Scientific Abstract Presentations: Global Partners Session 2 Saturday, October 11 Sat, Oct 11 5:00-6:00 p.m. CDT

Background:

Palatal fistulas represent the most challenging complication after cleft palate repair, with recurrence rates ranging from 2.4% to 35%. The lack of a standardized difficulty index complicates surgical decision-making, specifically in the management of complex defects. The Palatal Fistula Difficulty Index (PFDI) was formulated as a quantitative tool to stratify fistula complexity based on anatomical and functional factors. With numerical scores assigned across six categories - location, size, configuration, number of fistulae, velopharyngeal function, and recurrence - the index ensures patients with complex defects receive timely referrals to tertiary institutes, optimizing postoperative outcomes. This study aimed to develop and validate the Palatal Fistula Difficulty Index by assessing its reliability and accuracy in identifying high-risk cases necessitating specialized intervention.

Methods:

A prospective study was conducted at CLAPP Hospital, Lahore, Pakistan, over three months from November 2024 to January 2025. A total of 30 patients with palatal fistulas were selected and assessed using the six-category index, which assigned scores for: (1) Fistula Location (Midline, Lateral, Subtotal); (2) Size (<1 cm, 1–3 cm, >3 cm); (3) Configuration (Longitudinal, Transverse, Irregular); (4) Number of Fistulae (Single, Two, >Two); (5) Palate Function (Both Adequate, Function Adequate but Length Inadequate, Neither Adequate); and (6) Recurrence (Primary, Operated Once, Operated More Than Once). Selected cases were distributed to 20 experienced cleft surgeons across different institutions. Each surgeon independently evaluated the cases and assigned a score, which they sent back for analysis. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Postoperative outcomes were analyzed, focusing on fistula recurrence, operative time, and functional outcomes. Statistical analyses were conducted using R Statistical Software (Version 4.3.2; R Core Team 2024).

Results:

The inter-rater reliability of the PFDI was excellent (ICC = 0.91, 95% CI: 0.87–0.94), indicating high agreement among evaluators. The index score correlated significantly with operative time (r = 0.82, p < 0.001), confirming its predictive value for surgical complexity. Logistic regression analysis demonstrated that each 1-point increase in the score was associated with a 2.95-fold increased risk of recurrence (OR = 2.95, 95% CI: 2.11–4.27, p < 0.001). The recurrence rate increased significantly with complexity, with low complexity cases (6–9 points) showing a 5% recurrence rate, moderate cases (10–14 points) an 18% recurrence rate, and high complexity cases (15–18 points) a 42% recurrence rate (p < 0.001, χ² test). Operative time also varied significantly between groups (low complexity: 43 ± 11 min; moderate: 74 ± 19 min; high: 112 ± 24 min, p < 0.001, ANOVA). 72% of high-complexity cases treated at non-specialized centers ultimately required referral to the tertiary cleft center due to failed closure.

Conclusion:

The Palatal Fistula Difficulty Index is a reliable and predictive tool for classifying palatal fistula complexity and guiding referral decisions. Higher scores were strongly associated with longer operative times, increased recurrence risk, and the need for specialized surgical intervention, making the scorecard a valuable triage system for identifying cases that should be referred to tertiary cleft centers.

