<p><em>Background:</em> There is a shifting culture toward evidence-based plastic surgery. The use of high-quality evidence in patient decision-making is essential. To help achieve this goal the best evidence in the field needs to be identified, and the validity of this evidence verified.</p> <p><em>Objective:</em> This systematic review was designed to evaluate the plastic surgery literature by focusing on the prevalence of, and examining key components of quality of, Randomized Controlled Trials (RCTs) comparing surgical interventions.</p> <p><em>Methods: </em>An electronic search of the pertinent plastic surgery literature identified all RCTs published from 2000 to 2013 that compared one surgical intervention to another surgical intervention. Working in teams of two investigators independently, and in duplicate, assessed each manuscript for potential relevance and performed data extraction. Descriptive statistics, theory-driven multinomial regression, and independent samples t-test were used for data analysis.</p> <p><em>Results:</em> Of the 1664 hits obtained, 173 RCTs were included. These RCTs demonstrated the following data: 35% of RCTs performed and reported randomization properly, and 12% of RCTs reported proper allocation concealment methods. Outcome assessors were blinded in 48 (34%) RCTs, and patients blinded in 45 (26%) RCTs. Multinomial regression demonstrated that trials reporting an a <em>priori</em> sample size are significantly more likely to have a low risk of bias. One-third of trials did not state a primary outcome. The mean and median sample sizes were 73 and 43 patients respectively. Funding and conflict of interest reporting improved over time.</p> <p><em>Conclusions:</em> This systematic review establishes a baseline of the quality of evidence that currently guides practice for surgical interventions in plastic and reconstructive surgery. For the readers of plastic surgery literature to have confidence in the literature, risks of bias should be minimized and transparently reported. This will encourage plastic surgeons to apply the results and findings from published RCTs in their practice, providing patients them with the best possible treatments.</p> / Master of Science (MSc)

INTRODUÇÃO: A rinoplastia tem uma posição de destaque no universo da Cirurgia Plástica, decorrente da complexidade anatômica do nariz, do seu papel estético facial e de sua importância na fisiologia respiratória.Desde Joseph e Roe, a redução do excesso de dorso ósteo-cartilaginoso vem sendo baseada na ressecção parcial dos processos laterais da cartilagem septal, do próprio septo e dos ossos próprios do nariz. Divulgou-se um número considerável de complicações e resultados estéticos e funcionais inadequados, tais como: alteração funcional da válvula nasal interna, pinçamento do terço médio, teto aberto, deformidade em V invertido, nariz em sela, irregularidades de dorso, entre outros. Ishida et al. propuseram uma técnica inovadora que realiza o tratamento do dorso nasal com a preservação da estrutura cartilaginosa do mesmo, mantendo a função da válvula nasal interna. Desde o início do século XX, diversos autores tentaram um método objetivo e quantitativo para o diagnóstico e seguimento da função da válvula nasal. Diante deste problema de diagnóstico das alterações da válvula nasal interna, surgiu a rinometria acústica, aonde se pode especificar o sítio anatômico das alterações de fluxos e resistências da cavidade nasal. A rinometria acústica (RA) foi descrita em 1989 por Hilberg et al. quando novas perspectivas foram lançadas no estudo objetivo das fisiopatologias nasais. OBJETIVO: Este estudo avaliou as alterações das áreas das válvulas nasais internas, comparando os valores obtidos no pré-operatório com os valores obtidos no pós-operatório oriundos da rinometria acústica em pacientes submetidos a rinoplastia com preservação do dorso cartilaginoso. MÉTODO: Foram estudados 75 pacientes submetidos a rinoplastia com preservação do dorso cartilaginoso. Os pacientes realizaram avaliação rinométrica no pré-operatório e no pós-operatório de 2 anos. Utilizamos o aparelho de rinometria acústica da Rhinometrics, o Rhino Scan 2.5. Utilizamos a área da ASM II (com vasoconstrictor), que representa o início da válvula nasal interna. Foi utilizada uma análise de variância (ANOVA). RESULTADOS: Observou-se que no momento pré-cirurgia houve diferença estatisticamente significante entre os dois lados na medida de VNI (p=0,007), ou seja, o lado direito apresentou, em média, 0,014 ± 0,004 cm2 