 m2 ). The objective of this clinical essay is to make a perfect treatment in the knowledge of big hernia repair. It is not a hernia repair, every patient has to be perfect evaluated, and with the dissection during the surgery will be better for the closure of the middle line, and all the skin flaccidity will be out of it with the abdominoplasty. All the study was made by the same surgeon, and groups of surgeon, including the General Surgery Team, and the Plastic Surgery Team, the surgery was made at the operation room, with and average of surgery time of 4 hours , with the beginning of the surgery by the general surgery team, if they have something to do at the bowels, and then we prepare the abdominal wall to the transversus abdominal release, and the abdominoplasty by the end.

3.- ANALYSIS.

We analyzed 59 patients, divides 2 groups, the experimental group with 26 patients, in the variables there where 7 feminine, and 18 male, with an average of age about 40 years, all patients in this group where evaluated, and admitted with a 2 filters of Services[ Algorithm 1 ], once they have the date of surgery,- 1 Mont Before Surgery - the Toxin Botulinum Type A ( Dysport 500 UI – Dilution - [ Figure 1 ] ) has had injected by direct view ( Lineal Transductor Ultrasound of 8 MHz of Skeletal Muscle View – with Radiology Intervention ) at the transverse muscle by the 3 points [Figure 2] at the semilunar of the abdominal wall. The Toxin Botulinum type A ( TBA ) It was placed by ultrasound, we take pictures before colocation ( 1 month ) doing contraction [ Figure 3 ], we measure the length of the hernia and compare with his Computerized Tomography Scan ( CT ), then we take another picture – doing contraction ( 1 month )[ Figure 4 ] after the TBA, to measure what the length has decrease in millimeters.

4.- RESULTS. The analysis of this study was with the hypothesis, we might not be sure if the dissection of the transversus abdominus will close the midline, in all patients, even the experimental group. In both groups, we analyze complications and improves of the surgery, in the surgery, after the surgery and we divided by immediately and lately. Within the observed analyzes, the results were divided into trans-surgical (99% of the patients closed the midline), immediate post-surgical (Pain, Seroma and Infection < 1%) and late (with < 3% recurrence) in the experimental group.

5.- DISCUSION. Botox is a neurotoxin derived from the bacterium Clostridium botulinum (botulinum toxin type A) that has been observed at the sensory level causing atrophy in the extrafusal and intrafusal muscle fibers. Repair of the abdominal wall after incisional hernias has been a great challenge with recurrence rates of 11%. Performing the release of the transverse muscle has a recurrence of 6%, as well as the compensation of skin flaps are ideal for proper management.

6.- CONCLUSIONS. The main objective of this study, was done; creating a reliable, positive, learned technique, that can be teached by the head resident, to others, but the most important thought is about the perfect protocolization of the patients, and well know, that not all patients are good candidate for this technique, and the TBA is not a magical thing that close the abdominal wall without a big dissection, that the mesh is all. The close of the midline is one of the big problems, in the big hernia repair, if the dissection is well done, you will have 5 o 7 cms of each side and can solve it.

Background: Reconstructive surgeons have shifted from correcting contour irregularities using autologous fat transfer (AFT) toward reconstructing full breasts. Although many studies have researched the volumetric aspects of AFT, some outcomes such as fat graft survival and viability, as well as possible confounders for graft survival, remain unclear. This study aimed to answer these questions.

Methods: Post-mastectomy women of the multicenter prospective BREAST-trial were randomized to either AFT breast reconstruction or implant-based reconstruction (IBR). Volumes were assessed using the Vectra 3D imaging system and compared at 12 months postoperative. Graft survival was defined as the augmented volume divided by the lipofilling volume. Significant confounders for graft survival were identified using multivariable regression analysis.

Results: A total of 148 patients (75 AFT, 73 IBR) were included in the final analyses. Postoperative volumes differed significantly at 12 months in favor of the IBR group (83.8ml, p<0.001). For AFT patients, graft survival did not decrease between 6 and 12 months, with a mean graft survival of 37.1% at 12 months. Significant confounders for graft survival included chest circumference (β=1.107, p=0.001), comorbidities (β =28.567, p=0.002), age (β =-0.514, p=0.007) and total lipofilling (β =-0.028, p<0.001).

Conclusion: Plastic surgeons can reconstruct voluminous breasts post-mastectomy using only AFT, these breast volumes stabilize at six months and VECTRA 3D is reliable for breast volume measurement. About a third of the grafted fat survives postoperative and reconstructive surgeons should be aware not to transfer too much fat in one session.

Background: A major cause of death among patients with major burns is bloodstream infections, which are known to be caused by microorganisms. The study on bacteremia helps identify the appropriate antibiotics before the culture test results are revealed.