Scars are the endpoint of wound healing after the body worked to restore continuity of tissues after an injury. An uncontrolled proliferating phase or inadequate remodeling phase of wound healing result to abnormal scars such as hypertrophic and keloid scars. They are thick, mostly hyperpigmented raised layers of connective tissues growing beyond the site of injury. These are associated with pain, pruritis, tenderness that is easily abraded with minimal trauma, while some may only complain of aesthetically unpleasant scar but above all it could negatively impact the patient's quality of life. The management entails time, effort, money, endurance, and full participation of patient and caregivers. This study aimed to prevent the development of hypertrophic scar using Moist Exposed Burn Ointment (MEBO) Scar and comparing its results to the widely accepted treatment using Silicone Gel Dressing. Silicone gel is available in smaller preparation but is more expensive than MEBO. MEBO Scar had been used locally to all phases of wound healing but remained to be controversial and unpopular universally as part of wound care management. The result of the study hopes to provide scientific data and be able to contribute to the literature of wound healing management. This study was done with no non-disclosure agreement from manufacturers. Subjects of the study were patients who underwent split thickness skin graft. The harvested area of skin graft was assessed monthly for 3 months after treatment with either Silicone Gel or MEBO Scar as they undergo phases of wound healing and monitored for the development of hypertrophic scar. Two board certified plastic surgeons blinded of the treatment independently assessed the patients' donor site. A total of 24 patients were included in the study. Twelve patients were treated with Silicone Gel and 12 patients for MEBO Scar after randomization. No dropouts were recorded. Patient's demographic and clinical profiles were recorded including history or presence of hypertrophic scars other than the area studied. Both groups showed a continuous decline in the proportion of hypertrophic scar over time, such that none of the patients remained positive at Week 12 and there was no significant difference between the two groups was observed. Median pain scores were not significantly different on both treatment groups as well. This study demonstrated that MEBO Scar is as effective as Silicone gel dressing in preventing the development of hypertrophic scar. Septemeber 2022

Chittoria, R. A prosective, randomized, placebo controlled, double blind study of silicone gel in prevention of hypertrophic scar at donor site of skin grafting. Journal of cutaneous and aesthetic surgery. 2013. Jan-Mar; 6 12-16 Majeed, M. The use of MEBO scar ointment in the treatment and prevention of post-operative wound scars. International Journal of Pharma research and health sciences. June 2016, 1171-1178. Chuan-ji, L. Clinical application of MEBO Scar ointment in the treatment and prevention of hyperplastic scar. The Chinese journal of burns wound & surface ulcers 2000, (1): 2-25. Wan-hui L, et al. The efficacy analysis of MEBO Scar reducer in treating hypertrophic scar tested by B ultrasound. http://en.mebo.com/article/showinfo.asp?infoID=509. 2010.

Aim. This study synthesizes advancements from three comprehensive investigations into rhinoplasty, emphasizing the innovative integration of advanced imaging modalities, precise surgical techniques, and structural refinement. These findings address critical challenges in primary and revision rhinoplasty, including structural integrity, functional optimization, and aesthetic harmony. Methods. The research encompassed over 300 cases, leveraging a multimodal approach combining preoperative computed tomography (CT), 3D imaging, and algorithmic surgical planning. The studies included: - The use of nasal CT in structured rhinoplasty for functional and aesthetic planning. - Combined rhinoplasty and lip lift procedures for enhanced facial harmony. - Costal graft integration in revision rhinoplasty using advanced imaging for precision planning. Functional and aesthetic outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) scores at baseline and postoperative intervals. A diverse cohort of patients presented with varying nasal and facial concerns. Follow-up durations ranged from 3 months to 5 years, enabling comprehensive evaluation of outcomes and long-term efficacy. Results. With preoperative nasal CT, patients demonstrated significantly enhanced nasal airflow and aesthetic satisfaction, with NOSE and ROE scores improving by 78% and 300%, respectively. CT-guided planning enabled precise correction of structural anomalies while minimizing radiation exposure. The combined approach of simultaneous rhinoplasty and lip lift achieved optimal balance between nasal and lip enhancements, delivering harmonious facial rejuvenation. Aesthetic satisfaction exceeded 92%, with reduced recovery time compared to separate procedures. In revision rhinoplasty, costal cartilage integration facilitated effective reconstruction of complex nasal deformities. Imaging-guided graft sculpting improved structural stability and aesthetic proportions, achieving a 95% satisfaction rate and reducing complication rates to 2.9%. Conclusions. The integration of advanced imaging modalities with precise surgical techniques represents a paradigm shift in rhinoplasty. These innovations enable patient-specific solutions, optimizing both aesthetic and functional outcomes while addressing the complexities of primary and revision rhinoplasty. These findings underscore the transformative potential of modern rhinoplasty practices, setting new benchmarks for surgical precision and patient satisfaction.