a mais na VNI do que o lado esquerdo. Do momento pré para o momento pós observou-se um decréscimo médio estimado em 0,007 ± 0,005 cm2 na VNI do lado direito, entretanto esse decréscimo não se mostrou estatisticamente significante (p=0,284). Para o lado esquerdo observou-se comportamento distinto ao apresentado para o lado direito, ou seja, do momento pré para o momento pós observou-se um acréscimo médio estimado em 0,009 ± 0,005 cm2 na VNI, porém este acréscimo não foi significativo do ponto de vista estatístico (p=0,735). DISCUSSÃO: Em relação aos resultados obtidos neste estudo, podemos evidenciar o evento de simetrização das válvulas nasais, mostrando um decréscimo na VNI D e aumento de área da válvula nasal E, porém sem diferença estatisticamente significativa, ratificando a não manipulação significativa da região anatômica da válvula nasal interna. CONCLUSÃO: Concluímos que a técnica de rinoplastia com preservação do dorso cartilaginoso não alterou de forma estatisticamente significante os valores das áreas das válvulas nasais internas obtidos através da rinometria acústica, quando comparamos o momento pré-operatório com o momento pós-operatório. / INTRODUCTION: The rhinoplasty is a position of prominence in the world of Plastic Surgery, due to anatomical complexity of the nose, facial aesthetic of its role and its importance in physiology. Since Joseph Roe, the reduction of excessive back-cartilaginous has been based on partial resection of the lateral process of septal cartilage of the septum and the bone\'s own nose. It has been related a considerable number of complications and inadequate functional and aesthetic results, such as: functional change of the internal nasal valve, clamping the middle third, \"roof open,\" deformity in \"V\" inverted, in saddle nose, irregularities of the back, among others. Ishida et al. proposed an innovative technique that performs the treatment of nasal dorsum with the preservation of the cartilaginous structure of it, maintaining the function of internal nasal valve. Since the beginning of the twentieth century, many authors haven trying an objective and quantitative method for diagnosis and follow the function of the nasal valve. Facing the problem of diagnosis of changes in internal nasal valve, appeared acoustic rhinometry, where you can specify the site of the anatomic changes of flow and resistance of the nasal cavity. Acoustic rhinometry (AR) was described in 1989 by Hilberg et al. when new prospects were launched in the study goal of nasal pathophysiology. OBJECTIVE: This study evaluated changes in the areas of internal nasal valve, comparing the values obtained preoperatively with the values obtained in the postoperative period from the acoustic rhinometry in patients who underwent rhinoplasty with preservation of cartilaginous back. METHOD: We studied 75 patients submitted a rhinoplasty with the preservation of cartilaginous back. Patients held in rhinometry evaluation preoperative and postoperative period of 2 years. We use the apparatus of the acoustic rhinometry Rhinometrics, the Rhino Scan 2.5. We use the area of ASM II (with vasoconstrictor), which represents the start of the internal nasal valve. We used an analysis of variance (ANOVA). RESULTS:Observed that in the pre-surgery statistically significant difference between the two sides since the NIV (p = 0007), namely the right side showed, on average, 0014 ± 0004 cm2 in the NIV more than the left side. From time to time pre post observed a decrease in estimated average 0007 ± 0005 cm2 in the NIV on the right side, however this decrease was not statistically significant (p = 0284). To the left was observed different behavior to that presented to the right side, that is the moment for pre the moment after it was observed an average gain estimated at 0009 ± 0005 cm2 in the NIV, but this increase was not significant from the point of statistically (p = 0735). DISCUSSION: Regarding the results of this study, this study shows the event of simetrização nasal valve, showing a decrease in the NIV R and increase the area of the nasal valve L, but there were no statistically significant difference, in ratifying no significant manipulation of the anatomical region of the internal nasal valve. CONCLUSION: We conclude that the technique of rhinoplasty with preservation of the back cartilaginous no statistically significant changes in the values of the areas of internal nasal valves when compared Preoperative the moment to moment after surgery, obtained from Acoustic rhinometry.