Aims & Objectives: The aim of this study is to analyze the most common organism that contribute to the development of a bloodstream infection in patients in burn intensive care unit. Patients / Materials & Methods: This is a retrospective, observational follow-up study of a cohort of patients admitted to khoula hospital Burns Unit in Oman. The data collected from the khoula hospital burns ICU from 2014 to 2019 included all episodes of BSI. The inclusion criteria included patients with a 20% or more total body surface area burned. The changes in BSI during the early and late hospitalizations were analyzed.

Results: A total of 155 patient was analyzed. Whom 79 patients showed a positive BSI. Age range 2–80 years (mean:32.45). Number of males:89/57.42%. Number of females:66/42.58%. Survival rate 74.84%. Number of expired patients:39/ 25.16%. Mortality among +ve blood culture 34.17%. Mortality among -ve blood culture 15.78%. The most common pathogen causing BSI is Gramnegative Acinetobacter species. Many cultures showed multi-organism growth. Total number of expired patients is 39. 27 of them have +ve blood.

Discussion & Conclusion The most common pathogen causing BSI is Gram-negative Acinetobacter species over the 5-year period and during the course of hospitalization. The problematic increase in multidrug organisms in major burns highlights the need for new antimicrobial stewardship policies and antibiotic prescribing protocols

Introduction: -

Palatal fistulae have been classified by many surgeons in different time periods and the idea behind each classification was to provide good information about the location of the fistula, its size and expected difficulty in the management. Veau, Smith DM, Ohsumi and Richardson (Veau, 1931, Smith DM, 2007, Ohsumi N, 1993 and Richardson S, 2014) have elaborated useful criteria to help and plan the management of palatal fistulae. Fayyaz GQ et al(2019) proposed a new system of classification for palatal fistula based on Location, size & Velopharyngeal functional status of the patient.

Materials & Methods: -

Anterior fistulae in the palate are known complication after palate repair. Anterior fistulae are not always easy to be managed due to paucity of tissues, available for oral layer cover. We usually elevate the tip of the mucoperiosteal flap, before developing the turn in flap for nasal layer closure. The mucosalized undersurface of the mucoperiosteal flap is unfolded & opened up with a sharp blade, thus leading to increase in the length of mucoperiosteal flap. Nasal layer is now developed all around the fistulae. After the nasal layer closure, the lengthened Mucoperiosteal flap provides ample amount of tissue for oral layer cover.

Results: - Using this technique, we have covered most of the anterior palatal fistulae comfortably and successfully. This approach eliminates the need for more complex procedures such as tongue flap, buccinator flap/s, FAMM flaps, or free flap.

Conclusion: - In selected cases, the Mucosal Rugosity Unfolding Technique offers a single-stage procedure for the closure of challenging anterior palatal fistulae. This technique provides an effective alternative to more complex reconstructive options.

Keywords: - Anterior palatal fistula, Unfolding of the mucosal Rugosity, Lengthened Mucoperiosteal flap.

Otoplasty, Simple and Anatomical Approach

Approximately 5.6% of the population has prominent ears; there are more than 200 otoplasty techniques, and more than 800 related articles in Pub med, meaning, that there is not only one technique by itself to solve the problem completely. Suture placement and cartilage incision are the two main approaches, represented by modified Mustarde and Converse techniques that are considered best practice today. Otoplasty does not mean just bringing the ears closer to the skull; All structures must be present naturally, without visible marks. We present here the technique base in John Clark Mustarde work from Scotland, with some modification and tips (Hidrodissection) to make it simple and natural. This, Being a short duration procedure 1-1.5 hours, Ambulatory, under local anesthesia, with very fast recovery and very little or non-complications.

Background: The reconstruction of lower leg and foot is very challenging due to their anatomical characteristics. In complex injuries of the lower leg and foot or after oncological surgery we should understand that the reconstruction does not mean just the skin coverage, but should address to more requirements, as: replacing like with like; preparing a good bed for other reconstructed elements (bones, tendons, nerves, vessels); obtaining a good cosmetic appearance; low donor site morbidity. The final aim should be the correction of the functional impairment. In the last half century, we assisted to a dramatical change in thinking and approaching the lower leg and foot complex tissue defects. This became possible due to the new knowledge in vascular anatomy and advances in microsurgical techniques and instrumentation. Aims & Objectives: The main way to well treat this kind of lesions is to ensure a multidisciplinary approach by collaboration between the specialists involved in approaching them. That's why, in the later part of the last millennium, a new concept appeared: Orthoplastic Surgery. Patients / Materials & Methods: Will be analysed the trauma cases involving the lower leg and foot solved in our department in the last 25 years. The cases were solved by a single surgeon with both plastic and orthopaedic competences. Results: Will be presented the important role of debridement, bone fixation and as soon as possible reconstruction by using both traditional and free/local perforator flaps. Discussion & Conclusion: The orthoplastic approach contributes to: • Save unnecessary or extra operations • Reduce the risk of complications • Optimize time, services, and resources • Bring numerous benefits in term of cost-efficiency, quality of care and patient safety

