scholarly journals Internal Fixation Method Using EZ-Tcon for Transconjunctival Fat Repositioning: Clinical Outcomes and Efficacy

2020 ◽  
Vol 44 (5) ◽  
pp. 1-12
Author(s):  
Cheol Ho Chang ◽  
Juyoung Bae ◽  
Myung Kyu Cha ◽  
Sa Ik Bang ◽  
Kyeong-Tae Lee
Keyword(s):  
Internal Fixation ◽  
Fixation Method ◽  
Full Description ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Advantages And Disadvantages ◽  
Tear Trough ◽  
Tear Trough Deformity ◽  
If Technique ◽  
Fat Repositioning

Abstract Background Transconjunctival fat repositioning is the gold standard for the correction of tear trough deformity. For fixation of fat pedicle, the internal fixation (IF) and externalized percutaneous suture (EPS) techniques are used, which have their own advantages and disadvantages. The present study aimed to introduce a new IF technique using a devised needle (EZ-Tcon) and to compare its outcomes with those of the conventional EPS technique. Methods Patients with primary tear trough deformity who underwent transconjunctival fat repositioning were reviewed and categorized into two cohorts according to the fixation technique: cohort 1 consisted of patients treated using the conventional EPS technique and cohort 2 consisted of those in whom the new IF technique using EZ-Tcon was adopted. Post-operative complications and aesthetic outcomes were assessed using a four-scale grading system. Results A total of 545 patients, 211 from cohort 1 and 344 from cohort 2 were evaluated with a median follow-up of 70 days. Compared to cohort 1, cohort 2 showed significantly lower rates of long-standing conspicuous scars on lower eyelid, re-operation and overall complications. In the analysis of aesthetic outcomes, 88.9 percent of cohort 2 showed grade 0 (no deformity) or I (mild deformity) post-operatively. The rate of excellent outcomes (improvements of ≥ two grades) was significantly higher in cohort 2 than in cohort 1 (p-value < 0.001). Conclusion Our technique using EZ-Tcon could possess advantages of the conventional IF and EPS techniques, showing lower complication rates and aesthetically satisfactory outcomes, and could be a safe and reliable method of transconjunctival fat repositioning. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Fat Repositioning With a Combination of Internal Fixation and External Fixation in Transconjunctival Lower Blepharoplasty

2021 ◽  
Author(s):  
Jianwu Chen ◽  
Tao Zhang ◽  
Xuanru Zhu ◽  
Wenhua Huang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Internal Fixation ◽  
External Fixation ◽  
Fixation Method ◽  
Resonance Imaging ◽  
Facial Soft Tissue ◽  
Level Of Evidence ◽  
Tear Trough ◽  
Fat Repositioning

Abstract Background Various methods on transconjunctival fat repositioning have been promoted to treat tear trough deformities in patients with eye bags. Objectives The authors present a modified approach based on the facial soft-tissue spaces with the combined fixation method. Methods A total 226 patients underwent this procedure. Through a preseptal approach, the premaxillary and prezygomatic spaces were sequentially separated. Orbital fat was repositioned into the spaces together with the septum. The proximal part of the septum-fat flap was sutured to orbital rim with internal fixation, and their distal stumps were fixed to the end of the soft spaces with externalized percutaneous sutures. Surgical outcome was assessed by surgeons based on Hirmand’s grading system. Patients’ satisfaction and quality of life were measured using FACE-Q scales. Magnetic resonance imaging was employed to assess the long-term fate of the transposed fat. Results Tear trough deformities were eliminated in 86.7% of cases. Scores of lower eyelid FACE-Q decreased significantly (P &lt; 0.05). Patients demonstrated enhanced social confidence (P &lt; 0.05) and high satisfaction (74.3 ± 17.2) and were satisfied with their decision to undergo blepharoplasty (78.2 ± 18.7). Undercorrection occurred in 1 patient. Additional complications included transient granulomas, dye eye, unexplained swelling, and numbness, which resolved in all patients. Magnetic resonance imaging confirmed viability of the transposed fat within 6 to 8 months follow-up. Conclusions Transconjunctival fat repositioning, utilizing a combination of internal fixation and external fixation, is an effective approach to treat eye bags and tear trough deformities with good patient and surgeon satisfaction. Level of Evidence: 4

Nonsurgical Tear Trough Volumization: A Systematic Review of Patient Satisfaction

2021 ◽  
Author(s):  
Enrique Gorbea ◽  
Sarah Kidwai ◽  
Joshua Rosenberg
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Facial Rejuvenation ◽  
Filler Material ◽  
Filler Materials ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Filler Injection ◽  
Tear Trough ◽  
Tear Trough Deformity