Syfte och frågeställningar Syftet med denna studie är att förklara hur subjektiva upplevelser runt familj påverkar intresse av estetisk kirurgi. Specifika frågeställningar har formulerats för att undersöka detta: – Hur påverkas intresse av estetisk kirurgi av familjemedlemmar som pratat om att utföra eller som har utfört estetisk kirurgi? – Hur påverkas intresse av estetisk kirurgi av upplevd skilsmässa under uppväxt och uppväxt med en ensamstående förälder? – Hur påverkas intresse av estetisk kirurgi av fysisk eller psykisk frånvaro av mamma eller pappa under uppväxt? – Hur påverkas intresse av estetisk kirurgi av att minst en person gett stöd och varit älskande under uppväxt? – Hur påverkas intresse av estetisk kirurgi av ouppnådda familjefunktioner? – Hur påverkas intresse av estetisk kirurgi av en upplevd familjekris? Metod Denna uppsats har använts sig av en kvantitativ forskningsmetod med enkät. En egen enkät komponerades och delades ut i Stockholms län. 60 enkäter delades ut, varav 58 av dessa besvarades. Enkäterna hanterades anonymt och sammanställdes först i Excel-ark för att sedan analyseras i SPSS genom Mann-Whitney och Chi-2 test, samt logistisk regression. Resultat Prediktorer för intresse för estetisk kirurgi är föräldrar som pratat om att utföra estetisk kirurgi (P=0,049), lägre skattning av psykisk närvaro av mamma (P=0,029), lägre skattning av psykisk närvaro av pappa (P=0,042), lägre skattning av att pappa ingivit respekt kring den egna personens värde (P=0,001) och vid lägre skattning av att familj gett en god grund för en stabil och harmonisk uppväxt (P=0,003). Ingen av dessa kunde enskilt förklara den beroende variabelns variation, utan alla samvarierade. Genom att stegvis exkludera prediktorer i en logistisk regression kunde den viktigaste prediktorn till intresse av estetisk kirurgi identifieras, vilket var, den sistnämnda. Slutsats Slutsatsen är att vissa subjektiva upplevelser runt familj påverkar intresse av estetisk kirurgi medan påverkan av andra inte gett signifikanta skillnader. / Aim The purpose of this study is to explain how subjective experiences around the family affect interest in esthetic surgery. Specific questions were made to investigate this: - How is the interest in esthetic surgery affected by family members who has been talking about undergoing or have been undergoing esthetic surgery? - How is the interest in esthetic surgery affected by the experience of divorce during childhood and growing up with a single parent? - How is the interest in esthetic surgery affected by physical or psychological absence of mother or father, during childhood? - How is the interest in esthetic surgery affected by at least one person who has been supported and loving, during childhood? - How is the interest in esthetic surgery affected by family functions that are unmet? - How is the interest in esthetic surgery affected by the experience of a family crisis? Method This thesis has used a quantitative research method, with a survey. An own survey was made, and handed out in Stockholm. 60 surveys was handed out, of which 58 was answered. The survey was managed anonymously, and at first consolidated in spreadsheets of Excel and then analyzed in SPSS, trough Mann-Whitney and Chi-2 test, and also logistic regression. Results The predictors of interest in esthetic surgery are parents who talked about undergoing esthetic surgery (P = 0.049), lower estimates of mental presence of the mother (P = 0.029), lower estimates of mental presence of father (P = 0.042), lower estimate of that the father has given respect of the own person´s value (P = 0.001) and lower estimation of that the family have provided a good basis for a stable and harmonious childhood (P = 0.003). None of these could individually explain the dependent variable's variation, but all of them interacted. By gradually exclude the predictors in a logistic regression, the main predictor of interest in esthetic surgery was identified, which was the last one mentioned. Conclusions The conclusion is that certain subjective experiences around the family affect interest in cosmetic surgery, while the influence of others has shown no significant differences.