Introduction: Platelets are rich in cytokines and growth factors. Exposed tendons in wounds do not naturally heal by granulation and epithelization. The study aimed to explore the effects of PRP injection therapy on exposed tendons in open wounds and determine if the tendon could support wound healing. Materials and Methods: A retrospective observational clinical study was undertaken from 2012 to 2018 to assess wound healing from exposed tendons in wounds in patients treated with PRP injections and occlusive dressings. Parameters studied included patient and management factors, wound and functional outcomes, wound healing progression, and the direct effects of PRP therapy on tissues. Results Twenty-three patients with several co-morbidities received treatment. The average age of patients was 56 years, with an age range of 25 to 79 years. Twenty of the 23 patients (87%) reached complete healing. Eighteen of the 20 (90%) had good tendon excursion and associated joint movement for the limb's function. The complication rate was low. PRP injection therapy produced a response of increased vascularity, the proliferation of granulation tissue from the tendon, and epithelialization from the surrounding skin. Conclusion: Intra-tendinous PRP injections used with occlusive dressings can heal the exposed tendon and open wound by process of granulation and epithelization, restoring adequate limb function.

Background: Automatic evaluation of breast aesthetics is in need both for clinical and research purposes. However, traditional software are time-consuming, which limits their use in the clinical setting. To improve the efficiency of aesthetic analysis, we developed the Seoul Breast Esthetic Scoring Tool (S-BEST), a deep-learning-based automatic photometric analysis software for improved breast landmarks and feature assessments.

Methods: S-BEST was developed using frontal breast photographs as input and trained using deep learning (DenseNet-264) to automatically provide landmark detection and breast asymmetry indices. To validate the accuracy of S-BEST in providing breast asymmetry indices, physical measurements of breast landmarks were compared to those obtained by S-BEST in 100 females diagnosed with breast cancer using a paired t-test and Bland-Altman plots.

Results: S-BEST showed accurate automatic landmark localization and measurements, with no statistically significant differences between the physical examination and S-BEST's automatic measurements for most distances. However, the nipple-to-inframammary fold distance showed a high bias. S-BEST provided accurate breast asymmetry indices based on these measurements.

Conclusions: S-BEST is an accurate, fast, and automatic photometric analysis tool for clinical and research purposes in breast aesthetics. Further studies are needed to validate its accuracy and applicability to other breast conditions.

INTRODUCTION In the surgical reconstruction of facial paralysis, the available techniques have evolved substantially over the last two decades based on the available technology and, more importantly, on the evaluation of the aesthetic results, complications, and patient satisfaction. The purpose of this work is to relay the lessons learned after 376 consecutive cases and present a treatment algorithm.

MATERIAL & METHODS We retrospectively reviewed 376 patients treated surgically for facial paralysis in the last 23 years in our center. Clinical data including characteristics of the paralysis were collected, as well as objective outcome measures with a focus on the recovery of facial symmetry and smile spontaneity.

RESULTS For the rehabilitation of incomplete facial paralysis, the use of masseteric to facial nerve transfer offers the best results, with a greater capacity to restore spontaneity in women. In bilateral facial paralysis, the technique of choice is bilateral gracilis muscle transplantation in two stages, with the masseter nerve as the source of innervation. As an alternative or adjunct to the dynamic techniques, static techniques can restore facial symmetry and improve the quality of life of patients. The choice of surgical technique is determined firstly by the time of evolution of the paralysis, as well as the laterality and the type of paralysis. In addition, the result is conditioned by age and sex, with better recovery of spontaneity in children and women. All these factors need to be considered, along with patient preferences, to achieve an optimal result.

CONCLUSIONS The proposed algorithm, based on our experience after 376 cases, simplifies the reconstruction of facial paralysis, mainly taking into account the characteristics of the paralysis and the patient's gender as factors that influence smile recovery.

Background: Non-syndromic cleft lip with or without cleft palate (NSCL/P) is one of the most common craniofacial anomalies with multifactorial genetic and environmental etiologies. Senescence, as indicated by senescence-associated markers, including Alu methylation, AGE, RAGE and p16 expressions may be the pathogenesis of NSCL/P. However, link between those senescence-associated markers and the severity of NSCL/P has not been investigated. Thus, the present study aimed to explore the association of senescence-associated markers and the severity of NSCL/P.

