Search Results (35)

Background/Objectives: Since breast cancer (BC) survival rates have increased to 91% at 5 years and 80% at 15 years postdiagnosis, there is a growing awareness of the importance of addressing the long-term well-being of patients. Consequently, integrative oncology, which combines standard therapies with complementary approaches (nutrition, mind–body practices, and lifestyle modifications), has emerged as a patient-centred model aimed at improving symptom management, treatment adherence, and overall quality of life (QoL). This study aims to demonstrate how integrative therapies can benefit body composition, phase angle, and fluid and electrolyte balance through bioelectrical impedance analysis (BIA). Methods: This study considers a patient who underwent BC surgery and was enrolled in the AMICO clinic for anamnesis, as well as their oncological pathology data, assessment of QoL, and BIA. The breast surgeon specialising in integrative oncology therapies prescribed the patient curcumin and polydatin, moderate physical activity, a balanced diet, and Qigong sessions. The patient underwent monitoring through haematochemical analysis, BIA, and a QoL questionnaire, with follow-up every four months. Results: Between 4 and 12 months, fat mass (FM) and body mass index (BMI) markedly decreased, whereas fat-free mass (FFM), total body water (TBW), and skeletal muscle mass (SMM) increased progressively. Moreover, the improvements in the Na/K ratio and phase angle (PhA) suggest a shift toward better electrolyte and fluid balance and enhanced cellular integrity and membrane function. Equally outstanding were her psychological benefits in terms of mood, sleep, anxiety, and melancholy. Conclusions: Patient progress in body composition, metabolic function, pain management, and psychological status measured during the 12-month follow-up demonstrates the potential benefits of an integrative approach to supportive cancer care. Full article

Upper extremity amputations significantly impact an individual’s physical capabilities, psychosocial well-being, and overall quality of life. The level at which an amputation is performed influences residual limb function, prosthetic compatibility, and long-term patient satisfaction. While surgical guidelines traditionally emphasize maximal limb preservation, prosthetists often advocate for amputation sites that optimize prosthetic fit and function, highlighting the need for a collaborative approach. This review examines the discrepancies between surgical and prosthetic recommendations for optimal amputation levels, from digit amputations to shoulder disarticulations, and explores their implications for prosthetic design, functionality, and patient outcomes. Various prosthetic options, including passive functional, body-powered, myoelectric, and hybrid devices, offer distinct advantages and limitations based on the level of amputation. Prosthetists emphasize the importance of residual limb length, not only for mechanical efficiency but also for achieving symmetry with the contralateral limb, minimizing discomfort, and enhancing control. Additionally, emerging technologies such as targeted muscle reinnervation (TMR) and advanced myoelectric prostheses are reshaping rehabilitation strategies, further underscoring the need for precise amputation planning. By integrating insights from both surgical and prosthetic perspectives, this review highlights the necessity of a multidisciplinary approach involving surgeons, prosthetists, rehabilitation specialists, and patients in the decision-making process. A greater emphasis on preoperative planning and interprofessional collaboration can improve prosthetic outcomes, reduce device rejection rates, and ultimately enhance the functional independence and well-being of individuals with upper extremity amputations. Full article

Background: Nipple-sparing mastectomy (NSM), given demonstrated oncologic safety, is widely used for both therapeutic and prophylactic mastectomy. The popularity of NSM has spurred advancements by breast and plastic surgeons, liberalizing the indications for NSM and improving patient and aesthetic reconstructive outcomes. This review explores these developments and establishes up-to-date surgical tenets for successful NSM and reconstruction. Methods: A comprehensive literature review was conducted using the PubMed, Google Scholar, and Cochrane Library databases, focusing on peer-reviewed studies published up to 2024. Articles were selected based on relevance, quantity, and documentation of clinical outcomes and patient satisfaction. Results: NSM is utilized frequently for both invasive breast cancers and prophylactic mastectomy, with expanded criteria for candidacy by breast surgeons. Staged procedures such as adjunct reduction, mastopexy, or nipple delay allow patients with larger or ptotic breasts to undergo NSM with comparable outcomes. Long-term outcome studies have identified important risk factors for complications, including smoking history, higher mastectomy weight, certain medical comorbidities, and suboptimal mastectomy flaps. Evolutions in reconstructive decision making in direct-to-implant and staged tissue expander placement have improved aesthetic results while accounting for poor mastectomy flap quality or adjuvant therapy. Long-term outcomes show NSM remains safe and has comparable rates of local recurrence. Patient-reported outcomes demonstrate satisfaction with NSM, especially in sexual and psychological wellbeing metrics. Conclusions: NSM has been demonstrated to be safe in long-term oncologic outcomes. Its widespread popularity over the past ten years has helped identify methods to improve upon surgical and aesthetic outcomes, including decision-making in reconstruction; considerations for challenging patient-related characteristics such as macromastia, ptosis, and NAC asymmetry; and novel advances in areas such as neurotization. Full article

