Plastic and reconstructive surgery最新文献

{"title":"Moving Toward the Outpatient DIEP Flap: Factors Influencing Early Discharge.","authors":"Francis D Graziano, Ethan L Plotsker, Uchechukwu O Amakiri, Ronnie L Shammas, Perri S Vingan, Babak J Mehrara, Carrie S Stern, Jonas A Nelson, Evan Matros, Robert J Allen","doi":"10.1097/PRS.0000000000011951","DOIUrl":"10.1097/PRS.0000000000011951","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, allowing most patients to be discharged by postoperative day 2. However, some patients require a prolonged inpatient stay because of difficulty completing postoperative milestones. This study aims to identify factors associated with increased LOS after DIEP flap breast reconstruction and to assess safety of earlier discharge.</p><p><strong>Methods: </strong>A retrospective review was performed of all patients who underwent unilateral DIEP flap reconstruction between January of 2021 and December of 2022 at Memorial Sloan Kettering Cancer Center. The authors assessed patient characteristics, comorbidities, and complications to identify correlations with LOS and milestone completion after implementation of an ERAS protocol.</p><p><strong>Results: </strong>A total of 278 patients were included; the median LOS was 2.25 days (interquartile range, 2.19 to 2.33 days). Factors associated with delayed discharge included increased age, increased operative time, history of diabetes, and history of immunologic disease. Increased operative time was the only variable associated with prolonged milestone completion. A subanalysis of the safety of an earlier discharge goal of postoperative day 1 when compared with a goal of postoperative day 2 demonstrated no significant differences in complication rates.</p><p><strong>Conclusions: </strong>Discharge timing and milestone completion after unilateral DIEP flap reconstruction is variable and dependent on patient and operative characteristics. These insights can aid in patient optimization and may suggest ERAS protocol adjustments to enable earlier discharge for more patients. Furthermore, earlier discharge goals appear safe for appropriate patients.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"162e-171e"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histologic Comparison of Ultrafine Diced Cartilage and Conventionally Diced Cartilage Wrapped in Fascia in a Rabbit Model.","authors":"Seok Joon Lee, Young Sam Kim, Hyung Hwa Jeong, Tae Hyung Kim, Jong Woo Choi","doi":"10.1097/PRS.0000000000012026","DOIUrl":"10.1097/PRS.0000000000012026","url":null,"abstract":"<p><strong>Background: </strong>Ultrafine dicing, which reduces cartilage particles to less than 0.2 mm, has gained attention for producing dense implants with reduced distortion. However, concerns about long-term viability and cell damage because of extensive manipulation remain. The authors aimed to compare the histologic outcomes of ultrafine and conventionally diced cartilage wrapped in fascia in a rabbit model, providing insight into their potential use in rhinoplasty.</p><p><strong>Methods: </strong>Ten New Zealand White rabbits were divided into 2 groups. Cartilage was harvested from both ears, with 1 graft diced into 1- to 2-mm pieces and the other into pieces smaller than 0.2 mm. Both types were wrapped in fascia and implanted subcutaneously. Histologic analyses, using hematoxylin and eosin, Masson trichrome, and safranin-O staining, were performed at 8 weeks and 6 months postoperatively. The percentages of cartilage cells and dead space were compared between groups.</p><p><strong>Results: </strong>There was significantly higher cartilage cell density in the ultrafine diced group at both 8 weeks and 6 months than in the conventionally diced group. The ultrafine diced cartilage also exhibited less dead space and maintained a dense composition of type II collagen, suggesting a resilient and natural implant material.</p><p><strong>Conclusions: </strong>Ultrafine dicing resulted in superior histologic outcomes, with higher cartilage cell density and less fibrosis compared with conventional methods. These findings suggest that ultrafine diced cartilage may be an effective method for achieving natural and stable results in rhinoplasty. Further research involving human participants is needed to confirm these results.</p><p><strong>Clinical relevance statement: </strong>Ultrafine dicing of cartilage provides superior histological outcomes, with higher cell density and less fibrosis compared with conventional methods. This technique may offer plastic surgeons a more effective option for achieving stable, natural results in rhinoplasty, pending further human studies.