Η εργασία αυτή πραγματεύεται την εφαρμογή των εργαλείων του Management στην σύσταση και λειτουργία μιας επιχείρησης Πλαστικής Χειρουργικής. Θα πρέπει να επισημάνουμε εδώ ότι η Πλαστική Χειρουργική είναι μία ιατρική ειδικότητα που δεν αφορά μόνο στις κοσμητικές επεμβάσεις, αλλά και στις λεγόμενες επανορθωτικές, μέρος των οποίων είναι θεραπευτικές σε προβλήματα που απειλούν την ζωή του ανθρώπου. Επομένως, είναι προς όφελος των ασθενών η σωστή και οικονομική λειτουργία μίας τέτοιας επιχειρήσεως. Επειδή στην βιβλιογραφία υπάρχουν αρκετές αναφορές στην επιχειρηματική οργάνωση εταιριών που προσφέρουν υπηρεσίες υγείας σε τριτοβάθμιο νοσοκομειακό επίπεδο, ενώ λείπουν αντίστοιχες για την οργάνωση σε επίπεδο προσωπικής επιχειρήσεως, επελέγη η εργασία να αφορά σε αυτό το μάλλον παραμελημένο τμήμα. Άλλωστε, οι ιατρικές υπηρεσίες είναι κατ’ εξοχήν προσωπικές όσον αφορά στον ιατρό και εξατομικευμένες όσον αφορά στον ασθενή. Έτσι, το θέμα που θα αναλυθεί είναι το “Eπιχειρηματικό σχέδιο μιας νεοσύστατης επιχειρήσεως Πλαστικής Χειρουργικής”. Όλα τα στοιχεία που αναφέρονται ανταποκρίνονται στην τρέχουσα αγορά, αποτελούν πόρισμα εξειδικευμένης γνώσης και πληροφόρησης και ταυτόχρονα με την εργασία βρίσκονται σε εφαρμογή σε πραγματική επιχείρηση. Το επιχειρηματικό σχέδιο εκπονήθηκε με βάση όλα τα απαραίτητα προς τούτο, εργαλεία του Management και τις αρχές της επιστήμης τόσο της ιατρικής όσο και της διοικήσεως επιχειρήσεων. Ο στόχος είναι να μπορεί με βάση το σχέδιο αυτό να αναπτυχθεί μία βιώσιμη και κερδοφόρα επιχείρηση στον τομέα αυτό. Έχει προηγηθεί η απαραίτητη έρευνα αγοράς, τόσο σε επίπεδο υφιστάμενου και μελλοντικού ανταγωνισμού όσο και σε επίπεδο αποτίμησης πόρων και χρηματοδοτήσεως από πιστωτικά ιδρύματα. Δεν έχει παραληφθεί και η αξιολόγηση των μελλοντικών αποδόσεων του χώρου και ακόμη και το ιδιαίτερο νομικό – ασφαλιστικό πλαίσιο, μέσα στο οποίο θα δράσει η επιχείρηση. / A business plan of a newly formed plastic surgery clinic.

INTRODUÇÃO: A rinoplastia tem uma posição de destaque no universo da Cirurgia Plástica, decorrente da complexidade anatômica do nariz, do seu papel estético facial e de sua importância na fisiologia respiratória.Desde Joseph e Roe, a redução do excesso de dorso ósteo-cartilaginoso vem sendo baseada na ressecção parcial dos processos laterais da cartilagem septal, do próprio septo e dos ossos próprios do nariz. Divulgou-se um número considerável de complicações e resultados estéticos e funcionais inadequados, tais como: alteração funcional da válvula nasal interna, pinçamento do terço médio, teto aberto, deformidade em V invertido, nariz em sela, irregularidades de dorso, entre outros. Ishida et al. propuseram uma técnica inovadora que realiza o tratamento do dorso nasal com a preservação da estrutura cartilaginosa do mesmo, mantendo a função da válvula nasal interna. Desde o início do século XX, diversos autores tentaram um método objetivo e quantitativo para o diagnóstico e seguimento da função da válvula nasal. Diante deste problema de diagnóstico das alterações da válvula nasal interna, surgiu a rinometria acústica, aonde se pode especificar o sítio anatômico das alterações de fluxos e resistências da cavidade nasal. A rinometria acústica (RA) foi descrita em 1989 por Hilberg et al. quando novas perspectivas foram lançadas no estudo objetivo das fisiopatologias nasais. OBJETIVO: Este estudo avaliou as alterações das áreas das válvulas nasais internas, comparando os valores obtidos no pré-operatório com os valores obtidos no pós-operatório oriundos da rinometria acústica em pacientes submetidos a rinoplastia com preservação do dorso cartilaginoso. MÉTODO: Foram estudados 75 pacientes submetidos a rinoplastia com preservação do dorso cartilaginoso. Os pacientes realizaram avaliação rinométrica no pré-operatório e no pós-operatório de 2 anos. Utilizamos o aparelho de rinometria acústica da Rhinometrics, o Rhino Scan 2.5. Utilizamos a área da ASM II (com vasoconstrictor), que representa o início da válvula nasal interna. Foi utilizada uma análise de variância (ANOVA). RESULTADOS: Observou-se que no momento pré-cirurgia houve diferença estatisticamente significante entre os dois lados na medida de VNI (p=0,007), ou seja, o lado direito apresentou, em média, 0,014 ± 0,004 cm2 a mais na VNI do que o lado esquerdo. Do momento pré para o momento pós observou-se um decréscimo médio estimado em 0,007 ± 0,005 cm2 na VNI do