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Shekhar K Gadkaree - One of the best experts on this subject based on the ideXlab platform.
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associations between national financial trends and facial plastic surgery procedural volume
Laryngoscope, 2020Co-Authors: Shekhar K Gadkaree, Justin C Mccarty, Rachel E Weitzman, Adeeb Derakhshan, Suresh MohanAbstract:OBJECTIVE(S) To characterize procedural trends in facial plastic and reconstructive surgery procedures in relation to the United States economy. METHODS Retrospective cohort study examining annual procedure rates were determined from the American Society of Plastic Surgeons (ASPS) National Clearinghouse of Plastic Surgery Procedural Statistics from January 1 2007 to December 30, 2017. Procedures were compared to economic activity of the United States as measured by gross domestic product (GDP) were compared using Kolmogorov-Smirnov goodness of fit testing and piecewise multivariate regression modeling. RESULTS Annual trends in procedural rates showed an overall decrease in the rates of rhinoplasty (284,960 to 218,924), blepharoplasty (240,660 to 209,571), and Otoplasty (28,571 to 23,433) from 2007 to 2017. Total cosmetic surgery remained fairly stable, while minimally invasive cosmetic surgery increased in frequency over the study period. On piecewise regression analysis, rhinoplasty (P = .02), rhytidectomy (P = .007), invasive cosmetic surgery (P < .001) were significantly associated with GDP, whereas Otoplasty (P = .98) and reconstructive surgery (P = .11) were not associated with GDP. CONCLUSION Cosmetic plastic surgery procedures show a greater correlation to GDP than reconstructive procedures. Trends in plastic surgery cases over the last decade show a decreasing number of rhinoplasty, Otoplasty, and blepharoplasty, with stabilization in the last few years. An increasing number of reconstructive cases are found. LEVEL OF EVIDENCE 4 Laryngoscope, 130:632-636, 2020.
Jill Chorney - One of the best experts on this subject based on the ideXlab platform.
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parental decision making in pediatric Otoplasty the role of shared decision making in parental decisional conflict and decisional regret
Laryngoscope, 2016Co-Authors: Paul Hong, Ayala Y Gorodzinsky, Benjamin A Taylor, Jill ChorneyAbstract:Objectives/Hypothesis To date, there has been little research on shared decision making and decisional outcomes in pediatric surgery. The objectives of this study were to describe the level of decisional conflict and decisional regret experienced by parents considering Otoplasty for their children, and to determine if they are related to perceptions of shared decision making. Study Design Prospective cohort clinical study. Methods Sixty-five consecutive parents of children who underwent surgical consultation for Otoplasty were prospectively enrolled. Participants completed the Demographic Form, the Decisional Conflict Scale, and the Shared Decision-Making Questionnaire after the consultation visit. The consulting surgeons completed the physician version of the Shared Decision-Making Questionnaire. Six months after surgery, parents completed the Decisional Regret Scale. Results The median decisional conflict was 15.63; 21 (32.8%) parents scored 25 or above, a previously defined cutoff indicating clinically significant decisional conflict. Parent ratings of shared decision making and decisional conflict were significantly negatively correlated (P < 0.001); however, there was no significant correlation between physician ratings of shared decision making and parental decisional conflict. Significant decisional regret was reported in two (3.2%) participants. Decisional regret and parent and physician ratings of shared decision making were both significantly negatively correlated (P = 0.044 and P = 0.001, respectively). Decisional regret and decisional conflict scores were significantly positively correlated (P = 0.001). Parent and physician ratings of shared decision making were correlated (intraclass correlation = 0.625, P < 0.001). Conclusion Many parents experienced significant decisional conflict when making decisions about their child's elective surgical treatment. Fewer parents experienced significant decisional regret after the procedure. Parents who perceived themselves as being more involved in the decision making process reported less decisional conflict and decisional regret. Parents and physicians had varied perceptions of the degree of shared decision making. Future research should develop interventions to increase parents' involvement in decision making and explore the influence of significant decisional conflict and decisional regret on health outcomes. Level of Evidence 2b. Laryngoscope, 2016
Nolst Trenité, Gilbert J. - One of the best experts on this subject based on the ideXlab platform.
