Daily Cosmetic Research Analysis

BACKGROUND: The optimal method of wound closure after ileostomy reversal remains uncertain. Pursestring approximation reduces surgical site infections but requires prolonged wound care. Combining negative pressure wound therapy with primary linear closure may offer a more convenient approach while maintaining acceptable infection rates. OBJECTIVE: To determine whether primary linear closure with negative pressure wound therapy is noninferior to pursestring approximation in preventing surgical site infection after ileostomy reversal. DESIGN: Prospective, non-blinded, multi-institutional, non-inferiority randomized controlled trial. SETTINGS: Community tertiary hospital and academic medical center. PATIENTS: Adults undergoing elective ileostomy reversal between October 2018 and March 2024. INTERVENTION: Participants were randomized to undergo either primary linear closure with negative pressure wound therapy or pursestring approximation for skin closure after ileostomy reversal. MAIN OUTCOME MEASURES: The primary outcome was the occurrence of surgical site infection, with a non-inferiority margin set at 16%. Secondary outcomes included time to wound healing and scar appearance using the validated Patient and Observer Scar Assessment Scale. RESULTS: One hundred twelve patients completed the study, with 61 in the negative pressure wound therapy arm and 51 in the pursestring approximation arm. Primary linear closure- negative pressure wound therapy was noninferior to pursestring approximation arm in terms of SSI: 7% and 2% respectively with an absolute risk difference of 5% (95% CI: 2.5% to 12.5%). Early wound healing at 2 weeks was achieved in 77% vs 23.5% of patients, respectively (p < 0.001, GEE analysis). All wounds healed by 6 weeks in both groups. No negative pressure wound therapy device malfunctions occurred. LIMITATIONS: Nonblinded study limited to 2 institutions. CONCLUSIONS: Ileostomy reversal by Primary linear closure- negative pressure wound therapy is noninferior to pursestring approximation in terms of the occurrence of surgical site infections while achieving significantly faster wound healing. The method is safe, convenient and cosmetically acceptable. (See Video Abstract)Trial Registration: Advocate Aurora Health IRB, IRB# 22.034 (7082).

BACKGROUND: Short nose correction in Asian rhinoplasty is challenging due to weak septal cartilage, thick skin envelopes, and strong postoperative contractile forces that compromise long-term tip stability. OBJECTIVES: This study aimed to quantitatively compare the long-term outcomes of three nasal tip-plasty techniques-derotation graft with columellar strut (DG+CS), septal extension graft alone (SEG only), and combined septal extension with derotation graft (SEG+DG). METHODS: A total of 324 patients who underwent cosmetic rhinoplasty by a single surgeon from 2015 to 2022 were retrospectively analyzed. Standardized lateral-view photographs were used to measure nasal length, tip projection, and nasolabial angle, normalized to facial length, and expressed as percentage change over time. Long-term outcomes (>12 months) were compared using non-parametric statistical tests. RESULTS: The SEG+DG group demonstrated the most consistent and durable improvements in nasal length and tip projection across all postoperative intervals. Significant intergroup differences were observed in long-term nasal length and tip projection (p < 0.001), with SEG+DG and SEG only both outperforming DG+CS. SEG+DG also showed the lowest variability and most stable trend, whereas the nasolabial angle showed a significant omnibus difference (p = 0.009) that did not persist after post-hoc pairwise correction. Revision rates were lowest in the SEG+DG group (6.5%), compared to SEG only (10.6%) and DG+CS (14.3%). CONCLUSIONS: The combined use of septal extension and derotation grafts provides superior and sustained structural support, offering a more reliable approach for correcting short nose deformity in Asian rhinoplasty.

OBJECTIVE: To evaluate the differences in quality of life at 5 years postoperatively between laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein tension-free repair for adult patients with primary unilateral inguinal hernia, with a primary focus on EuraHS-QoL scale scores and an exploration of long-term outcomes including chronic postoperative pain, recurrence rates, functional recovery, and patient satisfaction. METHODS: This was a single-center retrospective cohort analysis. Adult patients who underwent TAPP or Lichtenstein repair for primary unilateral inguinal hernia between January 2015 and December 2020 were included. Patients were categorized into a TAPP group (n = 300) and a Lichtenstein group (n = 200) based on the surgical approach. The primary outcome was the quality of life score at 5 years postoperatively, assessed using the EuraHS-QoL scale across three domains: pain, activity restriction, and cosmetic appearance. Secondary outcomes included the incidence of chronic postoperative pain, hernia recurrence rate, postoperative complications, time to functional recovery (e.g., return to daily activities and work), and subjective satisfaction. Multivariate regression models were used to control for confounding factors, and sensitivity analysis was performed using propensity score matching (PSM). RESULTS: The median follow-up duration was 62 months (IQR: 60-66). The TAPP group demonstrated a significantly better total EuraHS-QoL score [median 2.0 (IQR: 1.0-4.0)] compared to the Lichtenstein group [median 3.0 (IQR: 2.0-5.0)] (P < 0.001), with particularly pronounced differences in the activity restriction and cosmetic appearance domains (P < 0.01). The TAPP group had a lower incidence of chronic postoperative pain (12.0% vs. 20.5%, P = 0.006), faster functional recovery (time to return to daily activities: 6 days vs. 8 days, P < 0.001), and higher satisfaction scores (8.8 ± 1.1 vs. 7.9 ± 1.4, P < 0.001). No statistically significant differences were observed between the two groups in recurrence rates or overall complication rates. The findings remained consistent after multivariate regression and PSM analysis. CONCLUSION: In this retrospective analysis, both TAPP and Lichtenstein repair provided favorable long-term quality of life. While initial unadjusted comparisons suggested a total score advantage for TAPP, this was not maintained in the matched sensitivity analysis. TAPP demonstrated benefits in reduced chronic pain and faster functional recovery, without increasing recurrence. These findings support the consideration of TAPP as a viable option in suitable patients, though they should be interpreted in light of the study's retrospective design and require prospective validation.