CC BY
22MEDICAL SCIENCES
INSTRUMENTAL MODALITIES FOR DECISION-MAKING IN FACIAL RECONSTRUCTIVE
SURGERY
Valikhnovskyi R.
Clinic 311 LLC, Surgeon, MD, PhD, Kyiv, Ukraine ORCID: 0000-0002-6037-3752
Abstract
Decision performance in general surgery and especially in reconstructive plastic surgery has direct effect on the medical, psychological, social and economic effectiveness. The study of the instrumental modalities for decision-making in facial reconstructive surgery 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. The aim was to identify the main clusters of instrumental modalities for decision-making in facial reconstructive surgery 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 main instrumental modalities for decision-making in facial reconstructive surgery were selected. Instrumental modalities for decision-making in facial reconstructive surgery predominantly concern computerized technologies, i. e. three-dimension scanning and modeling, 3D planning, 3D printing, 3D stereophotography, computer-aided design and manufacturing, surgical simulation, robot-assisted surgery and also - biometry, bioprinting, development of evidence-based algorithms; equipment failure analysis etc. There is a significant predominance of type studies, in descending order: description of individual cases, series of cases, sectional, "case-control" - thus, there is a lack of randomized controlled trials and objective need in them. The prospect of further research is to complete the systematic review with meta-analysis.
Keywords: reconstructive surgery, plastic surgery, face defects, instrumental modalities, decision support.
Background. The role of plastic, especially reconstructive, surgery in global health is fundamental [1]. Decision performance in general surgery and especially in reconstructive plastic surgery has direct medical, psychological, social, economic, cultural, legal aspects [7,8,12]. Shared decision making is one of the most frequently used method [5,20]. A separate problem are the parental decisions about an outlook of their children with congenital facial defects [16].
There is an unknown evidence of systemic analysis of different modalities for decision support in plastic surgery [2], most of known studies concern some specific issues - laser application [13], photo editing techniques [18], telemedicine [7], information sources evaluation [19], machine learning framework [10], artificial intelligence [9,11,14].
According to modern approach with patient-centered, an accent in decisions is made on patient-reported satisfaction, and psychometric screening tools are used for evaluation and prediction [5,15,17]. Pandemic COVID-19 exacerbates a difficult decision-development procedure in facial reconstructive plastic surgery [4,6,21,22]. Same as in general surgery, there is a lack of evidence-based data in plastic reconstructive surgery, with a few exceptions [3].
Thus, the study of the main instrumental modalities for decision-making in facial reconstructive surgery 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 instrumental modalities for decision-making in facial reconstructive surgery 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, reconstructive facial surgery, cra-niofacial 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, surgical correction, nasal reconstruction, nasal reconstructive surgery, otoplasty, blepharoplasty, lip, orbital, cheek, lipoplasty, cheiloplasty, feminization, masculin-ization, 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, systemati-zation 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 instrumental modalities for decision-making in facial reconstructive surgery; 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 is pending.
Results and discussion.
According to the inclusion criteria, 129 publications were selected on certain aspects of instrumental modalities for decision-making in facial reconstructive surgery (Table 1, Fig. 1).
Table 1
The number of publications of the results of different types of medical research on the instrumental modalities
Parameters SR RCT CS CCS CsS Ind Total
Publications quantity 1 1 19 37 29 42 129
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.
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40
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Fig. 1. The
CCS
CsS
Ind
SR RCT CS
number ofpublications of the results of different types of medical research on the instrumental modalities for decision-making in facial reconstructive surgery
There is a significant predominance (p <0.01) of type studies, in descending order: description of individual cases, series of cases, cut, "case-control" (Fig. 2).
CsS
% 100,0
SR
RCT
CS
CCS
Fig. 2. The proportion ofpublications of the results of different types of medical research on the instrumental modalities for decision-making in facial reconstructive surgery 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.
Conclusions:
1. Instrumental modalities for decision-making in facial reconstructive surgery predominantly concern computerized technologies, i. e. three-dimension scanning and modeling, 3D planning, 3D printing, 3D ste-reophotography, computer-aided design and manufacturing, surgical simulation, robot-assisted surgery and also - biometry, bioprinting, development of evidence-based algorithms; equipment failure analysis etc.
2. There is a significant predominance (p < 0.01) of type studies, in descending order: description of individual cases, series of cases, sectional, "case-control" - thus, there is a lack of randomized controlled trials and objective need in them.
3. The prospect of further research is to complete the systematic review with meta-analysis.
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