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"208e-214e"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Grafting Using AlloDerm to Lengthen the Levator Aponeurosis and Correct Upper Eyelid Retraction Caused by Cosmetic Blepharoplasty.","authors":"Nam Seok Park, Won Lee, Seong Hwan Kim","doi":"10.1097/PRS.0000000000011980","DOIUrl":"10.1097/PRS.0000000000011980","url":null,"abstract":"<p><strong>Summary: </strong>Upper eyelid retraction often results from overcorrection of the levator palpebrae muscle during upper eyelid surgery. In such patients, the time between wound healing and reoperation may be prolonged and could result in symptoms, including dry eye. Therefore, the correction surgery-in which the levator aponeurosis that was shortened by cosmetic blepharoplasty is lengthened-should be performed as early as possible for better patient satisfaction and surgical outcomes. Between August of 2020 and September of 2022, the authors performed spacer grafting using AlloDerm dermal matrix after detaching the levator palpebrae muscle from the tarsus in 64 patients who experienced upper eyelid retraction after bilateral eyelid surgery and cosmetic blepharoplasty. Among 64 patients, 50 (78%) had satisfactory results, 8 (12%) had blepharoptosis, and 6 (10%) had insufficient correction. The authors' method produced a normalized levator aponeurosis position, symmetric eyes, and reduced adverse effects, including surprised and dry eyes. In addition, the method is easy to follow and safe.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 2","pages":"189e-193e"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plastic and Reconstructive Surgery Highlights: Breast.","authors":"Arash Momeni","doi":"10.1097/PRS.0000000000012127","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012127","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 2","pages":"341-343"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion: Effect of Age, Harvest Site, and Body Mass Index on the Cell Composition of the Stromal Vascular Fraction.","authors":"Arthur Y Yu","doi":"10.1097/PRS.0000000000012092","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012092","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 2","pages":"263-264"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion: Moving Toward the Outpatient DIEP Flap: Factors Influencing Early Discharge.","authors":"Gabriel M Kind","doi":"10.1097/PRS.0000000000012073","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012073","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 2","pages":"172e-173e"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Palatal Bone Regeneration in Cleft Palate Patients after a 2-Stage Palatoplasty Using a Modified Furlow Procedure.","authors":"Sofie Teblick, Elke Van de Casteele, Maria Scheuermann, Inne Vanreusel, Lieven Renier, Nasser Nadjmi","doi":"10.1097/PRS.0000000000011817","DOIUrl":"10.1097/PRS.0000000000011817","url":null,"abstract":"<p><strong>Background: </strong>A palatal cleft can be reconstructed using various palatoplasty techniques. Many techniques use local mucoperiosteal flaps to close the hard palate cleft, without closing the underlying bone defect. The purpose of this study was to explore the possibility of spontaneous bone regeneration in the remaining bone defect following 2-stage palatoplasty. The effect of this bone regeneration on transverse maxillary growth also was studied.</p><p><strong>Methods: </strong>A retrospective study of patients with unilateral cleft lip and palate was performed. Cleft size was measured at the hard-soft palate junction on plaster models obtained during palatoplasty. Residual bony cleft was evaluated at the time of alveolar process reconstruction using cone beam computed tomography images. The presence of crossbite was evaluated using clinical photographs to assess transverse maxillary growth.</p><p><strong>Results: </strong>Forty-six patients were included in this study. Thirteen patients (28%) presented with complete ossification of the hard palate at age 6 years. Six patients (13%) had no ossification, and 27 patients (59%) demonstrated partial closure, averaging 75% of the total hard palate length. All patients with complete closure and 89% of patients with partial closure presented without lateral crossbites. Statistical analysis revealed no significant correlation between lateral crossbites and the extent of hard palate ossification ( P = 0.4314).</p><p><strong>Conclusions: </strong>A total of 87% of children presented with at least partial ossification of the hard palate after a 2-stage palatoplasty, indicating the potential for spontaneous bone regeneration. Lateral crossbites demonstrated no correlation with palatal ossification ( P = 0.1819), suggesting no detrimental impact of regenerated bone on transverse maxillary growth.