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Interest in facial plastic and reconstructive surgery among otorhinolaryngologists: a survey in The Netherlands
'American Medical Association (AMA)', 2005Co-Authors: Van Pinxteren, Sors A. T., Lohuis, Peter J. F. M., Ingels, Koen J. A. O., Nolst Trenité, Gilbert J.Abstract:To assess the interest of Dutch otorhinolaryngologists in facial plastic and reconstructive surgery (FPRS). We conducted a 22-question survey among otorhinolaryngology physicians and residents concerning their experience with and interest in FPRS. The response rate was 71% (335/475; 275 physicians and 60 residents). Most respondents associated FPRS with rhinoplasty, Otoplasty, and the reconstruction of skin cancer defects. Of the physicians, 81% said that 1% to 33% of their practice involves FPRS; 62% were satisfied with this percentage, whereas 36% would like it to be higher. Approximately 70% of physicians regarded their training in FPRS as insufficient, although most (70%) had taken supplementary courses. Moreover, 73% of the otorhinolaryngology physicians and 72% of all respondents said that FPRS should be taught during and after residency, with a preference for hands-on courses. Finally, 84% of all respondents thought that FPRS should be part of the field of otorhinolaryngology, whereas 48% thought that it should become a subspecialty. There is interest in integrating FPRS training into the Dutch otorhinolaryngology residency program, as it is in the United State
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Otoplasty: a modified anterior scoring technique
'Georg Thieme Verlag KG', 2004Co-Authors: Nolst Trenité, Gilbert J.Abstract:In the long history of Otoplasty, the basic techniques used to correct prominent ears with a missing antihelix are based on incisions, scoring, and suturing of the cartilaginous framework of the auricle. In this article, modifications (subperichondrial dissection and adjusting sutures) of the anterior scoring technique of Chongchet are describe
Nolst Trenite G.j. - One of the best experts on this subject based on the ideXlab platform.
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Interest in facial plastic and reconstructive surgery among otorhinolaryngologists: a survey in The Netherlands.
'American Medical Association (AMA)', 2005Co-Authors: Pinxteren, S.a. Van, Lohuis P.j., Ingels K.j.a.o., Nolst Trenite G.j.Abstract:OBJECTIVE: To assess the interest of Dutch otorhinolaryngologists in facial plastic and reconstructive surgery (FPRS). METHODS: We conducted a 22-question survey among otorhinolaryngology physicians and residents concerning their experience with and interest in FPRS. The response rate was 71% (335/475; 275 physicians and 60 residents). RESULTS: Most respondents associated FPRS with rhinoplasty, Otoplasty, and the reconstruction of skin cancer defects. Of the physicians, 81% said that 1% to 33% of their practice involves FPRS; 62% were satisfied with this percentage, whereas 36% would like it to be higher. Approximately 70% of physicians regarded their training in FPRS as insufficient, although most (70%) had taken supplementary courses. Moreover, 73% of the otorhinolaryngology physicians and 72% of all respondents said that FPRS should be taught during and after residency, with a preference for hands-on courses. Finally, 84% of all respondents thought that FPRS should be part of the field of otorhinolaryngology, whereas 48% thought that it should become a subspecialty. CONCLUSION: There is interest in integrating FPRS training into the Dutch otorhinolaryngology residency program, as it is in the United States
Аветіков, Давид Соломонович - One of the best experts on this subject based on the ideXlab platform.