References: 1. Szychta P. Optimizing Precision Rhinoplasty with Nasal Computed Tomography. Maxillofac Plast Reconstr Surg. 2024;46(10):1-9. 2. Szychta P. Simultaneous Rhinoplasty and Lip Lift for Enhanced Facial Harmony. Eur J Plast Surg. 2024;47(37):1-8. 3. Szychta P. Enhanced Revision Rhinoplasty with Costal Grafts Guided by Imaging. Maxillofac Plast Reconstr Surg. 2024;46(13):1-11.

INTRODUCTION Venous leg ulcers (VLUs) are a prevalent and challenging consequence of chronic venous insufficiency, resulting in significant morbidity, prolonged healing, and high recurrence rates. They adversely affect patients' quality of life and impose a substantial economic burden on healthcare systems. Traditional treatments, including compression therapy and wound care management, often lead to slow and incomplete healing. Recently, platelet-rich plasma (PRP) has emerged as a potential therapeutic option, containing high levels of platelets and growth factors that are believed to enhance wound healing. However, PRP's effectiveness in VLUs remains controversial, with studies reporting varying degrees of success. This systematic review and meta-analysis aim to assess PRP's overall impact on wound healing in VLUs and clarify its efficacy. METHODS A systematic search was conducted in PubMed and Web of Science databases. Thirteen studies were included, with a total of 554 patients. Healing outcomes, such as total and partial ulcer healing rates, were analyzed using binary random-effects models. Heterogeneity was assessed using tau², Q-tests, and I² statistics to account for variations across studies. RESULTS The meta-analysis demonstrated that PRP significantly increased total wound healing by 50% compared to conventional treatments. The pooled estimate for complete ulcer healing in patients treated with PRP showed a meta-analytical incidence of 1.5 [95% CI 1.09-2.07], indicating a significant improvement in healing outcomes. Substantial heterogeneity was observed across studies (I² = 58%, p<0.001). The percentage of ulcer area reduction at the end of the follow-up period was significantly higher in the PRP group, with a meta-analytical incidence of 16.37 [95% CI 6.45-26.28]. This outcome also exhibited severe heterogeneity (I² = 97%, p< 0.001). Complete ulcer healing at the 4th week of follow-up showed a meta-analytical incidence of 3.65 [95% CI 1.08-12.32], with substantial heterogeneity (I² = 61%, p<0.001). Meta-regression analysis revealed a significant positive association between age and treatment effect (standardized mean difference: 1.023, 95% CI: 0.418 to 1.628, p<0.001). Ulcer recurrence rates were lower in the PRP group, with a meta-analytical incidence of 0.25 [95% CI 0.06-0.99], associated with low heterogeneity. CONCLUSION PRP is an effective therapy for venous leg ulcers, significantly increasing total wound healing by 50%. These findings support PRP's integration as a valuable approach to manage VLUs, especially for patients with slow-healing or chronic wounds.

Aim: Free flap transfer reconstructive surgery remains one of the most demanding chapters of plastic surgery also for patients and surgeons. This kind of patients management requires continuous analysis for patients security and outcome improvement, but also to reduce the effort of the medical team and lower treatment costs. Method: This paper evaluates 10 years free flap transfer in one plastic surgery department. Microsurgical technique aquire, number of patients, surgeries and free flaps, healthy donor site involvment, functional and cosmetic aspects of donor and recipient sites, strategies and tactics of approach, treatment stages, particularities and critical situations are analized. Results / Discussion:
High diversity of free flaps was used for different kinds of reconstruction in all body regions. Numerous cases needed multidisciplinary approach and some several operating stages in consecutive steps or the same operating time. Good training and communication of team member can avoid or solve complications, which are common part of complex cases. Some complications require changes in strategy to reduce risks. Conclusion: Free flap reconstruction represents a common solution in any plastic surgery department. The free flap transfer patient needs holistic multidisciplinary approach. Microsurgical reconstruction is always a teamwork. Common strategy includes back up (plan B and sometimes even plan C). All parts involved (patients, patients relatives, medical staff, insurance companies) must admit that surgery, sometimes in several stages, is just one step of a long walk. A correct assessment of each stage allows good planning, minimizing risks and enhancing outcome.

