Plastic and reconstructive surgery最新文献

{"title":"The Tipping Point: Predictors of Implant Flipping in Staged Breast Reconstruction.","authors":"Rami Elmorsi, Archana Babu, Paul L Shay, Jose E Barrera, J Bryce E Olenczak, Mark W Clemens, Rene D Largo, Alexander F Mericli","doi":"10.1097/PRS.0000000000012882","DOIUrl":"10.1097/PRS.0000000000012882","url":null,"abstract":"<p><strong>Background: </strong>Surgeon preferences in implant-based reconstruction have increasingly favored firmer gel implants for their superior stability, reduced gel bleed, and lower capsular contracture rates. However, this has paralleled an increase in 180-degree anteroposterior implant flipping. The authors aimed to identify the patient and implant factors contributing to this complication.</p><p><strong>Methods: </strong>This is a 5-year retrospective cohort study of 343 patients (502 breasts) who underwent expander-to-implant exchange. For each breast, delta (expander fill minus implant volume) and delta-to-expander percentage (relative underfilling or overfilling) were calculated and analyzed by tertiles. Categorical and continuous variables were compared using chi-square or Fisher exact and Wilcoxon rank-sum tests, respectively. Multivariable logistic regression identified predictors of implant flipping.</p><p><strong>Results: </strong>Implant flipping occurred in 21 breasts (4.2%) and was associated with higher body mass index (BMI) (median, 29.6 versus 25.4 kg/m 2 ; P = 0.014), greater expander fill volumes (575 versus 425 mL; P = 0.006), use of high-firmness implants (86% versus 51%; P = 0.006), and smaller implant-to-expander volume ratios (median, -20 versus -65 mL; P = 0.013). On multivariable analysis, independent predictors were BMI (adjusted odds ratio [aOR], 1.1; P = 0.047), high-firmness implants (aOR, 4.41; P = 0.023), and the highest delta-to-expander tertile (aOR, 5.09; P = 0.041).</p><p><strong>Conclusions: </strong>Implant flipping was linked to higher BMI, firmer implants, and greater implant-to-expander volume mismatch, reflecting a looser pocket. Firmer implants may reduce the risk of capsular contracture and gel bleed, but flipping emerges as a potential trade-off. This risk may be reduced through surgical refinements that optimize implant-pocket dynamics. These findings emphasize the importance of individualized planning during expander-to-implant exchange, especially in patients at elevated risk for malposition.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"511-518"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133141","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":"A Novel Single-Stage Pleated Nailbed Flap for Toe Macrodactyly Debulking.","authors":"Martin Van Carlen, Parisa Moori, Pundrique Sharma, Paul McArthur","doi":"10.1097/PRS.0000000000012847","DOIUrl":"10.1097/PRS.0000000000012847","url":null,"abstract":"<p><strong>Summary: </strong>The authors describe a novel single-stage, nailbed-preserving debulking procedure for macrodactyly used in their unit. This simple technique preserves perfusion and venous drainage of the nailbed complex through a subperiosteal dissection and use of a dermal bridge by de-epithelialization of the proximal area, followed by folding the nailbed flap back onto itself in a pleated fashion. Four toes of 3 patients were treated with this technique, and all achieved a shorter, less bulky appearance with nail preservation at 2-year follow-up. The single-stage pleated nailbed flap is a simple and robust method for nail complex preservation in cases of macrodactyly debulking, with good cosmetic results and high patient satisfaction.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"703e-705e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019229","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":"Retrospective and Comprehensive Evaluation of Posttraumatic Enophthalmos after Intraorbital Fat Injection.","authors":"Shiqi Xie, Yimin Wang, Longfei Weng, Qianya Yi, Lu Cheng, Guichuan Chen, Xiaoxia Ren, Meng Liu, Li Ding, Hui Chen","doi":"10.1097/PRS.0000000000012790","DOIUrl":"10.1097/PRS.0000000000012790","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic enophthalmos is characterized by a posteriorly displaced eyeball (enophthalmos), deep superior sulcus (sunken upper eyelid), and bilateral asymmetry. Intraorbital injection of autologous fat has shown potential for correcting enophthalmos, but several limitations remain, such as patient heterogeneity, small sample sizes, nonquantitative assessment methods, and a focus solely on enophthalmos. This study assessed both enophthalmos and sunken upper eyelids in a homogeneous patient group using quantitative methods.</p><p><strong>Methods: </strong>Forty-three sighted eyes with posttraumatic enophthalmos were retrospectively analyzed after fat injection. Enophthalmos was assessed by the bilateral enophthalmos value difference (BEVD), sunken upper eyelid by a structural similarity index measure (SSIM), and satisfaction by a questionnaire. Intraoperative and postoperative complications were recorded.</p><p><strong>Results: </strong>The mean follow-up period was 35.0 ± 15.1 months. The BEVD was significantly improved from 3.8 ± 1.9 mm preoperatively to 1.4 ± 1.2 mm postoperatively ( P < 0.001). No significant correlation was found between fracture type, previous surgery, and BEVD improvement. The SSIM was significantly improved from 0.714 ± 0.119 to 0.803 ± 0.063 ( P = 0.003) in 14 eyes with sunken upper eyelid. The satisfaction rate was 83.7% among patients, parents, friends, and colleagues. No severe complications such as embolism or vision loss occurred.</p><p><strong>Conclusion: </strong>Favorable BEVD, SSIM, and patient satisfaction outcomes following intraorbital autologous fat injection suggest promising applicability in the treatment of posttraumatic enophthalmos and sunken upper eyelids.