Abstract Background Nonsurgical rejuvenation of the tear trough area via the use of injectable filler material has become a popular procedure in facial rejuvenation. This procedure offers immediate, albeit temporary, results with minimal recovery time. Objectives The aim of this systematic review was to report on patient satisfaction and complication rates to further guide practitioners. Methods PubMed, Cochrane, and Scopus libraries were queried for articles containing relevant terms. Articles with more than 5 patients who reported on satisfaction and/or complications from the procedure were included for review. In addition to these variables, we noted other aspects of injection, including filler material, technique, and needle or cannula delivery. Studies that did not otherwise fulfill inclusion criteria for statistical analysis but reported on intravascular injection–related complications were cited. Results Initial query resulted in 1655 studies which were assessed for duplicates and inclusion/exclusion criteria. After screening, 28 articles were included for analysis. In total, 1956 patients were captured who had been injected with 1 of 4 materials: hyaluronic acid (1535), calcium hydroxyapatite (376), autologous fibroblast/keratin gel (35), and collagen-based filler (10). Short- and long-term satisfaction rates were 84.4% and 76.7%, respectively. Minor complications were common (44%). Secondarily, we found the use of cannula for filler injection of this region to be associated with a lower rate of ecchymosis (7% vs 17%, P &lt; 0.05). Conclusions Filler injection volumization of tear trough deformity is an effective technique for facial rejuvenation associated with high patient satisfaction. Multiple filler materials offer acceptable satisfaction and complication profiles. Level of Evidence: 4

Effects of Fat Repositioning for Tear Trough Deformity on Eye Movement

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kenichi Kokubo ◽  
Nobutada Katori ◽  
Kengo Hayashi ◽  
Akiko Fujii ◽  
Sho Kitamura ◽  
...  
Keyword(s):  
Eye Movement ◽  
Tear Trough ◽  
Tear Trough Deformity ◽  
Fat Repositioning

Comparison of Fat Repositioning Versus Onlay Segmental Fat Grafting in Lower Blepharoplasty

2021 ◽  
Author(s):  
Per Hedén ◽  
Sebastian Fischer
Keyword(s):  
Online Survey ◽  
Study Groups ◽  
Fat Grafting ◽  
Fat Graft ◽  
The Novel ◽  
Level Of Evidence ◽  
Lower Blepharoplasty ◽  
Novel Technique ◽  
Tear Trough ◽  
Tear Trough Deformity

Abstract Background Lower blepharoplasty is one of the most challenging procedures in aesthetic surgery. In particular, blending the lid-cheek junction and correction of the tear trough are prone to failure and unsatisfactory outcomes. Objectives The aim of this study was to combine lower eyelid blepharoplasty with a novel technique of autologous fat grafting, commonly called segmental fat grafting, and to analyze the safety and efficacy of this approach. Methods A retrospective analysis of 339 lower blepharoplasties was performed to compare the novel technique of segmental fat grafting to traditional fat transposition during lower blepharoplasty. Outcomes were assessed objectively by several measurements as well as via online survey of 148 invited experts in plastic surgery. Statistical analysis included t test for unpaired and paired samples as well as 1-way analysis of variance for matched data. Results There were no differences in baseline characteristics and comorbidities between study groups. After a mean follow-up of 12.9 months (range, 5-120 months), the group that underwent segmental fat grafting had a significant reduction in tear trough width compared compared with the group receiving lower blepharoplasty with fat transposition. Based on an expert (blinded) online survey, segmental fat grafting was superior or equal in 47% and 35% of cases, respectively. Complications (4%) and revision surgeries (9%) did not differ significantly between study groups. Conclusions The novel technique of transplantation of a segmental fat graft during lower blepharoplasty is a safe and effective way to overcome tear trough deformity and blend the lid-cheek junction. Level of Evidence: 4

Predictors of reoperation after internal fixation of intra-articular distal humerus fractures

