Daily Cosmetic Research Analysis
Across pediatric surgery, studies highlight strategies to improve cosmetic and clinical outcomes: percutaneous internal ring suturing (PIRS) for inguinal hernia shortened anesthesia time and reduced 1-year recurrence versus intra-corporeal purse-string laparoscopy; epidermal autografting enabled wider mesh ratios without delaying healing in pediatric burns; and a modified epispadias repair preserving the glans–frenular unit achieved favorable cosmetic results without ischemic glans loss.
Summary
Across pediatric surgery, studies highlight strategies to improve cosmetic and clinical outcomes: percutaneous internal ring suturing (PIRS) for inguinal hernia shortened anesthesia time and reduced 1-year recurrence versus intra-corporeal purse-string laparoscopy; epidermal autografting enabled wider mesh ratios without delaying healing in pediatric burns; and a modified epispadias repair preserving the glans–frenular unit achieved favorable cosmetic results without ischemic glans loss.
Research Themes
- Pediatric minimally invasive surgery and cosmetic outcomes
- Burn reconstruction with epidermal autografting
- Genitourinary reconstruction preserving vascular anatomy
Selected Articles
1. Pediatric Inguinal Hernia Repair with Laparoscopy (PIHRL)-trial: A multicenter study comparing extra-corporeal Percutaneous Internal Ring Suturing (PIRS) and intra-corporeal purse-string suture for inguinal hernia.
In this multicenter prospective non-randomized trial (n=177), PIRS significantly shortened anesthesia time and reduced 1-year recurrence compared with intra-corporeal purse-string laparoscopy. Safety was comparable, though the PIRS group required more re-interventions that were not statistically significant.
Impact: This study provides comparative prospective data supporting PIRS as an efficient minimally invasive option for pediatric inguinal hernia with potential cosmetic and quality-of-life benefits assessed by standardized tools.
Clinical Implications: PIRS may be preferred when aiming to minimize anesthesia exposure and recurrence risk at 1 year, with formal assessment of scar appearance and QoL. Confirmation in randomized trials with longer follow-up and standardized cosmetic endpoints is warranted.
Key Findings
- Total anesthesia time was shorter with PIRS (62.1 ± 24.6 min) than LIHR (84.7 ± 21.7 min), p=0.001.
- One-year recurrence was lower with PIRS (2%) versus LIHR (8%), p=0.038.
- One LIHR patient required readmission for subcutaneous hemorrhage; one PIRS patient had testicular atrophy; more re-interventions followed PIRS but were not statistically significant.
Methodological Strengths
- Prospective multicenter comparative design with predefined 1-year follow-up
- Objective endpoints including anesthesia time and recurrence; use of standardized scar and QoL questionnaires (POSAS, TAPQoL/TACQoL)
Limitations
- Non-randomized allocation with baseline age differences and potential confounding
- Imbalance in group sizes (PIRS n=126 vs LIHR n=51) and only 1-year follow-up
Future Directions: Randomized controlled trials with longer follow-up and core outcome sets including standardized cosmetic and patient-reported outcomes.
2. Modified anatomical repair of epispadias (MARE)-with preservation of glans-frenular unit during urethral disassembly.
A seven-patient case series describes a modified epispadias repair that preserves the glans–frenular unit during urethral disassembly. Over a median 18-month follow-up, there were no ischemic glans losses, fistulae, or residual dorsal chordee, and cosmetic outcomes were satisfactory.
Impact: By preserving critical vascular connections, this technique may reduce risk of glans necrosis and improve cosmetic outcomes in epispadias repair, representing a meaningful surgical innovation.
Clinical Implications: For penile epispadias without incontinence, preserving the glans–frenular unit may minimize vascular complications and support better cosmetic reconstruction; comparative prospective studies are needed before broader adoption.
Key Findings
- Seven male patients (median age 18 months) with penile epispadias underwent MARE between 2000 and 2023.
- Mean operative time was 180 minutes (range 150–210) with no intraoperative or immediate postoperative complications and no ischemic glans loss.
- At a median follow-up of 18 months (12–36), there were no residual dorsal chordee or fistulae, and cosmetic outcomes were satisfactory.
Methodological Strengths
- Clear description of a reproducible surgical technique with anatomical rationale (vascular preservation)
- Follow-up up to 36 months with consistent reporting of functional and cosmetic outcomes
Limitations
- Small single-arm case series without a comparator group
- Limited sample size (n=7) limits generalizability and statistical inference
Future Directions: Prospective multicenter comparative studies evaluating complication rates, cosmesis (standardized scar scales), and functional outcomes versus conventional techniques.
3. Outcomes of Split-Thickness Skin Grafting With and Without Epidermal Autografting in Pediatric Burn Care.
In a retrospective pediatric cohort (n=47), combining epidermal autografting with split-thickness skin grafting enabled wider meshing ratios and reduced donor site size without prolonging healing, with no graft failures observed. The analysis was univariate and did not report detailed cosmetic scale outcomes.
Impact: Findings support an adjunctive technique that can spare donor skin in children without compromising healing, addressing a key constraint in pediatric burn reconstruction.
Clinical Implications: When donor skin is limited, adding epidermal autografting to STSG may allow higher mesh ratios and smaller donor sites without increasing graft failure or healing time; prospective studies should quantify scar quality and pain.
Key Findings
- Retrospective cohort of 47 pediatric burn patients (median age 6 years; median TBSA 7%).
- STSG plus epidermal autografting allowed wider meshing ratios and smaller donor sites.
- No increase in healing time and zero graft failures were reported with STSG+EA.
Methodological Strengths
- Direct comparative cohort focusing on practical reconstructive endpoints (mesh ratio, donor site, healing)
- Pediatric real-world population with diverse burn etiologies
Limitations
- Retrospective design with univariate analysis only and small sample size
- Cosmetic outcomes were not quantified with standardized scar scales in the abstract
Future Directions: Prospective controlled studies using standardized scar assessments (e.g., POSAS), pain metrics, and long-term functional outcomes to validate pediatric EA adjunct use.