Background: The Institute of Medicine defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information. Low health literacy is at a crisis level in the United States. Health literacy is a stronger predictor of a person’s health than age, income, employment status, education level, and race. In the plastic surgery literature to date, there is no study that evaluates health communication between plastic surgery patients and providers. This study also aims to establish the readability of the American Society of Plastic Surgeons informed consent forms. Methods: A survey instrument was designed to assess health literacy of plastic surgery patient and health communication competencies of providers. The Readability Calculator and Hemingway Editor were used to determine the readability of a sample of the American Society of Plastic Surgeons informed consent forms. Results: Twenty-one percent of patients did not complete high school. Fifty-one percent of patients agreed that better communication with their provider would improve their health. Seventy-six percent of providers agreed that they have difficulty communicating with patients with different cultural backgrounds; 29% of providers stated that they offered patients low-literacy educational material. The average readability of the informed consents distributed to plastic surgery patients is above 12th grade. Conclusions: This study identifies the gap in communication between plastic surgery patients and providers in a county hospital setting. Failure to take appropriate actions toward eliminating inherent barriers in health communication is costly to both the hospital and the patients. These findings also raise concern about the understanding of informed consent in plastic surgery patients.
Background: Health literacy of plastic surgery patients may affect surgical decisionmaking and perioperative outcomes. In addition to consulting a plastic surgeon, patients often refer to online-based resources to learn about surgical options. The aim of this scoping review was to identify evidence detailing the state of health literacy of plastic surgery patients and available resources to highlight areas of improvement for clinical practice and future research. Methods: Utilizing PubMed and Web of Science databases, 46 eligible studies that analyzed health literacy in plastic surgery patients and readability of plastic surgery resources were included. Extracted characteristics from eligible studies included study size, type of analysis, findings, and conclusions. Results: Regardless of plastic surgery procedure or subspecialty, resources presenting plastic surgery information to patients exceeded the American Medical Association and National Institutes of Health recommended sixth-to eighth-grade reading level. Plastic surgery patients demonstrated greater knowledge of preoperative indications and surgical benefits compared with postoperative outcomes and surgical risks. Conclusions: Most health literacy research in plastic surgery focuses on readability of written internet-based resources as opposed to direct assessment of health literacy in plastic surgery patients. Plastic surgery resources exceed the recommended mean reading grade level. Dedicated efforts to recognize and accommodate a patient's level of health literacy in plastic surgery should be considered.
INTRODUCTIONFacelifts are in the top five aesthetic procedures performed in plastic surgery. In 2019, almost 124,000 facelifts were performed in the United States per the American Society of Plastic Surgery. 1 Bleeding and hematomas arise in facelift surgery secondary to disrupted vascular and lymphatic networks as skin flaps are elevated, which may lead to postoperative complications and unsatisfactory patient outcomes. 2 Hematoma is the most common postoperative complication in facelifts with a reported incidence from 0.2% to 8%. 3 The pressure of an expanding hematoma on the overlying skin flaps may decrease arterial perfusion, cause venous congestion, and increase inflammation that may lead to skin irregularities. While expanding hematomas require immediate re-exploration, minor hematomas of smaller volume may be aspirated. Predisposing risk factors to hematoma in facelift surgery include male gender, history of hypertension, and coagulopathy. 4 Multiple methods have been developed, and new evidence continues to be generated about how to best manage bleeding in facelifts. This literature review aims to summarize evidence-based methods in minimizing bleeding and postoperative hematoma in facelift surgery. METHODSAn evidence-based review of methods used to minimize bleeding in facelift surgery was conducted using the PubMed database adhering to PRISMA guidelines (Fig. 1). Inclusion criteria entailed randomized controlled trials, prospective/ retrospective cohort and case-control studies, and case series. Exclusion criteria included (1) lack of availability Disclosure: Dr. Jeffrey Janis receives royalties from Thieme and Springer Publishing.
Cutaneous hypersensitivity-like reactions to breast implants seem to be rare complications, sometimes necessitating implant removal. Future studies are needed to establish their incidence and etiology, and the diagnostic role of patch testing and preoperative screening.
Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy.Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed.Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation.Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.
Reconstruction of the vagina is performed for patients undergoing abdominoperineal resection, pelvic exenteration for cancer involving the cervix, vagina, or rectum, and other causes of acquired pelvic defects. Immediate reconstruction after partial or total vaginal resection facilitates primary healing of the perineal defect, decreases fluid loss from the pelvis, reduces infection rate, and decreases nutritional demands. The gracilis flap is one of the most commonly used flaps for reconstruction of these challenging pelvic defects because it is versatile, has minimal donor side morbidity, and often lies outside the field of radiation. This chapter provides a detailed account of patient assessment and operative techniques.
To the Editor:W e have read the article "Surgical Outcomes of Implant-based Breast Reconstruction Using TiLoop Bra Mesh Combined With Pectoralis Major Disconnection" by Chen et al 1 with a great interest. In our opinion, there are some points in the article that needs further clarification based on our clinical experience.The objective of the study was to compare breast symmetry and patient satisfaction with breast appearance between implant-based breast reconstruction using titanized polypropylene mesh combined with pectoralis major disconnection and conventional implant reconstruction, to analyze differences in complications. In patients who underwent pectoralis major disconnection, the whole lower edge of the pectoralis major to the fourth intercostal was disconnected to sink the prosthesis, which was covered with the lower edge of the pectoralis major combined with the titanized polypropylene mesh (TiLoop Bra) by suture. 1 We know that, in the initial stage of immediate breast reconstruction, surgeons use in particular acellular dermal matrix when the pectoral muscle is not sufficient to cover the subpectorally located expander. Histologic analyses of acellular dermal matrix show retention of transplanted elastic fibers after graft incorporation. 2,3 During acellular dermal matrix-assisted breast reconstruction with tissue expanders, it appears that the pectoralis muscle stretches primarily rather than the graft. Once the acellular dermal matrix graft becomes incorporated, it is repopulated with host fibroblasts and ultimately converted to the host tissue. 4 In this way, we can conclude that the acellular dermal matrix loses its foreign body properties by showing biocompatibility over time.Nevertheless, we wondered why authors prefer titanized polypropylene mesh in immediate reconstruction, which does not give away its foreign body properties over time, instead of the acellular dermal matrix, which shows biocompatibility over time.The authors should be congratulated because they offer a new surgical technique in this regard.
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