The COVID-19 pandemic was a worldwide crisis with significant impact on professional, economic, and social well-being. In medical academics, researchers were hampered by the need to provide critical support to pandemic efforts at their institutions, while balancing rapid communication of information that could impact practices and inform behavior. Autoethnography as a research method was employed by many early on as a means of characterizing aspects of the COVID-19 response. Two surgeons from heavily hit areas early in the epidemic—Bergamo, Italy, and Boston, the United States—entered into an online, virtual, professional relationship that helped them both endure the pandemic and inform their institutions and communities. Their relationship influenced practices across the United States and beyond. This paper explores how the principles of autoethnography as a valid, essential and important method of research can lead to significant impacts during times of crises. Full article

Background: The Profunda Artery Perforator (PAP) flap is a viable alternative to the Deep Inferior Epigastric Perforator (DIEP) flap, particularly for patients with low BMI and therefore insufficient abdominal tissue. To reduce the high complication rate, especially in our low BMI patient population, we have adapted the use of the vertical skin island design. This study compares complication rates and long-term outcomes of vertical versus horizontal skin island designs in PAP flap breast reconstruction. Methods: This prospective, single-center study included 20 patients who underwent PAP flap breast reconstruction. Quality of life and scar quality were assessed using the BREAST-Q and POSAS questionnaires. Additionally, the cosmetic outcomes were analyzed by four plastic surgeons. Results: Mean BMI in the vertical group was 23.9 kg/m² and 22.7 kg/m² in the horizontal group. Mean flap weight was 326 g for the vertical group and 355 g for the horizontal group. Fewer complications were observed at the donor site in the vertical group (Clavien–Dindo Classification 3b at donor site: p = 0.25). The BREAST-Q evaluation revealed significantly better results regarding the psycho-social well-being (p = 0.04) in patients with the horizontalskin island design. Scar evaluation using the POSAS revealed that the scar was perceived as thinner (p = 0.02), less pigmented (p = 0.03), and showed less relief (p = 0.02) in the vertical group. No significant difference was observed in the overall scar assessment by observers (p = 0.46). The aesthetic analysis by plastic surgeons showed significantly better results in the horizontal group. Conclusions: The vertical skin island design in PAP flap breast reconstruction was associated with lower complication rates and better scar quality compared to the horizontal design. Surgeons, however, rated the overall aesthetic outcome of the vertical design less favorably. These findings highlight the importance of balancing donor site morbidity with overall aesthetic results. Full article

Background: While the well-being and working conditions of healthcare professionals are increasingly scrutinized, there remains a critical research gap regarding the quality of life and job satisfaction of plastic surgeons in Switzerland. No prior national study has systematically examined these aspects within this specialty. Objective: This study aims to address this gap by evaluating workload, career satisfaction, and quality of life among Swiss plastic surgeons and trainees, thereby providing evidence to inform systemic improvements in the profession. Methods: A national, multilingual online survey was distributed to all members of the Swiss Society for Plastic Surgery and the Association of Young Plastic Surgeons. A total of 102 plastic surgeons responded (response rate: 22.7%). The survey assessed contractual versus actual working hours, work performed during personal time, mental health indicators (e.g., burnout), and career satisfaction. Descriptive and correlational analyses were conducted. Results: The respondents reported an average of 58 actual versus 49 contractual working hours per week, with an additional 8.1 h spent working during leisure time. Burnout symptoms were present in 29%, and 63% experienced work-related stress during their free time. While 42% wished to reduce their workload, 88.7% would still choose the profession again. Career satisfaction averaged 3.66/5, although 35% rated their salary as inadequate. Notably, 79.8% reported work negatively affecting private relationships, despite 82.65% feeling supported by their environment. Conclusion: This first nationwide assessment highlights the high workload and psychological strain faced by Swiss plastic surgeons. Key priorities include targeted burnout prevention, structural workload reduction, enhanced support for work–life integration (especially among women and younger surgeons), and improved compensation. These measures are essential to sustain the well-being of practitioners and ensure long-term quality in surgical care. Full article