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"295-302"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ultrathin Parascapular Flap: Proof of Concept and Use in Plantar Foot Reconstruction.","authors":"John M Felder, Kenan Tawaklna, Abdullah M Said, Suphalerk Lohasammakul, Nirvana B Saraswat, Joon Pio Hong","doi":"10.1097/PRS.0000000000011902","DOIUrl":"10.1097/PRS.0000000000011902","url":null,"abstract":"<p><strong>Summary: </strong>Optimal reconstruction of weight-bearing plantar foot defects is challenging due to the need for relatively thin coverage with simultaneous durability. The medial plantar flap provides an excellent tissue match but is not always available or appropriate. Microsurgical free-flap reconstruction provides many options for coverage. However, few skin flaps are thin enough to contour appropriately but still provide thick dermis for durable weight-bearing, particularly in patients with an average or obese body habitus. The back and buttocks provide the thickest skin in the body, but relatively little attention has been paid to use of these flaps in the foot. The suprascarpal plane of elevation has been increasingly used to provide tailored coverage with appropriate thickness matching to the surrounding tissues. Even thinner \"ultrathin flaps\" are raised within the subcutaneous fat superficial to the Scarpa layer. Little attention has been paid to applying this concept specifically to flaps from the back that provide thicker skin. The scapular and parascapular flaps have many ideal characteristics for foot reconstruction, including minimal donor-site morbidity, simple pedicle dissection, short pedicle for appropriate reach to nearby recipient vessels, and thick skin for durable weight-bearing. However, thus far, these flaps seem to have been overlooked as candidates for suprascarpal or ultrathin elevation to provide a thin flap with thick skin coverage for plantar foot reconstruction. In this article, the authors present a case series exemplifying the utility of the thinned parascapular flap elevated at the ultrathin plane for reconstruction of weight-bearing plantar foot defects.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"305e-309e"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging-Conditional Tissue Expanders in Breast Reconstruction: Clinical Outcomes and Radiation Therapy Implications.","authors":"Mark W Clemens, Melissa P Mitchell, Joani M Christensen, J Bryce Olenczak, Paul L Shay, Philip J Hanwright, Austin Y Ha, Sahil K Kapur, Adam D Melancon, John W Shuck","doi":"10.1097/PRS.0000000000012029","DOIUrl":"10.1097/PRS.0000000000012029","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging-conditional tissue expanders (MRI-CTEs) were developed to address imaging artifacts and challenges in radiation planning associated with traditional tissue expanders (TTEs). This study compared the clinical outcomes and impact of radiation protocols of MRI-CTEs and TTEs in postmastectomy breast reconstruction.</p><p><strong>Methods: </strong>A retrospective review was conducted of immediate breast reconstruction performed with MRI-CTEs or TTEs between 2021 and 2024. Outcomes, such as seroma, infection, malposition, and expander loss, were analyzed.</p><p><strong>Results: </strong>A total of 867 tissue expanders were evaluated in 559 patients. The MRI-CTE cohort consisted of 103 patients (161 devices), and the TTE cohort included 456 patients (706 devices). Demographic characteristics, surgical details, and outcomes did not differ significantly, including seroma ( P = 0.091), malposition ( P = 0.827), and mastectomy skin flap necrosis ( P = 0.251). Three cases (1.9%) in the MRI-CTE cohort required MRI evaluation but did not require explantation. The MRI-CTE group had a lower need for artifact management during radiation therapy and reduced imaging artifact size from 4 cm to 1 cm in diameter. This allowed for a reduction in planning target volume margins from 20 mm to 5 mm, which improved delineation accuracy by 75% and decreased irradiation of healthy tissue by up to 60%.</p><p><strong>Conclusions: </strong>MRI-CTEs may contribute to improved clinical outcomes, with fewer surgical interventions and enhanced precision in radiation treatment planning. MRI-CTEs demonstrated surgical outcomes similar to those for TTEs, but offered improved accuracy in radiation dose calculations. Reduced manual interventions for artifact adjustment decrease the potential for human error, enhancing the overall precision of radiation treatment delivery.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"225-233"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion: Magnetic Resonance Imaging-Conditional Tissue Expanders in Breast Reconstruction: Clinical Outcomes and Radiation Therapy Implications.","authors":"Joseph J Disa","doi":"10.1097/PRS.0000000000012144","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012144","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 2","pages":"234-235"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}