lado direito, entretanto esse decréscimo não se mostrou estatisticamente significante (p=0,284). Para o lado esquerdo observou-se comportamento distinto ao apresentado para o lado direito, ou seja, do momento pré para o momento pós observou-se um acréscimo médio estimado em 0,009 ± 0,005 cm2 na VNI, porém este acréscimo não foi significativo do ponto de vista estatístico (p=0,735). DISCUSSÃO: Em relação aos resultados obtidos neste estudo, podemos evidenciar o evento de simetrização das válvulas nasais, mostrando um decréscimo na VNI D e aumento de área da válvula nasal E, porém sem diferença estatisticamente significativa, ratificando a não manipulação significativa da região anatômica da válvula nasal interna. CONCLUSÃO: Concluímos que a técnica de rinoplastia com preservação do dorso cartilaginoso não alterou de forma estatisticamente significante os valores das áreas das válvulas nasais internas obtidos através da rinometria acústica, quando comparamos o momento pré-operatório com o momento pós-operatório. / INTRODUCTION: The rhinoplasty is a position of prominence in the world of Plastic Surgery, due to anatomical complexity of the nose, facial aesthetic of its role and its importance in physiology. Since Joseph Roe, the reduction of excessive back-cartilaginous has been based on partial resection of the lateral process of septal cartilage of the septum and the bone\'s own nose. It has been related a considerable number of complications and inadequate functional and aesthetic results, such as: functional change of the internal nasal valve, clamping the middle third, \"roof open,\" deformity in \"V\" inverted, in saddle nose, irregularities of the back, among others. Ishida et al. proposed an innovative technique that performs the treatment of nasal dorsum with the preservation of the cartilaginous structure of it, maintaining the function of internal nasal valve. Since the beginning of the twentieth century, many authors haven trying an objective and quantitative method for diagnosis and follow the function of the nasal valve. Facing the problem of diagnosis of changes in internal nasal valve, appeared acoustic rhinometry, where you can specify the site of the anatomic changes of flow and resistance of the nasal cavity. Acoustic rhinometry (AR) was described in 1989 by Hilberg et al. when new prospects were launched in the study goal of nasal pathophysiology. OBJECTIVE: This study evaluated changes in the areas of internal nasal valve, comparing the values obtained preoperatively with the values obtained in the postoperative period from the acoustic rhinometry in patients who underwent rhinoplasty with preservation of cartilaginous back. METHOD: We studied 75 patients submitted a rhinoplasty with the preservation of cartilaginous back. Patients held in rhinometry evaluation preoperative and postoperative period of 2 years. We use the apparatus of the acoustic rhinometry Rhinometrics, the Rhino Scan 2.5. We use the area of ASM II (with vasoconstrictor), which represents the start of the internal nasal valve. We used an analysis of variance (ANOVA). RESULTS:Observed that in the pre-surgery statistically significant difference between the two sides since the NIV (p = 0007), namely the right side showed, on average, 0014 ± 0004 cm2 in the NIV more than the left side. From time to time pre post observed a decrease in estimated average 0007 ± 0005 cm2 in the NIV on the right side, however this decrease was not statistically significant (p = 0284). To the left was observed different behavior to that presented to the right side, that is the moment for pre the moment after it was observed an average gain estimated at 0009 ± 0005 cm2 in the NIV, but this increase was not significant from the point of statistically (p = 0735). DISCUSSION: Regarding the results of this study, this study shows the event of simetrização nasal valve, showing a decrease in the NIV R and increase the area of the nasal valve L, but there were no statistically significant difference, in ratifying no significant manipulation of the anatomical region of the internal nasal valve. CONCLUSION: We conclude that the technique of rhinoplasty with preservation of the back cartilaginous no statistically significant changes in the values of the areas of internal nasal valves when compared Preoperative the moment to moment after surgery, obtained from Acoustic rhinometry.