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Deformation properties of mastoid area skin
Єреванський державний медичний університет, 2018Co-Authors: Steblovskiy D., Стебловський, Дмитро Валерійович, Аветіков, Давид Соломонович, Попович, Іван Юрійович, Avetikov D. S., Локес, Катерина Петрівна, Lokes K. P., Yu. I. Popovich, Boychenko O. N., Бойченко, Ольга МиколаївнаAbstract:The mechanical properties of the skin have been studied in vivo and in vitro using various test methods. It has been found that with age, the skin undergoes considerably less deformation at the same voltage, which is probably due to the change of collagen and elastin nets. Two-dimensional biomechanical behavior and the content of collagen in human skin samples from different areas of topical localization were studied. The minimum and maximum reduction axes were determined after removal and their connection with Langer’s lines. The experimental equipment was designed to keep the geometry and measure loads acting perpendicular to the circle of skin samples. Using in vivo geometry of samples as a base, various deformations were applied. After the voltage relaxation, the final values of the voltage were taken and compared with the deformations. It was found that the axes of maximum and minimum stress do not coin-cide with the Langer’s lines, and rotated 10°. This article describes the structure of the mastoid area skin. After the objective morphological studies, we came to the conclusion that during the surgery on the mastoid region, namely cosmetic Otoplasty and lower rhytidectomy, the length of stretching skin-fat grafts must be taken into account. No visible lesions were found in their deformation in the range of 5-10 mm. This is the optimal minimum and maximum limit of biomechanical parameters in such interventions. Patho-logical changes primarily in the form of balloon degeneration were observed at the 15-20 mm flap tension, indicating a greater likelihood of necrosis in the postoperative period. Deformation of the skin-fat grafts of 25 mm leads to irreversible changes and hemodynamic disorders, thus flap stretching within these parameters is unacceptable. The aim of this study was to investigate the morphological features of skin-fatty grafts of mastoid area at various stages of deformation. In the experiment we used 30 skin-fatty grafts taken from the patients with roughness during cosmetic Otoplasty. These pieces were elongated at 5, 10, 15, 20, 25 mm respectively; they were colored by hematoxylin-eosin as well as van Gieson stai
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Peculiarities of liberation and mobilization of adipose—cutaneous flaps of a nipple—shaped part in cosmetic Otoplasty
Міністерство охорони здоров'я України Асоціація хірургів України Національний інститут хірургії та трансплантології імені О. О. Шалімова НАМН України, 2016Co-Authors: Аветіков, Давид Соломонович, Стебловський, Дмитро Валерійович, Ставицький, Станіслав Олександрович, Попович, Іван Юрійович, Гаврильєв, Віктор Миколайович, Avetikov D. S., Steblovskyi D., Stavytskyi S. O., І. Yu. Popovych, Gavrilev V. M.Abstract:Відстовбурчені вушні раковини — найчастіша вроджена деформація, що характеризується надмірним відхиленням вуха від поверхні голови, у більшості спостережень це пов'язане з недорозвиненням протизавитка. На етапах планування та виконання оперативних втручань використані результати біомеханічних та морфологічних досліджень з індивідуальним аналізом кожного пацієнта. Вдосконалено методику косметичної отопластики. У 15 хворих з приводу капловухості здійснено косметичну отопластику з огляду на біомеханічні та морфологічні особливості шкіри; Droopy ears — is a most frequent inborn deformity, which is characterized by excessive shift of the ear from the head surface. In majority of cases it is connected with underdevelopment of antelion. The results of biomechanical and morphological investigations were applied with individual analysis of every patient on stages of planning and conduction of operative interventions. A cosmetic Otoplasty procedure was improved. Taking into account biomechanical and morphological peculiarities of skin, a cosmetic Otoplasty was performed in 15 patients, suffering droopy ears
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Studying of biomechanical properties of skin in the mastoid region while the cosmetic Otoplasty performance