Background/Objectives: Our aim was to validate a self-reported patient-reported outcome measure (PROM) questionnaire for use by patients undergoing feminising genital reconstructive surgery (fGRS). Methods: We used the Patient Reported Outcomes in Genital REconstructive SurgerieS (PROGRESS) questionnaire to examine key domains: urinary function, sexual function, cosmetic appearance, bowel function, and general health and wellbeing, which were identified as key components by our experienced surgeons. A reduction in score post-operatively represented an improvement in symptoms. Internal consistency was performed to determine the reliability of the questionnaire. Results: Between 2014 and 2024, 117 patients had completed pre- and post-operative questionnaires by week 52. The overall median score for all domains was 0.37 (interquartile range [IQR] 0.32–0.44) at baseline. At week 52 post-surgery, it was 0.24 (IQR 0.16–0.32), with a median difference (% change in overall score) of −0.12 (−35.8%) (p < 0.001). In all domains apart from bowel function, there was a reduction in scores that achieved statistical significance. There were high Cronbach’s alpha scores at baseline and at week 52 for four out of the five domains: general health and wellbeing a = 0.71 at week 0 and a = 0.79 at week 52; sexual function a = 0.83 at week 0 and a = 0.88 at week 52; cosmetic function a = 0.64 at week 0 and a = 0.84 at week 52; urinary function a = 0.74 at week 0 and a = 0.83 at week 52. Bowel function scored poorly, with a = 0.44 at week 0 and a = 0.49 at week 52. Conclusions: The questionnaire is suitable for use in clinical practice as a standardised way to assess functional outcomes following fGRS. Full article

Background/Objectives: Patient safety is directly linked with health and wellbeing of healthcare workers. In the UK, COVID-19 severely disrupted healthcare, with surgeons tackling prolonged waiting lists and working longer hours under high stress. This study explored the biomechanical and psychosocial demands on hospital surgeons, as well as their experience of pain and work-life balance post-pandemic. Methods: A questionnaire was developed combining validated tools assessing physical demands; modified job demand, control, and support; the WHO-5 wellbeing index; work–life balance from the Copenhagen Psychosocial Questionnaire; musculoskeletal pain; job satisfaction and retirement intentions. An online survey was developed using the Qualtrics© (Provo, UT, USA) platform and circulated through surgical networks using snowball sampling. Poisson regression modelling with robust confidence intervals was used to explore relationships between work-related factors and musculoskeletal pain, and associations with retirement intentions. Results: In total, 242 replies were received. Surgeons frequently reported strenuous occupational activities and work–life imbalance, and one in six reported job dissatisfaction. Only 17% reported no pain; the one-month prevalence of pain ranged from 46% at the lower back to 12% at the ankle, and pain was frequently disruptive. Better work–life balance had a protective effect for pain (PRR = 0.92, 95% CI = 0.85–0.99), while risk of pain increased with increasingly physically demanding activities at work (PRR = 1.04, 95% CI = 1.01–1.07) in the age- and sex-adjusted models. Job dissatisfaction was associated with intention to retire early (PRR = 1.83, 95% CI = 1.02–3.27). Conclusions: This study demonstrated high physical and mental demands among surgeons and poor work–life balance. Physical and emotional links to pain were identified. Fit surgeons ensure safe patient care. Our findings suggest that surgeons were facing health issues and work–life conflict post-pandemic, potentially limiting their job satisfaction and career span. A follow-up study is recommended. Full article

Background: Up to 80% of patients experience late effects (LE) one year after surgery for peritoneal metastases (PM) from colorectal cancer (CRC). We tested the feasibility and outcome of a treatment strategy to address LEs. Methods: During January 2021–May 2023, patients who had undergone surgery for CRC-PM in Denmark were screened for biopsychosocial LEs (anxiety, depression, fear of cancer recurrence, insomnia, cognitive impairment, pain, fatigue). Patients scoring according to clinical cut-offs were referred to a Multi-Disciplinary Team conference (MDT). The patients, surgeon(s), nurse(s), and psychologists participated in the MDT, identified key concerns and proposed a personalized intervention. Pre- and post-intervention, patients completed a “Measure Yourself Concerns and Wellbeing” (MYCaW) questionnaire, rating the two most distressing LEs and general wellbeing on a 7-point Likert scale. Results: Of 28 eligible patients, 13 (59 years (mean), 85% women) accepted referral, participated in the MDT, and were offered a personalized intervention. The intervention was completed by 11 patients. Improvement in MYCaW score was observed 1 month postintervention for all three items: (1) the primary LE (p = 0.003, Hedges’s g 1.54), (2) the secondary LE (p < 0.001, Hedges’s g 1.65), and (3) general wellbeing (p = 0.005, Hedges’s g 1.09). This improvement was sustained 6 months postintervention. The 15 non-participants were, in general, older (66 years (mean), men 73%). Conclusions: Screening for LEs and conducting an MDT can provide a personalized intervention plan, which patients are able to complete and may benefit from. Full article