Introduction Endolaser technology, utilizing a 1470 nm diode laser, targets water and fat cells, making it a promising tool for skin tightening, body contouring, and facial rejuvenation in plastic surgery and cosmetic dermatology.

Aim This presentation aims to evaluate the effectiveness and safety of Endolaser procedures for improving skin texture and reducing fat in various facial and body areas.

Method A series of case studies were conducted, utilizing the Endolaser for treatments in areas such as the upper eyelids, nasolabial folds, and cellulite in the thigh and buttock regions. Quantitative analysis included patient satisfaction rates, histological changes, and imaging techniques to assess outcomes. Treatment parameters were followed according to the manufacturer's guidelines.

Results The Endolaser demonstrated significant efficacy, with up to 30% reduction in localized fat and high patient satisfaction rates (90%). Notable improvements were observed in skin texture, elasticity, and overall appearance, with minimal side effects and quick recovery times reported.

A patient satisfaction survey on Endolaser treatment was conducted and the preliminary result showed above-average satisfaction among participants. When asked if they would recommend Endolaser to others, they responded positively. Minor complications such as small burns and temporary neurofascial effects involving the mandibular frontal nerve were reported but were temporary in nature. Several patients highlighted noticeable improvements, with some noting that their appearance remained youthful compared to colleagues who had aged more visibly.

Conclusion Endolaser technology represents a valuable non-surgical option for patients seeking aesthetic enhancements. With ongoing research and clinical validation, its applications may expand, providing innovative solutions in cosmetic treatments while maintaining high safety and satisfaction levels.

Background: Immediate breast reconstruction following nipple-sparing mastectomy has become widely practiced due to the preservation of nipple-areolar complex (NAC) and improved aesthetic outcomes. To minimize loco-regional recurrence and ensure negative margins at the NAC, it is crucial to maximize breast tissue removal beneath the NAC. However, this increases the risk of nipple ischaemia and necrosis. Indocyanine green (ICG) angiography can assess the skin flap vascularity but is limited by the factors such as skin temperature, vasoconstrictors, and the unavoidable use of dye, which can hinder its utility in monitoring nipple necrosis. In contrast, thermal imaging cameras offer a non-invasive, dye-free way to assess blood perfusion. Therefore, we aimed to evaluate the usefulness of thermal imaging as an early predictor of nipple necrosis. Method: A retrospective single centre study was conducted, including patients who underwent nipple-sparing mastectomy followed by immediate breast reconstructions with autologous, direct-to-implant or tissue expander insertion between 2022 and 2024. Patients were stratified into two groups based on the presence of nipple necrosis. Temperature differences between the nipple and surrounding skins (measured at three points perpendicular to the incision site) were recorded using thermal imaging on postoperative day one (thermal resolution: 0.07℃). Data collected included patient demographics, diagnosis, cancer stage, reconstruction method (autologous, direct-to-implant, expander), plane (subpectoral, prepectoral), cancer location, incision method (upper outer, axillary, previous scar), skin resection, number of frozen biopsies of the nipple, excised breast size (g, ml), ASA classification, operation time, blood loss, smoking, medical history, menopause status, neoadjuvant chemotherapy, haemoglobin levels (pre-, post-operative), transfusion history, blood pressure (pre-, post-operative), and body temperature (pre-, post-operative). The collected data were analysed using StataNow/MP 18.5 software, with Fisher's exact test, the Wilcoxon rank-sum (Mann-Whitney), and receiver operating characteristics (ROC) curve analysis to compare both groups. Results: Of the 33 immediate breast reconstructions, 9 patients with nipple necrosis were analysed. (alpha 0.05, beta 0.8). Four patients required revisional procedures. A statistically significant temperature difference was observed between the nipple and surrounding tissue in patients with nipple necrosis compared to those without necrosis. (mean temperature difference -0.98℃ vs. -0.40℃, p=0.022). The ROC curve analysis revealed an area under the curve (AUC) of 0.76 and an optimal cut-off value of -0.63℃ (sensitivity: 0.778, specificity: 0.708). No additional factors were found to significantly increase the reliability of AUC. Discussion: Patients with nipple necrosis exhibited significantly lower nipple temperature compared to surrounding skin, indicating nipple ischemia. Although the AUC suggests that thermal imaging has acceptable reliability for predicting nipple necrosis, further research is needed to identify more reliable parameters for predicting nipple ischaemia and necrosis. Thermal imaging provides useful for non-invasive, intuitive postoperative monitoring of skin perfusion, allowing for repeated assessments to predict outcomes. These findings provide valuable insights that may guide decisions in managing nipple necrosis after immediate breast reconstruction.