ТОВ «Ліга Інформ» м. Київ, 2015Co-Authors: Аветиков, Давид Соломонович, Стебловский, Дмитрий Валерьевич, Стебловський, Дмитро Валерійович, Аветіков, Давид Соломонович, Попович, Іван Юрійович, Попович, Иван Юрьевич, Локес, Екатерина Петровна, Бойко, Игорь Васильевич, Локес, Катерина Петрівна, Бойко, Ігор ВасильовичAbstract:Существующие методики устранения лопоухости не гарантируют оптимальный косметический эффект. Изучены оптимальные границы деформации кожно—жировых лоскутов сосцевидной области при выполнении косметической отопластики. На основе анализа биомеханических исследований определены оптимальные углы растяжения и направление вектора силы кожно—жировых лоскутов при выполнении отопластики, обеспечивающие условия выполнения хирургического вмешательства с сохранением природных топографоанатомических соотношений тканей лица и шеи; Існуючі методики усунення капловухості не гарантують оптимальний косметичний ефект. Вивчено оптимальні межі деформації шкірно-жирових клаптів соскоподібного області при виконанні косметичної отопластика. На основі аналізу біомеханічних досліджень визначені оптимальні кути розтягування і напрямок вектора сили шкірно-жирових клаптів при виконанні отопластика, що забезпечують умови виконання хірургічного втручання зі збереженням природних топографоанатомічному співвідношень тканин обличчя і шиї; Existing methods for eliminating lop-earedness do not guarantee optimal cosmetic effect. The optimal boundaries for the deformation of the skin-fat flaps of the mastoid region were studied when performing cosmetic Otoplasty. Based on the analysis of biomechanical studies, the optimal stretch angles and the direction of the force vector of the skin-fat flaps were determined when performing Otoplasty, ensuring the conditions for performing the surgical intervention while preserving the natural topografical and anatomical relationships of the facial and neck tissues
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Biomechanical properties of skin in mastoid area undr lower rhytidectomy and cosmetic Otoplasty
Вищий державний навчальний заклад України «Українська медична стоматологічна академія», 2014Co-Authors: Аветіков, Давид Соломонович, Аветиков, Давид Соломонович, Стебловский, Дмитрий Валерьевич, Avetikov D., Стебловський, Дмитро Валерійович, Steblovskiy D.Abstract:Експериментально показано, що за механічними властивостями шкіра є нелінійним еластичним матеріалом. Метою дослідження було визначити оптимальні межі деформації шкірно-жирових кла- птів соскоподібної ділянки стосовно проведення нижньої рітідектомії та косметичної отопласти- ки. Висновок. Таким чином, було створену математичну модель при напруженому стані шкіри та її релаксації на етапі планування на основі отриманих математичних даних, їх комп’ютерної обробки за допомогою графічних редакторів візуалізації процесів та створення стандартизаційних таб- лиць щодо меж пластичної деформації шкіри у соскоподібній ділянці, дасть можливість у цифровому вигляді визначитися за даними щодо довжини зміщення або кута ротації шкірно-жирових клаптів при проведенні нижньої рітідектомії та косметичної отопластики в залежності від характеру де- фекту та конкретного пацієнта; Экспериментально показано, что по механическим свойствам кожа является нелинейным эластич- ным материалом. Целью исследования было определить оптимальные границы деформации кожно- жировых лоскутов сосцевидной области при проведении нижней ритидэктомия и косметической отоп- ластики. Таким образом, создание математической модели при напряженном состоянии кожи и ее ре- лаксации на этапе планирования, на основе полученных математических данных, их компьютерной обработки с помощью графических редакторов визуализации процессов и создания стандартизаци- онных таблиц относительно границ пластической деформации кожи в сосцевидной области позволит в цифровом виде определиться по данным относительно длины смещения или угла ротации кожно- жировых лоскутов при проведении нижней ритидэктомия и косметической отопластики в зависимости от характера дефекта и конкретного пациента; It has been experimentally shown that the skin by its mechanical properties is a nonlinear elastic material. The aim of the study was to determine the optimal deformation margins of cellulocutaneous flaps of mastoid area under lower rhytidectomy and cosmetic Otoplasty. Thus, a mathematical model of the skin under the tention and its relaxation at the stage of planning has been worked out on the basis of the mathematical data obtained and their computer processing by using graphics editors for visualization has been carried out. The standardized tables on the borders of skin plastic deformation in the mastoid area enables correct digital choice of the length of the displacement or rotation angle for rotation cellulocutaneous flaps under rhytidectomy and cosmetic Otoplasty depending on the character of the defect and on an individual patient
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What is role biomechanical properties of skin during lower rhytidectomy and cosmetic Otoplasty