Background: Gender-affirming surgery has become an integral part of the gender transition process that transgender and gender-diverse individuals undergo. Although ample literature exists on the short-term outcomes of gender-affirming surgery, very little is known about the long-term implications the surgery has on the psychological well-being of the patients. The purpose was to understand the long-term impact that gender-affirming surgery has on transgender and gender-diverse individuals and gain insight on potential contributors to improved psychological well-being and satisfaction. Methods: All patients who were operated on by a single surgeon during a 20-year period were invited to the clinic for a follow-up appointment. The patients were physically examined, their scars were graded, and NAC sensation was evaluated. BUT (A and B) and BREAST-Q questionnaires were filled out by them and evaluated by the research staff. Results: Satisfaction with pre-operative information provided to the patient was associated with satisfaction with the final appearance of the chest (R = 0.717, p < 0.001), the surgical outcome (R = 0.481, p = 0.037), psychosocial well-being at follow up (R = 0.489, p = 0.034), satisfaction with the surgeon (R = 0.486, p = 0.035), satisfaction with the medical team (R = 0.62, p = 0.005) and satisfaction with the office staff (R = 0.65, p = 0.003). Conclusions: Pre-operative communication between the medical staff and the patients improves the psychological outcomes and satisfaction of the patients over the years. Full article

Body image, a complex interplay of perceptions, thoughts, and feelings about one’s physical appearance, has been a subject of extensive research. It is a dynamic construct that evolves throughout a woman’s lifespan, influenced by a multitude of biological, psychological, and sociocultural factors. From adolescence, marked by the onset of puberty and societal pressures to conform to specific beauty standards, to adulthood and the physical changes associated with aging, women’s body image undergoes significant transformations. Aging is a universal process that affects all organs, including the female genitalia. The vaginal tract undergoes significant atrophy due to declining estrogen levels, particularly during and after menopause. Aesthetic gynecology offers a range of procedures to address both functional and aesthetic concerns related to aging genitalia. Aesthetic gynecology, a burgeoning field within women’s health, provides various procedures aimed at enhancing genital appearance and function. It also helps balance the hormonal and anatomical changes that every woman experiences over time. The goal is to strengthen each patient’s intimate well-being and self-esteem, enabling them to experience intimacy peacefully. While often driven by concerns about physical attractiveness and sexual satisfaction, the psychological implications of these procedures are complex and multifaceted. It is crucial to recognize the interplay between psychological factors and the decision to undergo these procedures. Collaboration between surgeons and mental health professionals can ensure that candidates are psychologically prepared and have realistic expectations. By adopting a patient-centered approach and conducting rigorous research, healthcare providers can ensure that aesthetic gynecology is used as a tool for empowerment rather than exploitation. This article explores the intricate relationship between psychological well-being and aesthetic gynecology, examining how these procedures can impact body image, self-esteem, and overall quality of life. Full article