2020 ◽  
pp. 175857321989597 ◽  
Author(s):  
Jeremy S Somerson ◽  
Mark E Morrey ◽  
Joaquin Sanchez-Sotelo ◽  
Bernard F Morrey
Keyword(s):  
Multivariate Analysis ◽  
Internal Fixation ◽  
Open Reduction ◽  
Injury Severity ◽  
Wound Dehiscence ◽  
Distal Humerus ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Background Despite good reported outcomes with open reduction and internal fixation of intra-articular distal humerus fractures, complication rates remain high. The objective of this work is to identify factors associated with reoperation. Methods Sixty-three patients treated with open reduction and internal fixation for intra-articular ( Arbeitsgemeinschaft für Osteosynthesefragen type C) distal humerus fractures between 2004 and 2010 were identified using an institutional trauma registry, 62 of which were followed for a minimum of six months. Age, gender, fracture subclassification, open fracture presence, Injury Severity Score, time to definitive surgery, length of postoperative immobilization, and type of approach were recorded. Multivariate analysis was utilized to identify factors independently associated with reoperation. Results Complications requiring reoperation developed in 25 (40.3%) elbows. The most common reasons were wound dehiscence or infection in nine elbows (14.5%) and symptomatic hardware in six (9.6%). During multivariate analysis, only olecranon osteotomy remained an independent predictor for reoperation ( P = 0.043). Discussion Despite improved internal fixation techniques, a high proportion of elbows require reoperation after open reduction and internal fixation for distal humerus fractures. Higher complication rates in fractures fixed through an olecranon osteotomy may reflect additional reoperations due to nonunion of the osteotomy or need to remove hardware from the ulna. Level of evidence Prognostic Level III.

scholarly journals Transconjunctival Orbital Fat Repositioning for Tear Trough Deformity in Young Asians

2008 ◽  
Vol 28 (3) ◽  
pp. 265-271 ◽  
Author(s):  
A MOMOSAWA ◽  
M KURITA ◽  
M OZAKI ◽  
S MIYAMOTO ◽  
I KURACHI ◽  
...  
Keyword(s):  
Orbital Fat ◽  
Tear Trough ◽  
Tear Trough Deformity ◽  
Fat Repositioning

scholarly journals Impact of fixation method on postoperative complication rates following surgical stabilization of diaphyseal tibial fractures in cats

2015 ◽  
Vol 28 (02) ◽  
pp. 109-115 ◽  
Author(s):  
M. Bruce ◽  
K. L. Perry
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
Complication Rate ◽  
Open Reduction ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Complication Rates ◽  
Significant Difference ◽  
Study Population

SummaryObjectives: To compare the complication rate between open reduction and internal fixation (ORIF) and external skeletal fixation (ESF) for feline diaphyseal tibial fractures.Methods: In a retrospective study spanning a 10 year period, 57 feline tibial fractures stabilized via ESF or ORIF were included for analysis and complication rates were compared between the two methods.Results: In the overall study population, 23 (40.4%) cases suffered complications (9 major, 20 minor, 6 with both major and minor). All of the major complications occurred in the ESF group. Complications were more common in cats with ESF (50.0%) while only one (7.7%) of the ORIF cases suffered complications (OR 12.0 [CI: 2.09; 228.10], p = 0.02). Use of postoperative antibiotic medications was identified as a confounder. After adjusting for confounding, stabilization using ESF remained associated with a higher risk of complications (OR = 13.71 [CI: 2.18; 274.25], p = 0.02). Cats with ESF had a longer duration of follow-up (15.6 weeks; 95% CI: 13.0; 18.3) compared to ORIF (9.5 weeks; 95% CI: 6.4; 12.7) (p = 0.003), and a higher number of revisits (mean 3.0; 95% CI: 2.4; 3.6) than the ORIF group (mean 1.6; 95% CI: 0.9; 2.3) (p = 0.002).Clinical significance: This study demonstrates a significant difference in complication rates between the methods of stabilization, with ESF resulting in a significantly higher complication rate compared to ORIF. Based on these results, it may be prudent to select ORIF for stabilization of feline tibial fractures wherever practical.

Posterior Arthroscopic Reduction and Internal Fixation for Treatment of Posterior Malleolus Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 115-120
Author(s):  
Kevin D. Martin
Keyword(s):  
Internal Fixation ◽  
Fracture Fixation ◽  
Lateral Approach ◽  
Fixation Method ◽  
Percutaneous Fixation ◽  
Alternative Technique ◽  
Surgical Indications ◽  
Level Of Evidence ◽  
Posterior Malleolus ◽  
Anterior Posterior

Posterior malleolus fractures and pilon variants refer to a pattern of fractures involving the posterior weightbearing surface of the tibial plafond. The surgical indications for fixation of posterior malleolus fractures varies considerably throughout the literature, based on the size and/or displacement. There is controversy on how to best address fracture fixation, with the main workhorses being either the posterior-lateral approach or indirect anterior-posterior–directed screws. We present an alternative technique for posterior malleolus fracture fixation using a direct posterior arthroscopic-assisted reduction internal fixation method. With this method, posterior malleolus fractures are reduced arthroscopically and percutaneous fixation is placed through the arthroscopic portals. Level of Evidence: Level V, expert opinion

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