References 1. Moyer HR, Ghazi B, Daniel JR, Gasgarth R, Carlson GW. Nipple-sparing mastectomy: technical aspects and aesthetic outcomes. Ann Plast Surg. 2012 May;68(5):446-50. doi: 10.1097/SAP.0b013e3182394bba. PMID: 22531398. 2. Ahn SJ, Woo TY, Lee DW, Lew DH, Song SY. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol. 2018 Aug;44(8):1170-1176. doi: 10.1016/j.ejso.2018.05.006. Epub 2018 May 18. PMID: 29859649. 3. ElSherif A, Bernard S, Djohan R, Atallah A, Tu C, Valente SA. Nipple necrosis rate with submuscular versus prepectoral implant-based reconstruction in nipple sparing mastectomy: Does it differ? Am J Surg. 2024 Apr;230:57-62. doi: 10.1016/j.amjsurg.2023.11.039. Epub 2023 Nov 29. PMID: 38071140. 4. Du F, Xiao Y, Liu R, Long X, Huang J, Zhang H, Zhou Y, Wang X. Noninvasive Real-Time Assessment of Nipple-Areola Complex Perfusion Using Laser Speckle Contrast Imaging in Direct-to-Implant Breast Reconstruction. Aesthetic Plast Surg. 2025 Jan;49(1):123-130. doi: 10.1007/s00266-024-04114-x. Epub 2024 Jun 11. PMID: 38862659.

Since 2005, nearly 52 face transplants have been performed worldwide. This is a highly specialized surgery reserved for a select group of patients. A candidate for a face transplant must meet certain criteria, including psychiatric and immunological evaluations, among others.

In September 2024, our team at Bellvitge University Hospital in Barcelona performed the 52nd face transplant in the world.

The recipient was a 46-year-old patient with a giant plexiform neurofibroma on his face, causing severe deformity on the right side. As a result, we proposed a face transplant involving the nose, half of the lips, the right eyelids, and the entire right side of the face, including the scalp.

What set this transplant apart was the organ donation protocol. Currently, around 60% of organ donations occur in controlled asystole, and since 2021, this technique has also been applicable to heart donations. In this case, we present our experience with a multi-organ donation from a donor in controlled asystole, which included the heart, kidneys, and face, with three recipients receiving these organs simultaneously.

The complexity of this donation was particularly high due to the fact that the facial dissection had to be performed under ischemic conditions, owing to the nature of the donation in asystole. When the heart was included in the donation, the complexity increased even further, as we could not begin the facial dissection until the heart had been removed from the donor. To address this, we followed a complex protocol to preserve the face for the recipient.

