An analysis of the cost and impact of cosmetic tourism and its associated complications: A multi institutional study

Background and purposeThe increasing cost of cosmetic procedures, long elective waiting times in the public system and affordability of procedures offered abroad has driven the rapid growth of cosmetic tourism. The incidence and cost of patients presenting to the Irish health service with complications related to cosmetic procedures carried out in overseas institutions is largely unknown. This heterogenous group of patients is challenging to identify. Limited data exists for this patient group in the Irish context.We aimed to perform a multicentre audit and cost analysis of patients presenting to Irish health services with complications related to cosmetic procedures performed in overseas institutions over a 2 year period.MethodsPatients presenting to two University Hospitals from March 2019–April 2021 with complications after a cosmetic surgical procedure was performed abroad were studied. The HPO ABF 2020 price list data was used to calculate the inpatient and procedure cost for each subject.Main findings14 (13/92.8% female, mean age 43 ± 11.85 years) patients presented during the study period. Countries of cosmetic operation included: Belgium (6/46.2%), the UK (2/15.4%), Latvia, Turkey, Poland, Lithuania, and Estonia (1 patient/7.7% each country). All required a re-operative procedure. These interventions included: removal of infected implant (n = 1), adjustment or removal of a gastric band (n = 9) and debridement of an infected/necrotic wound (n = 3). Mean length of stay was 9.14 ± 7.48 (range 2–28) days. Five (38.4%) patients required vac dressing. The mean cost of the cohort for the interventional procedure and in-patient stay was €15912.53 (+/? €6388). The sum total of all the costs for the cohort was €231038.60.ConclusionsSignificant costs were associated with prolonged hospital admissions, operative interventions, intravenous antibiotics, VAC dressing application and follow up visits. Complications from procedures performed in overseas institutions account for a significant cost burden to health services in Ireland.     

Antimicrobial peptides (AMP) in biofilm induced orthopaedic device-related infections

Orthopaedic device-related infection (ODRI) represent is one of the most challenging complications to manage in orthopaedic and trauma surgery. Biofilm formation is one of the crucial steps in the development of implant related orthopaedic infections due to the surface-adherent bacteria. Bacterial biofilms have several innate antimicrobial resistance mechanisms and hence difficult to eliminate with conventional antibiotics. Chronic, indolent, unresponsive infection can lead to clinical disability affecting quality of life with socio-economic consequences and compromised patient related health care outcomes. Although there is a basic understanding of the mechanism of biofilm associated antimicrobial resistance, enhanced knowledge, innovative treatment strategies and new therapeutic modalities is the need of the hour to manage biofilm associated Orthopaedic device-related infection (ODRI). Antimicrobial peptides (AMPs) represent an exciting opportunity to treat biofilm infections due to their diverse mechanisms of action. This article highlights the current role and mechanism of Antimicrobial peptides (AMPs) in preventing and eradicating Orthopaedic device-related infection (ODRI).     

A technique for intraoperative creation of patient-specific titanium mesh implants

Prefabricated, patient-specific alloplastic implants for cranioplasty reduce surgical complexity, decrease operative times, minimize exposure and risk of contamination, and have resulted in improved aesthetic results. However, in creating a prefabricated custom implant using a patient’s computed tomography data, a stable, unalterable defect must be clearly defined before surgery. In the event that an intraoperative modification of an exiting skull defect is required, or in cases of tumour resection in which the size of the skull defect is unknown preoperatively, these prefabricated implants cannot be used. The ideal method for alloplastic cranioplasty would enable cost-effective creation of a patient-specific implant with the capacity for intraoperative modification.The present article describes a novel technique of cranioplasty that uses a patient’s computed tomography data to create a custom forming tool (ie, mold), enabling intraoperative creation of a patient-specific titanium mesh implant. The utility of these implants in creating a custom reconstructive solution in cases in which the size of the skull defect is unknown preoperatively will be demonstrated using two case presentations.     

Modern Composite Materials and Technical Strategies in Posttraumatic Augmentation Rhinoplasty

The selection of ideal posttraumatic augmentation rhinoplasty materials and technical strategies has always been a pressing challenge.Owing to the complexity of the traumatic nasal anatomical structure,such procedures are more complicated than ordinary cosmetic rhinoplasty.The choice of reconstruction material should emphasize its inherent characteristics,such as biocompatibility,anti-infective ability,strength,and plasticity.With the development of rhinoplasty,the choice of material is less limited and composite materials have become mainstream.This review outlines current composite materials and techniques in posttraumatic augmentation rhinoplasty.