FACTORS OF FACIAL DEFECTS RECONSTRUCTIVE SURGERY EFFICIENCY Текст научной статьи по специальности «Клиническая медицина»

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FACTORS OF FACIAL DEFECTS RECONSTRUCTIVE SURGERY EFFICIENCY

Valikhnovskyi R.

Surgeon, MD, PhD, Clinic 311 LLC, Kyiv, Ukraine ORCID: 0000-0002-6037-3752

Abstract

The problem of reconstructive surgery for facial defects, its social and economic aspects remain on the agenda in Ukraine and around the world. The study of the factors of effectiveness of reconstructive surgery of facial defects is an urgent problem of plastic surgery, and the implementation of appropriate systematic review allows to determine the status and future prospects and priorities of research in this area. Identification of the main clusters of factors of efficiency of reconstructive surgery of facial defects by conducting a systematic review of the scientific literature on this issue. The systematic review includes the following types of studies: systematic reviews, randomized clinical trials, cohort studies, case-control studies, sectional studies, case studies, case series. Publications that contain data on reconstructive plastic surgery of facial defects. The search was conducted in the following databases: PubMed, Cochrane Library, Scopus, Web of Science. Excel and R software were used for analysis.

According to the inclusion criteria, publications devoted to certain aspects of determining the factors of effectiveness of reconstructive surgery for facial defects were selected. There is a significant predominance (p <0.01) of type studies, in descending order: description of individual cases, series of cases, sectional, "case-control". Factors for the effectiveness of reconstructive surgery of facial defects relate to medical and biological (congenital, acquired) aspects of each individual, environmental factors of natural, man-made nature, organizational and administrative issues, qualifications of medical professionals and technological equipment, as well as psychological status and psychological microclimate etc. The prospect of further research is to conduct an appropriate phase of meta-analysis of data selected at the current stage.

Keywords: reconstructive surgery, plastic surgery, face defects, efficacy, factors.

Background. The problem of reconstructive surgery of facial defects, its social and economic aspects remain on the agenda in Ukraine and around the world [1]. Appearance, especially - the face itself, has a significant impact on everyday life, its quality, professional career of people [2]. For this reason, any change in body image perception can lead to social losses, such as loss of job, status and role, as well as loss of beauty and attractiveness [3, 4]. The perception of the body image is a reflection in the mind of the body image and all the feelings associated with the body. When a person experiences any deformation of appearance or any dysfunction, he experiences an internal conflict between the perceived image of the body at that moment and the expected pattern. Cognitive processes, effectiveness

and response to the concept of self-control change, and self-confidence is lost along with changes in body image perception. Thus, it is important to improve the perception of body image and its deformation and dysfunction in the formation of image perception and self-esteem. Surgical reconstructive treatment of facial defects increases self-confidence and affects the quality of life [5-7].

The face has a symbolic meaning in social and personal relations and is a kind of "window" of the individual into the world. As a result, any dysfunction or deformity of the face adversely affects the appearance and psychology of the individual and leads to concerns about their appearance [8, 9]. Facial interventions in

plastic, aesthetic and reconstructive surgery are procedures in which aesthetic concerns as well as the psychosocial cost of error are high, especially because of their impact on appearance [2, 10, 11].

Thus, the study of the factors of effectiveness of reconstructive surgery of facial defects is an urgent problem of plastic surgery, and the implementation of appropriate systematic review allows to determine the status and future prospects and priorities of research in this area.

Aim: The aim of the study is to determine the main clusters of factors in the effectiveness of reconstructive surgery for facial defects by conducting a systematic review of the scientific literature on this issue.

Material and methods.

The semantic core of the publication search included the following keywords and their combinations: "face defect, eyelid, etiology, pathogenesis, pathophys-iology, face rejuvenation, reconstructive facial surgery, craniofacial reconstruction, (3D) computer technology, virtual surgical planning, craniofacial defects, 3D modeling, posttraumatic, three-dimensional modeling, virtual surgical planning, patient custom implants, intraoperative navigation, assisted techniques, patient specific modeling, generation of virtual models, VSP, one stage, soft tissue, surgical correction, one-piece, single-stage, nasal reconstruction, nasal reconstructive surgery, otoplasty, blepharoplasty, lip, orbital, cheek, lipoplasty, cheiloplasty, feminization, masculinization, periorbital, rhinoplasty, septum, septoplasty, correction, nose alar, anatomy features, auricular, costal cartilage, autologous cartilage, epidemiology, face trauma, treatment, midface, facial deformities, congenital, anomalies, malformation" etc.