Background/Objectives: Distal femur tumor resection with limb salvage is a demanding procedure that offers hope for patients by preserving the limb rather than opting for amputation. While limb salvage can improve both physical function and psychological well-being, there’s limited knowledge on how active patients remain afterward and how their Quality of Life (QoL) is affected, especially regarding physical activities and sports. This study investigates the quality of life of the patients through the development of motor activity, focusing on both physical and sporting activity of the above-mentioned individuals and their physical abilities to participate in activities of daily and sporting life after surgery. Methods: This study involved 16 patients aged 19–47 years who had undergone surgical resection and replacement of the distal femur for the treatment of sarcoma and were selected by random sampling from a total of 72 patients who had undergone a similar procedure. To explore the topic in depth, the researchers followed the triangulation method. From July 2023 to February 2024, we used surveys and interviews to explore their physical activity (PA) levels, sports participation, and QoL. This study included the International Physical Activity (PA) Questionnaire (IPAQ), the University of California and Los Angeles (UCLA) Activity Score, and semi-structured interviews. The data were analyzed using the statistical software packages SPSS 25 and Excel. Results: Most participants reported moderate to high levels of PA, according to IPAQ, and continued engaging in sports, with swimming, walking, and stair climbing being the most common activities. No significant relationship was found between their PA levels and factors such as age, BMI, or the side of the affected limb. Interviews showed that patients’ motivation and their surgeon’s guidance played key roles in their return to regular activities, though many exercised less frequently or intensely than recommended. Conclusions: Patients who undergo limb salvage surgery following distal femur tumor removal generally maintain a good level of physical activity, which supports their QoL. Encouraging these patients to stay active and even engage in sports appears feasible, especially when guided by medical professionals. These findings highlight the potential benefits of tailored rehab programs to improve long-term health and QoL in sarcoma survivors, although larger studies are needed for more comprehensive insights. Full article

Donor site morbidity remains a significant concern in free flap microsurgery, with implications that extend beyond immediate postoperative outcomes to affect patients’ long-term quality of life. This review explores the multi-faceted impact of donor site morbidity on physical, psychological, social, and occupational well-being, synthesizing findings from the existing literature. Particular attention is given to the functional limitations, sensory deficits, aesthetic outcomes, and chronic pain associated with commonly utilized free flaps. Advancements in surgical techniques, including nerve-sparing and muscle-sparing methods, as well as innovations, like perforator flaps, have demonstrated the potential to mitigate these morbidities. Furthermore, the integration of regenerative medicine strategies, such as stem cell therapy and fat grafting, and technological innovations, including virtual reality rehabilitation and biofeedback devices, has shown promise in enhancing recovery and minimizing long-term complications. Despite these advances, challenges persist in standardizing QoL assessments and optimizing donor site management. This review emphasizes the need for a holistic, patient-centered approach in reconstructive microsurgery, advocating for further research to refine current strategies, improve long-term outcomes, and develop robust tools for QoL evaluation. By addressing these gaps, reconstructive surgeons can better align surgical objectives with the comprehensive well-being of their patients. Full article

Carcinoid syndrome (CS) is a rare condition associated with neuroendocrine tumors (NETs), particularly those originating in the gastrointestinal tract, which secrete bioactive substances like serotonin. The management of CS requires a multidisciplinary approach due to its complex clinical manifestations, including flushing, diarrhea, bronchospasm, and carcinoid heart disease. Optimal care involves collaboration between several professional figures like oncologists, endocrinologists, gastroenterologists, surgeons, and dietitians. Currently, a wide range of treatments are available, focused on both symptom control and tumor burden reduction. Somatostatin analogs (SSAs) are the first-line therapy for symptom relief. Still, in patients with progressive disease or refractory CS, other options include targeted therapies, peptide receptor radionuclide therapy (PRRT), liver-directed therapies, and surgical resection, when feasible. Furthermore, management of complications related to prolonged serotonin release and malnutrition as a result of exocrine pancreatic insufficiency, post-surgical conditions, vitamin deficit, and chronic diarrhea often requires early detection to mitigate symptoms and improve the quality of life in these patients. The complexity of CS necessitates individualized care and continuous coordination among specialists to optimize outcomes and enhance patient well-being. Full article

Plastic surgery is a diverse speciality relevant to non-plastic doctors, as plastic surgeons frequently collaborate with other specialities and its basic principles are transferable across multiple specialities. Foundation-year (FY) doctors are the most junior doctors in the workforce and may need to apply plastic surgery knowledge and principles during their clinical duties. Despite this, formal plastic surgery education for junior doctors is limited, resulting in an educational gap. This study gains insight into the perceived confidence, knowledge gaps, skills, educational activities and needs related to plastic surgery. This qualitative study uses phenomenology through semi-structured individual interviews with eight FY doctors. Data was analysed using reflexive thematic analysis. This study revealed that plastic surgery features diversely in the work life of FYs, who often manage patients with a lack of knowledge and confidence, influencing patient care and FY wellbeing. FYs primarily acquire knowledge and confidence through experiential learning and individual initiative. A need for curriculum improvements was expressed. FYs are an essential part of the workforce who exhibited educational gaps and a lack of confidence in plastic surgery knowledge. We suggest improved integration of plastic surgery into the FY curriculum for improved FY knowledge and patient care. Full article