Orientador: Marcio Zaffalon Casati, Francisco Humberto Nociti Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T08:35:43Z (GMT). No. of bitstreams: 1 Bittencourt_Sandro_M.pdf: 2991746 bytes, checksum: 07beceb94fe31cbbaebc41ae56ff444c (MD5) Previous issue date: 2005 / Resumo: O objetivo deste estudo clínico controlado foi avaliar a utilização do retalho semilunar posicionado coronariamente (RSPC)para tratamento de recessões gengivais, comparando-o ao enxerto de tecido conjuntivo subepitelial (ECS). Foram selecionados dezessete pacientes com recessões gengivais vestibulares bilaterais classe I de Miller com altura:S 4,0 mm, em caninos ou pré-molares superiores. Um dente em cada paciente foi aleatoriamente designado para receber o retalho semilunar posicionado coronariamente (tratamento teste) ou o enxerto de tecido conjuntivo subepitelial (tratamento controle). Os parâmetros clínicos: altura e largura da recessão, nível de inserção clínica, profundidade de sondagem, altura da faixa de tecido queratinizado e espessura gengival foram avaliados antes dos procedimentos e 3 e 6 meses após com o uso de um paquímetro digital com precisão de 0,01 mm. Satisfação estética, hipersensibilidade dentinária e dor pós-operatória dos pacientes também foram analisadas. As médias percentuais de recobrimento radicular, após seis meses de acompanhamento, para o RSPC e o ECS, foram 90,95% e 96,10%, respectivamente. Não foi encontrada diferença significante na quantidade de recobrimento radicular entre RSPC e ECS. Completo recobrimento radicular foi alcançado em 52,94% e 76,46% dos dentes tratados com o RSPC e ECS, respectivamente. Com relação à espessura gengival foi encontrado um aumento estatisticamente significativo para o tratamento ECS (p<0,05). Para os demais parâmetros clínicos não foi identificada diferença estatisticamente significante. A condição estética de ambos os tratamentos foi considerada satisfatória pelos pacientes. Nenhum caso de hipersensibilidade residual ou adicional foi relatado após os procedimentos. Maior desconforto pós-operatório foi relatado pelos pacientes do tratamento ECS na área doadora do palato, apenas no primeiro dia pós-operatório. Baseado nos resultados desta investigação, pode-se concluir que ambas as técnicas são eficazes no recobrimento radicular de recessões gengivais classe I de Miller / Abstract: The purpose of this study was to compare the clinical efficacy of semilunar coronally positioned flap (SCPF) to subepithelial connective tissue graft (SCG) in the treatment of gingival recessions. Seventeen patients with bilateral Miller's Class I buccal gingival recessions of:S 4.0 mm in canines or premolars were selected. One tooth in each patient was randomized to receive either the semilunar coronally positioned fIap (test group) or subepithelial connective tissue graft (control group). Depth of the gingival defect, width at the coronal extent of the gingival defect, width and thickness of keratinized tissue, probing depth, and clinical attachment leveI were measured at baseline and 3 and 6 months post surgery to the next 0.01mm with the use of a caliper. Patient satisfaction with esthetics, root sensitivity, and postoperative pain were also evaluated. The average percentages of root coverage for SCPF and SCG were 90.95% and 96.10%, respectively. No significant difference in the amount of root coverage was found between SCPF and SCG. Complete root coverage for control and test groupswere 52.94% and 76.46%, respectively. The SCG was superior to the SCPF with regard to the increase of keratinized tissue thickness (p<0.05). No difference between groups was found in any other clinical parameters. The esthetic condition after both treatments was considered satisfactory by patients. There was no evidence of residual or new root sensitivity after both procedures. SCPF was superior to SCG with regard to patient-reported discomfort, only on first day. Based on the results of this investigation, the semilunar coronallypositioned flap provided root coverage in class I gingival recession similar to the provided by subepithelial connective tissue graft / Mestrado / Periodontia / Mestre em Clínica Odontológica

No description available.

