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      • Record: found
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      Evaluation of Live Surgery Meetings: Our Experience with the “Live Makeover Aesthetic Surgery Symposium”

      research-article
      Author(s): , MD 1 , , , MD 1 , , MSc 1
      Publication date (Electronic):
      Journal: Plastic and Reconstructive Surgery Global Open
      Publisher: Lippincott Williams & Wilkins

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          Background:

          Live Surgery Meetings have been established as a vey effective means to demonstrate certain surgical techniques and intraoperative decision-making. However, many authors still question the ethics of this approach. We present our experience as organizers of the Live Makeover Aesthetic Surgery Symposium, an annual international live surgery meeting taking place in Athens, Greece.

          Methods:

          Throughout the course of our meetings, 2 surveys were performed, 1 after Live Makeover Aesthetic Surgery Symposium 3, comparing the educational value between live surgery and pre-recorded videos, and the second after LMASS 6, re-evaluating the educational value of live surgery, as well as the ethics of this educational method and the patient safety. In addition, we studied the results of the patients operated on in all of our meetings, and their level of satisfaction.

          Results:

          Based on the results of the first survey, the superior educational value of live surgery was obvious. The second survey confirmed those valuable educational benefits. In addition, the concerns on both surgical outcomes and patient safety were minimal. The patients showed a very high level of satisfaction through their answers. The complications encountered were only 2 of the 49 live surgical demonstrations and were not directly related to the live demonstration.

          Conclusions:

          Based on our study, live surgery is an effective, safe educational tool. However, strict guidelines have to be followed to ensure high educational value and patient safety. Based on our 9-year experience with our live surgery meeting, we provide detailed guidelines for optimal outcomes.

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          Most cited references25

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          Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis

          Rei Ogawa (2017)
          Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.
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            Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis - Keloids and hypertrophic scars may be vascular disorders.

            Rei Ogawa, Satoshi Akaishi (2016)
            Keloids and hypertrophic scars are fibroproliferative disorders (FPDs) of the skin that result from abnormal healing of injured or irritated skin. They can be called pathological or inflammatory scars. Common causes are trauma, burn, surgery, vaccination, skin piercing, folliculitis, acne, and herpes zoster infection. The pathogenesis of these scars clearly involves local conditions such as delayed wound healing, wound depth, and the tension of the skin around the scars. Scar severity is also shaped by interactions between these local factors and genetic and systemic factors such as hypertension and sex hormones. Notably, to evaluate scar severity, the Japan Scar Workshop (JSW) has established the JSW Scar Scale. Our studies show that tension on the skin around the wound results in prolonged and/or repeated bouts of inflammation in the reticular layer of the dermis and that this inflammation generates abnormal numbers of blood vessels (as well as collagen and nerve fibers) in the dermal reticular layer. We hypothesize that local factors, such as the mechanobiology of the dermis and blood vessels, along with genetic and systemic factors promote pathological scar development by inducing endothelial dysfunction (i.e., vascular hyperpermeability) during the inflammatory stage of wound healing. The continued presence of these factors prolongs the influx of inflammatory cells and factors, thereby leading to fibroblast dysfunction. Evidence for this hypothesis includes the fact that all effective treatments of keloids, namely, radiotherapy, compression therapy, steroid administration, and long-pulsed Nd:YAG laser therapy, act, at least partly, by suppressing blood vessels. At present, keloids are classified as strongly inflammatory scars, while hypertrophic scars are considered to be mildly inflammatory scars. However, we propose that keloids and hypertrophic scars are simply manifestations of the same skin FPD and differ only in the degree of endothelial dysfunction and therefore inflammation. We therefore suggest that these pathological scars should be classified on the basis of the factor that causes the endothelial dysfunction. Thus, primary scars are caused by congenital endothelial dysfunction (e.g., a mutation prevents endothelial gaps from closing smoothly) while secondary scars are caused by endothelial dysfunction that results from aging, arterial sclerosis, and/or repeated/very strong local mechanical forces. We expect that primary keloids develop at younger ages and tend to become severe, while secondary keloids are seen in all ages and can vary in clinical severity. Thus, abnormal blood vessel regulation may underlie keloid and hypertrophic scar pathogenesis, which suggests that inhibiting abnormal angiogenesis and vascular hyperpermeability may be an important therapeutic approach.
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              Reducing the incidence of hematoma requiring surgical evacuation following male rhytidectomy: a 30-year review of 985 cases.

              Daniel C Baker, William Stefani, Ernest Chiu (2005)
              The reported incidence of hematoma following male rhytidectomy ranges from 7.9 to 12.9 percent. In 1976, it was demonstrated that postoperative hypertension is a key etiologic factor in hematoma formation and postoperative use of Thorazine was recommended to control blood pressure. This study analyzes the incidence of hematoma after male rhytidectomy at one institution after a strict and aggressive perioperative blood pressure control regimen was initiated.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Plast Reconstr Surg Glob Open
                Journal ID (iso-abbrev): Plast Reconstr Surg Glob Open
                Journal ID (publisher-id): GOX
                Title: Plastic and Reconstructive Surgery Global Open
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Electronic): 2169-7574
                Publication date (Electronic): 25 January 2021
                Publication date Collection: January 2021
                Volume: 9
                Issue: 1
                Electronic Location Identifier: e3350
                Affiliations
                [1]From the SkourasMed Clinic, Athens, Greece.
                Author notes
                George Skouras, MD, 8, Tsakalof Str., Kolonaki, Athens, Greece, E-mail: giorgos_skouras@ 123456yahoo.gr
                Article
                Accession ID: 00018
                DOI: 10.1097/GOX.0000000000003350
                PMC ID: 7859118
                SO-VID: b83d026e-9670-4b7f-ade5-eea1d9f1ed7c
                Copyright © Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                Date received : 1 June 2020
                Date accepted : 4 November 2020
                Categories
                Subject: Cosmetic
                Subject: Original Article
                Custom metadata
                OPEN-ACCESS TRUE
                COUNTRY GREECE

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