Faculty Bibliography

PURPOSE:Outcomes after female cosmetic genital surgery (FCGS) performed by plastic surgeons working in a group practice setting have not been well documented. This article aimed to assess outcomes and to describe FCGS techniques used in a large group private plastic surgery practice. METHODS:A retrospective chart review identified patients who underwent FCGS from 2009 to 2018. Demographic, clinical, and operative information was reviewed and recorded. Outcomes were assessed by evaluating postoperative complications and the need for revision surgery. RESULTS:Seventy-seven women between the ages of 14 and 53 years underwent FCGS performed by 1 of 6 surgeons. Forty-five patients underwent central wedge excision for labia minora hypertrophy, whereas 32 patients underwent extended central wedge excision for labia minora and clitoral hood hypertrophy. Four patients underwent liposuction of the mons pubis as an additional procedure. Over a mean follow-up of 37.4 months, postoperative asymmetry/redundancy occurred in 12 patients, requiring revision in 10. Wound dehiscence occurred in 12 patients, requiring revision in 9. There was one hematoma postoperatively requiring evacuation, one case of dyspareunia, and one case of decreased sensation. A single-layer wound closure (P = 0.050) and mons liposuction (P = 0.011) were risk factors for wound dehiscence. CONCLUSIONS:Central wedge excision and extended central wedge excision labiaplasty were the techniques used in a large group plastic surgery practice. Postoperative asymmetry and dehiscence were the most common complications, and the revision surgery rate was high. A single-layer wound closure and additional mons liposuction were risk factors for dehiscence after central wedge labiaplasty.

PURPOSE:Patient-reported outcomes after female cosmetic genital surgery (FCGS) have been well documented; however, methods vary widely between studies and are often very detailed, time-consuming, and difficult to reproduce. The purpose of this study was to assess patient-reported outcomes after FCGS using a novel method and survey as well as to present the results of a pilot study aimed at validating this survey. METHODS:A retrospective chart review identified patients who underwent FCGS. Demographic, clinical, operative, and outcome characteristics were recorded. A novel survey, including 14 items administered by telephone interview, was developed and extrapolated from the BREAST-Q for augmentation mammaplasty, to assess patient-reported outcomes after FCGS with regard to satisfaction with outcome and physical, psychosocial, and sexual well-being. RESULTS:The survey response rate was 50.6% (39 patients). Over a mean time after surgery of 56 months, 14 complications occurred in 11 patients (28.2%), and 10 complications required revision surgery. Postoperative asymmetry and dehiscence were the most common complications. Despite the higher complication and revision surgery rates, 97.4% agreed that the surgery was a good experience and were satisfied with the results after surgery. In addition, patient-reported outcomes after FCGS showed significant improvement in physical well-being, psychosocial well-being, and sexual well-being (P < 0.001). CONCLUSIONS:This novel survey can be used to assess patient-reported outcomes after FCGS in an efficient approach. Despite the potential complications and need for revision surgery, the vast majority of patients who undergo FCGS feel that it is a good experience, are satisfied with the results after surgery, and show significant improvement in physical, psychosocial, and sexual well-being after surgery.

A comprehensive approach to facial rejuvenation often requires facelift surgery combined with ancillary facial procedures. This may require prolonged operating time under general anesthesia or conscious sedation. When general anesthesia is used, secure endotracheal tube fixation and ready access to the face is essential. We describe an anesthetic technique that assures secure tube placement, rapid intubation, and ready access to the entire face. A fiber-reinforced tube is placed orotracheally, wired to the mandibular dentition, and brought over the head in the fashion similar to a nasotracheal tube. The reinforced nature of the tube prevents kinking and allows rapid repositioning inferiorly to allow access to the upper face. In over 400 rhytidectomies, this technique has allowed rapid intubation and surgical preparation. There have been no airway-related problems or other related complications. This is a safe, effective, and rapid means of securing orotracheal intubation during facial esthetic surgery allowing ready access to the face.

The donor-site morbidity from harvesting unilateral free fibular osteoseptocutaneous flaps has been previously evaluated and is considered minimal. The purpose of this study was to investigate functional deficits after bilateral fibular osteoseptocutaneous flap harvest. Between 1990 and 2004, 7 consecutive patients undergoing mandible reconstruction utilizing bilateral autogenous free fibular osteoseptocutaneous flaps were included in the study. They were evaluated for the following subjective symptoms on the donor leg: pain, paresthesia, walking ability, restriction in activity, gait alteration, and aesthetic result. In addition, balance test and gait analysis were used to quantitatively assess functional outcomes. The results of this objective assessment were compared with those of 8 age-matched control subjects. Most patients had few subjective symptoms. The most common complaints were pain after prolonged walking (14%), slight difficulty in squatting (28%), and minimal paresthesia on 1 of the donor legs (14%). There were no significant differences in reaction time and movement velocity on either the balance test or gait analysis between the study and control groups (P > 0.05). However, there were significant differences with regard to right backward directional control, maximum stability with eye closing, sway referenced support, and ankle strategy (P < 0.05). Long-term follow-up revealed minimal donor-site morbidity after bilateral fibular osteoseptocutaneous free flap harvests. The functional deficits could only be found under the most unfavorable sensory feedback conditions.

Gluteal compartment syndrome is an uncommon entity that has been described in the literature after drug overdose and orthopedic procedures. We describe the first case of bilateral gluteal compartment syndrome that followed pelvic revascularization after the repair of an abdominal aortic aneurysm with bilateral common and internal iliac aneurysms. The patient was treated with aggressive fluid hydration and bilateral gluteal fasciotomies with resolution. The bilateral gluteal compartment syndrome was likely caused by increased pressure on the gluteal muscles, secondary to increased patient weight combined with a period of local ischemia to the watershed areas during iliac cross-clamp

Minimally invasive techniques have become the standard of care for multiple procedures. This paper demonstrates both the surgeons' capacity to perform an accurate anatomic evaluation of the hand and forearm (n=10) and the use of this anatomic information to accurately perform sonographically guided, percutaneous carpal tunnel release using a single-portal endoscope without direct or indirect visualization in a cadaver model (n=6). Open dissection was then performed to confirm complete ligament transection and to evaluate the surrounding structures for injury. In all 6 cadavers, the transverse carpal ligament was transected completely without injury to any surrounding structures. With further investigation, this novel technique may offer a less invasive, office-based method for the surgical treatment of carpal tunnel syndrome that may offer patients an expedited recovery