The search was conducted in the following databases:

- PubMed,

- Cochrane Library,

- Scopus,

- Web of Science.

The systematic review includes the following types of studies: systematic reviews, randomized clinical trials, cohort studies, case-control studies, sectional studies, case studies, case series.

The design of data extraction (selection and encoding) was carried out as follows:

- search, systematization and analysis were performed by two independent reviewers and data extractors, who were not acquainted with each other's results;

- all differences between the judgments of each of the extractors and reviewers are resolved by describing the strengths and weaknesses of each version;

- obtaining data on medical and biological (somatic), psychosocial, economic, technical, organizational aspects;

- in the absence of the necessary data, a request was made from the authors of the publication;

- Excel and R software tools are used.

The author thanks the scientific consultants for valuable advice on research methodology and volunteer data extractors for the technical stages of the research. 100% of the contribution belongs to the author. The author has no conflict of interest. There are no differences from the protocol in the current version of the review. No notes have been previously published. None of the studies were excluded. Information on all selected studies is currently classified. No current research on this review has been identified.

PROSPERO registration code:

CRD42021218629.

Results and discussion.

According to the inclusion criteria, 689 publications were selected on certain aspects of determining the effectiveness of reconstructive surgery for facial defects (Table 1, Fig. 1).

There is a significant predominance (p <0.01) of type studies, in descending order:

- description of individual cases, series of cases,

- cut,

- "case-control".

Table 1

The number of publications of the results of different types of medical research on the effectiveness of re-

Parameters SR RCT CS CCS CsS Ind Total

Publications quantity 5 15 58 121 198 296 693

Note. SR - systematic reviews; RCT - randomized controlled trials; CS - cohort studies; CcS - case-control studies; CsS - cross-section studies; Ind - description of individual cases, series of cases.

□

□ Ind

43%

SR

0,01

□ RCT

0,02

□ CS 8%

□ CCS 17%

□ CsS 29%

Fig. 1. The proportion ofpublications of the results of different types of medical research on the effectiveness of

reconstructive surgery for facial defects Note. SR - systematic reviews; RCT - randomized controlled trials; CS - cohort studies; CcS - case-control studies; CsS - cross-section studies; Ind - description of individual cases, series of cases.

The decomposition of the factors of effectiveness of reconstructive surgery of facial defects into groups -medical-biological (somatic), psychosocial, economic, technical, organizational, etc. - provides a basis for detailing recommendations on each of the representative factors of groups designed to optimize medical care for plastic reconstruction. and publication of factual information on the effectiveness of reconstructive surgery by systematic review.

Conclusions:

1. Factors for the effectiveness of reconstructive surgery of facial defects relate to medical and biological (congenital, acquired) aspects of each individual, environmental factors of natural, man-made nature, organizational and administrative issues, qualifications of medical professionals and technological equipment, as well as psychological status and psychological microclimate etc.

2. The prospect of further research is to conduct an appropriate phase of meta-analysis of data selected at the current stage.

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Appendix (analyzed publications):

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STUDY OF THE SPECTRUM OF EMOTIONAL PATHOLOGY IN ADOLESCENTS WITH TYPE I

DIABETES MELLITUS

Sultonova K.

The Department of Psychiatry, Narcology, Child Psychiatry, Medical Psychology and Psychotherapy

Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan

Abstract

The article examines the spectrum of emotional pathology in adolescents with diabetes mellitus. At the initial stage, adolescents were tested for the presence of emotional changes using psychometric scales. In the course of the study of the psychoemotional background, 96.6% of the examined adolescents showed signs of a depressive disorder of the neurotic register. To reduce depressive symptoms, psychotherapeutic intervention was performed, as a result of which positive dynamics was observed in 80% of patients.

Keywords: emotional disorders, psychology, psychotherapy, adolescents, diabetes mellitus.

Relevance. The need for a comprehensive approach to the treatment of diabetes mellitus in adolescents with diabetes mellitus is reflected in the litera-ture[8]. An appropriate direction of work with children and adolescents with type I diabetes mellitus (DM) is to optimize complex pharmacotherapeutic and medical-psychological care with psychotherapeutic, psychosocial and rehabilitation measures[7]. Current trends in

clinical psychology show the importance of studying the processes of mental adaptation in the situation of the disease, that is, how children with DM react to the chronic frustrating situation of blocking their actual life needs. Diabetes mellitus (DM) is a widespread endocrine disease that reaches the scale of a non-communicable epidemic. Most patients who are diagnosed with