Вищий державний навчальний заклад України «Українська медична стоматологічна академія», 2014Co-Authors: Аветіков, Давид Соломонович, Аветиков, Давид Соломонович, Стебловский, Дмитрий Валерьевич, Avetikov D., Стебловський, Дмитро Валерійович, Steblovsky D.Abstract:Реконструктивна хірургія – це спроба повернутися до норми (після травм або захворювань, а також природних для людського життя змін). Багато патологічних та косметичних змін стану шкіри можуть бути описані за допомогою механічних властивостей. Діагностика, лікування і наступне визначення різних шкірних порушень часто вимагають детальної інформації про зміни в її структурі та функціях. Тому такі зміни зазвичай впливають на механічні властивості шкірних тканин і можуть бути дуже інформативні. Незважаючи на все різноманіття пропонованих методик проведення пластичних операцій, можна виділити кілька ключових моментів, які об'єднують або, навпаки їх поділяють на умовні групи: за розташуванням і довжиною шкірних розрізів, за площею відшарування шкірно-жирових клаптів, за векторами переміщення шкірно-жирових клаптів, за методиками фіксації клаптів; Реконструктивная хирургия – это попытка вернуться к норме (после травм или заболеваний, а также естественных для человеческой жизни изменений). Многие патологические и косметических изменений состояния кожи могут быть описаны с помощью механических свойств. Диагностика, лечение и последующее определение различных кожных нарушений часто требуют детальной информации об изменениях в ее структуре и функциях. Поэтому такие изменения обычно влияют на механические свойства тканей кожи и могут быть очень информативны. Несмотря на все многообразие предлагаемых методик проведения пластических операций, можно выделить несколько ключевых моментов, которые объединяют или, наоборот их разделяют на условные группы: по расположению и длине кожных разрезов, по площади отслойки кожно- жировых лоскутов, по векторам перемещения кожно-жировых лоскутов, по методикам фиксации лоскутов; Reconstructive surgery - is an attempt to return to normal (after injury or illness, as well as natural to human life changes). Many cosmetic and pathological changes of skin condition can be described with the aid of mechanical properties. Diagnosis, treatment and the subsequent determination of various skin disorders often require detailed information about changes in its structure and functions. Therefore, these changes usually affect the mechanical properties of tissues Skin and can be very informative. Today finally proven experimentally that the skin is highly non-linear viscoelastic material. Viscoelastic means that the skin represents a combination of elastic and viscous properties. Because of its viscous, mechanical properties depend on the time and history of mechanical skin. The skin is not homogeneous and not isotropic – a composite material consisting of discrete parts, which has the area of distribution. Also, the voltage to which the skin is prone enough, this means that the conventional theory of elasticity (based on the assumption of small deformations) in many cases, cannot be used. Incision, detachment and mobilization of skin and fat grafts during lower Rhytidectomy and cosmetic Otoplasty conducted mostly in the mastoid region, their evolution is as follows. The incision in the mastoid area may have a different length and direction is determined by the projected displacement vector and lateral tissues of the neck. In 2002, D. Marclac proposed a vertical incision in the crease and the outside of the back area, which he called a U-shaped incision. The prototype of this proposal was cut, described in 1933 by the French surgeon P. Claoue. Much later, in 1999, W. Little worked out a deal to access as inverted letters «Ω». Regardless of the design , the tip formed flap must not be below the level of the front legs contra curl , and the angle between the occipital and behind – cut components make up less than 60°, in order to avoid ischemia and necrosis peeled off the top skin- fat flap. Many surgeons under "short scar lifting" refers to the specific transaction SMAS-ektomy(involving subcutaneous muscle-aponevrotic system). The author does not claim to absolute innovation of their proposals, indicating that the first surgeon who made a "mini- facelift" in 1919, was R. Passot. Despite the diversity of the proposed techniques for plastic surgery, there are several key points that unite or conversely they are divided into groups: on the location and length of skin incisions, the area detachment skin-fat flaps on the displacement vector skin-fat flaps, according to the methods of fixing flaps