Methods: Prospective cohort study was conducted from January 2022 to January 2023. The Alu methylation and aging marker, as indicated by AGE, RAGE and p16 expression, were examined in NSCL/P patients and their mothers. The NSCL/P white blood cells (WBCs)-Alu methylation were evaluated in three phases of patients, including 0-3 months old, 3-6 months old (cheiloplasty), and 9-12 months old (palatoplasty). WBCs-Alu methylation of mothers was examined only at the first visit. We also investigated for tissue specific Alu methylation, such as lip and palate from discarded tissues in cheiloplasty and palatoplasty.

Results: 39 NSCL/P patients (cleft lip only (CLO: n=6); cleft palate only (CPO: n=9); cleft lip with palate (CLP: n=24) and their mothers were enrolled. 48.7% of patients were male. Our results showed that an increase in RAGE expression of WBCs-patients was positively correlated with severity of cleft subtypes (p<0.05). In mother, an increase in WBCs-Alu methylation was observed in CLP group, compared with CPO group, whereas WBCs-Alu methylation was not different between CLO and CPO groups. However, mean WBCs-Alu methylation in patients were 64.3  2.9%, 66.0  1.8%, 61.8  6.0% for CLO, CPO, CLP, respectively (p >0.05). For tissue Alu methylation, mean Alu methylation were 62.2  4.1%, 66.1  5.3% for lip and palatal tissues, respectively, and there was not statistically significant between groups. We found no significant correlation between senescence-associated markers in tissues and cleft specific subtypes.

Conclusions: Our findings suggest a link between systemic aging-senescence-associated markers in patients, increased WBCs-Alu methylation in mothers, and the severity of NSCL/P. Therefore, NSCL/P pathogenesis may be influenced by the maternal aging process and senescence of the patients.

Keywords: Cleft lip and palate; Alu methylation; Aging process; Senescence

Affiliation: This work (Grant No. RGNS 64-056) was supported by Office of the Permanent Secretary, Ministry of Higher Education , Science, Research and Innovation (OPS MHESI), Thailand Science Research and Innovation (TSRI) and Chiang Mai University, Thailand.

Aim: The co-location of ADSCs in the breast cancer microenvironment has been the focus of numerous scientific studies, and the origin of the modern safety debate. While ADSCs isolated from healthy patients have been shown to confer a malignant advantage when co-located with breast cancer in-vitro, they fail to provide a truly analogous model for the clinical cohort undergoing reconstruction. Systemic treatment with ER+ antagonists (Tamoxifen) is hypothesised to have a long-term effect on ADSC function, inhibiting their pro-tumorigenic potential and altering their interaction with ER+ breast cancer (MCF-7 and T47D).

Methods: Primary ADSC lines were isolated from breast cancer patients (n=10) established on systemic Tamoxifen (>12 months) alongside ADSCs isolated form a healthy control group (n=6). Indirect (conditioned media) and direct (3D non-contact co-culture) models were utilised to interrogate systemic ADSC exposure to Tamoxifen on their effect on the neoplastic traits (proliferation, cell adhesion, protein expression, migration, invasion, bioenergetics, and cellular morphology) of two ER+ breast cancer cell lines (MCF-7 and T47D).

Results: Comparing the effects of ADSCs on the key cancer hallmarks, there was a statistically significant difference (p<0.005) in the neoplastic traits of both ER+ cell lines when comparing both the indirect (n=16) and direct effects (n=12) of ADSCs isolated from patients undergoing systemic treatment compared with the healthy ADSC controls. Systemic Tamoxifen exposure inhibited the pro-tumorigenic effects of ADSCs, with this patient population failing to consistently upregulate neoplastic behaviour, unlike their healthy counterparts. This novel finding elucidates the potential impact systemic hormone treatment may have on the ADSCs within free fat grafts, accounting for the disparity seen between clinical and lab-based studies.

Conclusion: This novel study illustrates the divergence of ADSC behaviour in the microenvironment of breast cancer following systemic hormone receptor modulation. This may in part explain the disparity in scientific and clinical studies, highlighting the need for further research on factors that influence ADSC behaviour, and the safety of lipofilling.

Emman J Thomson 1,2, Thomas H Jovic 1,2, Iain S Whitaker 1,2, Shareen H Doak 3 1Reconstructive Surgery and Regenerative Medicine Research Centre (ReconRegen), Swansea University Medical School, Swansea, UK, SA2 8PP 2The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital Swansea, UK 3Centre for Nanohealth and CALIN Innovation Network, Swansea University Medical School, Swansea, UK, SA2 8PP