During the first 30 minutes, the cardiac surgeons carried out the heart dissection. In this initial period, the face was in warm ischemia. Once the heart was removed, we applied extracorporeal circulation to the face for 15 minutes to revascularize it. Finally, we began cold ischemia using Wisconsin solution and commenced the dissection of the face, which was carried out simultaneously with the kidney dissection.

The total cold ischemia time was 4 hours. The face transplant was ultimately successful, with the patient spending three weeks in the hospital before being discharged home.

Background Dermatochalasis is a skin excess in the upper eyelid which may be associated with orbital fat prolapse, lacrimal gland prolapse, and involutional blepharoptosis. Upper blepharoplasty is the gold standard procedure for correction of dermatochalasis, and it is the third most common plastic surgical procedure in the USA. However, it is performed mostly in elderly patients, who often have arterial hypertension, which might increase postoperative complications. It is not clear weather upper blepharoplasty can be safely performed in these patients, because of the high bleeding risk. We aimed to investigate the safety of blepharoplasty in patients affected by arterial hypertension.

Material and Methods A comparative retrospective study was conducted in 387 consecutive patients with dermatochalasis of the upper eyelid, who underwent upper eyelid blepharoplasty from January 1st 2015 to June 30th, 2017 at Turku University Hospital. Exclusion criteria included prior eyelid or orbital surgery. Patients were divided according to the arterial hypertension diagnosis and therapy (211 patients) versus control group (176 patients). Complications and outcomes were compared. Patient's and surgeon's satisfaction were also scored and assessed.

Results Baseline characteristics showed significant differences in age and comorbidity rates in the arterial hypertension group. Operative time, return to work and follow-up were similar between the two groups. A trend towards an increased estimate blood loss was detected among patients affected by arterial hypertension (7.4 vs 5.6 ml, p=0.163). No significant differences in any kind complications were detected (4.3% vs 5.1%, p=0.809). Ecchymosis requiring further observation was slightly higher in the study group (0.9% vs 0%, p=0.503). Subjective patients' and surgeon's satisfaction tended to be higher in the hypertension group.

Conclusions Occurrence of arterial hypertension appears to have no effect on the clinical outcomes of upper lid blepharoplasty for dermatochalasis. However, it is important to have a well-compensated antihypertensive treatment before operation.

Background: Facial paralysis profoundly affects function, emotion, and aesthetics, with restoring facial symmetry posing a significant challenge. While dynamic reconstructions like microvascular free muscle transfer are gold standards for achieving a spontaneous smile, static techniques are often necessary for optimal results. Traditional static approaches can improve lip and oral commissure symmetry but are associated with surgical complexity and morbidity. This study evaluates the outcomes of a minimally invasive subzygomatic tensor fascia lata (TFL) sling as an alternative for improving symmetry in unilateral facial paralysis. Methods: We reviewed 10 patients with unilateral facial paralysis who underwent a minimally invasive subzygomatic TFL sling between November 2018 and September 2023. Patient demographics, surgical techniques, outcomes, and complications were analyzed. Outcomes were measured using objective and subjective parameters. Results: The mean age at surgery was 54.5 years, with 70% of the patients being female. Nine patients had undergone prior reconstructive procedures, and one underwent a concurrent masseteric nerve transfer. No postoperative complications or additional procedures were required. Significant improvements in symmetry were observed: vertical lip inclination decreased by 1.90° and horizontal inclination by 3.10° (p < 0.001), while the difference in the upper and lower lip surface area between sides was significantly reduced (p < 0.001). Visual assessment and the perception of asymmetry improved significantly at 12 months postoperatively. Conclusion: The minimally invasive subzygomatic TFL sling provides effective, durable results for unilateral facial paralysis. This technique simulates the native orientation of the zygomaticus major muscle, reduces morbidity, and can complement dynamic reanimation procedures.