Introduction: Though xenogeneic acellular scaffolds are frequently used for surgical reconstruction, knowledge of their mechanical properties is lacking. This study compared the mechanical, histological and ultrastructural properties of various native and acellular specimens. Materials and methods: Porcine esophagi, ureters and skin were tested mechanically in a native or acellular condition, focusing on the elastic modulus, ultimate tensile stress and maximum strain. The testing protocol for soft tissues was standardized, including the adaption of the tissue’s water content and partial plastination to minimize material slippage as well as templates for normed sample dimensions and precise cross-section measurements. The native and acellular tissues were compared at the microscopic and ultrastructural level with a focus on type I collagens. Results: Increased elastic modulus and ultimate tensile stress values were quantified in acellular esophagi and ureters compared to the native condition. In contrast, these values were strongly decreased in the skin after acellularization. Acellularization-related decreases in maximum strain were found in all tissues. Type I collagens were well-preserved in these samples; however, clotting and a loss of cross-linking type I collagens was observed ultrastructurally. Elastins and fibronectins were preserved in the esophagi and ureters. A loss of the epidermal layer and decreased fibronectin content was present in the skin. Discussion: Acellularization induces changes in the tensile properties of soft tissues. Some of these changes appear to be organ specific. Loss of cross-linking type I collagen may indicate increased mechanical strength due to decreasing transverse forces acting upon the scaffolds, whereas fibronectin loss may be related to decreased load-bearing capacity. Potentially, the alterations in tissue mechanics are linked to organ function and to the interplay of cells and the extracellular matrix, which is different in hollow organs when compared to skin.

<p>A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn.</p><p>The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire.</p><p>Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity.</p><p>Social desirability was lower among care utilisers and was associated with burn-related health aspects.</p><p>The participants reported a low level of negative care experiences, the most common of which was Powerlessness.</p><p>Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R² was 0.25.</p><p>In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R² was 0.19.</p><p>The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.</p>

BACKGROUND: The understanding of facial anatomy and its changes through aging has led to the development of several different facelift techniques that focus on being less invasive and traumatic and, at the same time, providing natural long-lasting results. In this article we describe step by step our facelift technique as it has been done over the past 10 years by the senior author. METHODS: This is a retrospective, descriptive, transversal study in which all patients who underwent a rhytidectomy using our technique from January 2002 to September 2012 were included. All patients were operated on under local anesthesia and superficial conscious sedation. All surgeries were performed by the same surgeon. A complete step-by-step description of the surgical technique can be found in the main article. RESULTS: Between January 2002 and September 2012, a total of 113 patients underwent facelift surgery. Of these, 88.9 % were women and 11.1 % were men. The mean age was 55.3 (± 8.66) years. Primary surgeries represented 80.3 % (n = 94), secondary 18.8 % (n = 22), and tertiary 0.85 % (n = 1). Only one major complication, representing 0.8 %, consisting of a right-sided temporal paresis with 2 months complete recovery was seen. The minor complications rate was 23.1 %. The most common minor complication was hypertrophic/keloid scars which made up 77.8 % of all minor complications. CONCLUSIONS: The technique described provides good and long-lasting aesthetic results with shorter scars, smaller areas of dissection (without temporal and postauricular flaps), and a shorter recovery period. LEVEL OF EVIDENCE V: 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 http://www.springer.com/00266 .