Background: COVID-19 has been a source of several stays in intensive care units, increasing the number of prone positioning. In parallel, complications increased, such as facial ulcers. Herein, we present a literature review and a case series about facial pressure sores in COVID-19 patients during prone positioning. This study aimed to show that such facial pressure sores may require surgical intervention in specific cases. Methods: We performed a search of the literature with the Pubmed database, and we selected 13 articles for review. Therefore, we analyzed the results among the most frequent locations of facial ulcers: cheeks, ears, lips, nose, and chin. We also reported three original clinical scenarios with a gradual surgical approach to address facial pressure sores from less invasive to more invasive surgery (corresponding to the reconstructive ladder strategy) during the COVID-19 period. Results: We identified 13 articles related to the topic. Only four clinical cases discussed a surgical treatment but only for complications such as bleeding, infection, and sequelae after long-term management. Faced with a lack of literature about surgical options, we reported our case series showing that surgical treatments could be increasingly complex among the sore grades. The following surgical approach was selected: debridement, skin graft, and local or free flaps. Conclusions: Surgical intervention is the last course of treatment for pressure sores. However, the need for later surgical revision cannot be excluded, especially regarding the face, in case of dyschromia or retraction affecting the facial aesthetic subunits.
ABSTRACT Objective The optimal method for maintaining intraoperative blood pressure during microsurgical procedures remains controversial. While intravenous fluid administration is essential, overfilling can lead to complications. Vasopressor agents are used cautiously due to their vasoconstrictive effects, which could potentially lead to flap failure. Numerous studies have explored the possible link between amine administration and free flap failure, yielding inconsistent results. This study aims to determine whether intraoperative norepinephrine administration increases the flap failure rate in microsurgical breast reconstructions. Methods All women ( n = 335) who underwent breast reconstruction using DIEP or PAP flaps ( n = 400) in 2018 and 2022 in the Plastic Surgery Department of Georges‐Pompidou European Hospital (Paris, France) were included in the study. These patients were classified into two groups based on the intraoperative administration of norepinephrine: the N + group (50 patients) and the N − group (285 patients). Norepinephrine was administered when systolic blood pressure fell below 90 mmHg or mean arterial pressure (MAP) dropped below 65 mmHg, following fluid resuscitation in 2018, or without prior fluid loading in 2022. The primary endpoint was total flap loss. Secondary endpoints included arterial and venous thrombosis and the need for revision surgeries. Results Norepinephrine administration significantly increased the risk of total flap loss in DIEP and PAP flap surgeries ( p < 0.001). It also heightened the risk of arterial thrombosis ( p = 0.002) and venous thrombosis ( p = 0.04), and led to a greater number of revision surgeries ( p < 0.001). Subgroup analysis indicated that PAP flaps are more sensitive to norepinephrine compared to DIEP flaps. Conclusions Our study suggests that the intraoperative administration of any dose of norepinephrine is associated with an increased risk of flap failure in breast reconstructive microsurgery using DIEP and PAP flaps.
Breast hypertrophy, a common pathological condition, often requires surgical intervention to alleviate musculoskeletal pain and improve patients' quality of life. Various techniques have been developed for breast reduction, each with its own advantages and complications. The primary aim of this study is to evaluate the efficacy, safety, and patient-reported outcomes of the authors technique: the Superomedial-Posterior Pedicle-Based Reduction Mammaplasty.
Abstract Background Many therapeutic options are currently available for facial skin rejuvenation, but little evidence exists about the efficacy of combining such procedures. Objectives The aim of this study was to assess and investigate the synergistic effect of hyaluronic acid (HA) and autologous platelet-rich plasma (a-PRP) injections on facial skin rejuvenation. Methods For this randomized controlled prospective study, 93 eligible patients were enrolled and randomized into 3 intervention groups to undergo a series of 3 treatment sessions with either a-PRP, HA, or a mixture of a-PRP and HA (Cellular Matrix; Regen Lab) injected into facial cheeks. Results A total of 93 patients were included. Treatment with Cellular Matrix led to a very significant improvement in the overall facial appearance compared with treatment with a-PRP or HA alone (P < 0.0001). Participants treated with Cellular Matrix showed a 20%, 24%, and 17% increase in FACE-Q score at 1, 3, and 6 months posttreatment, respectively. For the HA group, the improvement in FACE-Q score was 12%, 11%, and 6% at 1, 3, and 6 months posttreatment, respectively, whereas for the a-PRP group the improvement was 9%, 11%, and 8% at 1, 3, and 6 months posttreatment, respectively. Biophysical measurements showed significantly improved skin elasticity for the Cellular Matrix group compared with the groups receiving a-PRP or HA alone. No serious adverse events were reported. Conclusions Combining a-PRP and HA seems to be a promising treatment for facial rejuvenation with a highly significant improvement in facial appearance and skin elasticity compared with a-PRP or HA alone. Level of Evidence: 3