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"686e-697e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893199","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: Long-Term Outcomes of Microform Cleft Lip Repair with Nasolabial Muscle Tension Line Group Reconstruction: A 19-Year Experience.","authors":"Arshad R Muzaffar","doi":"10.1097/PRS.0000000000012763","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012763","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"158 4","pages":"673e-674e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081592","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":"Exploring Facial Asymmetry Metrics Correlated with Preoperative SCHNOS Scores Using Artificial Intelligence.","authors":"Haoge Huang, Cherian Kurian Kandathil, Lianji Xu, Cherine H Kim, Sarah R Akkina, Sam P Most","doi":"10.1097/PRS.0000000000013031","DOIUrl":"10.1097/PRS.0000000000013031","url":null,"abstract":"<p><strong>Background: </strong>Facial asymmetry is often overlooked in evaluations of nasal function and aesthetics, despite its potential impact on assessments in facial plastic surgery. In this study, artificial intelligence tools were used to identify facial asymmetry metrics that correlate with both nasal function and aesthetic measures evaluated by preoperative Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scores.</p><p><strong>Methods: </strong>Two facial landmark detection models were applied to frontal plain facial images of 1523 patients to extract 506 fiducial points. From these, more than 64 million facial elements were computed, including point-to-point and point-to-line distances. Asymmetry indices were calculated based on each element with its mirrored counterpart. Spearman correlation coefficients were used to assess associations between these asymmetry metrics and 13 outcome scores.</p><p><strong>Results: </strong>Facial elements correlated with SCHNOS-nasal obstruction demonstrated modest but statistically significant Spearman correlations (0.185 to 0.224; P < 10 -11 ), particularly those capturing vertical facial height differences relative to a horizontal reference line between the nasal tip and ear base. No meaningful correlations were observed with SCHNOS-nasal cosmesis scores.</p><p><strong>Conclusions: </strong>These findings suggest that vertical midfacial asymmetry may affect nasal function, whereas facial asymmetry has minimal influence on patients' perception of nasal aesthetics. The study also underscores the potential of artificial intelligence-based facial analysis as a valuable tool in rhinoplasty evaluation.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"576-585"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147459259","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":"Reconstructing Dorsal Hand Defects Using the Distally Based Subcutaneous Perforator Fascia Flap Harvested through Small Incisions.","authors":"Jingqiao Li, Wenzhu Zhang, Lihua Zhang, Yadong Yu, Xu Zhang, Xiaoliang Yang","doi":"10.1097/PRS.0000000000012720","DOIUrl":"10.1097/PRS.0000000000012720","url":null,"abstract":"<p><strong>Background: </strong>The authors describe reconstructing dorsal hand defects using the distally based subcutaneous perforator fascia flap harvested through small incisions.</p><p><strong>Methods: </strong>From January of 2019 through May of 2023, dorsal hand defects were reconstructed with the fascia flap, using loupes and headlights or arthroscopes. At the final follow-up, scars at the donor and recipient sites were assessed using the Scar Cosmesis Assessment and Rating scale.</p><p><strong>Results: </strong>This series included 16 patients (16 hands). There were 14 male and 2 female patients. The mean defect size was 6.8 × 5 cm (range, 5.6 × 6.4 cm to 9.1 × 5.3 cm). The mean flap size was 8.3 × 6.3 cm (range, 7 × 5.1 cm to 10.2 × 6.8 cm). The mean follow-up period was 32 months (range, 24 to 60 months). The mean pedicle length was 6 cm (range, 4 to 7 cm). All fascia flaps and skin grafts survived. At the final follow-up, the mean scar quality of the recipient site and skin over the donor site was rated as 2 (range, 1 to 3) and 3 (range, 2 to 4), respectively, based on the Scar Cosmesis Assessment and Rating scale.</p><p><strong>Conclusions: </strong>The distally based subcutaneous perforator fascia flap is reliable for reconstructing dorsal hand defects, avoiding scar formation at the donor site. Loupes and headlights are more helpful than arthroscopes in fascia flap transfer.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"645e-653e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763681","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":"Unemployed Burn Survivors Experience Significantly Worse Long-Term Psychosocial and Functional Outcomes: A Burn Model System Study.","authors":"Artur Manasyan, Ayumi Saito, Deborah Choe, Andrew Humbert, Kimberly Roaten, Karin Blen, Jeffrey C Schneider, Juan Herrera-Escobar, Haig A Yenikomshian","doi":"10.1097/PRS.0000000000012792","DOIUrl":"10.1097/PRS.0000000000012792","url":null,"abstract":"<p><strong>Background: </strong>The impact of preinjury employment status on patient-reported outcomes after injury is not well described. This study compared psychosocial and functional domains between adults who were employed or unemployed before sustaining a burn injury to examine the association of employment status with long-term outcomes.</p><p><strong>Methods: </strong>Adult participants enrolled in the Burn Model System national, multicenter database between 2013 and 2023 were included. Associations between preburn employment status and long-term outcome scores were analyzed using mixed-effects models while adjusting for sex, age, total body surface area burn size, presence of the COVID-19 pandemic, and time after injury.</p><p><strong>Results: </strong>A total of 814 participants were included, 635 of whom were employed and 179 of whom were unemployed before the burn injury. The unemployed group reported significantly worse pain interference t scores (3.02, 6.04; P < 0.001), anxiety t scores (1.38, 4.56; P < 0.001), depression t scores (1.45, 4.59; P < 0.001), fatigue t scores (1.29, 4.79; P = 0.001), ability to participate in social roles t scores (-5.91, -2.69; P < 0.001), physical function t scores (-6.47, -3.59; P < 0.001), Community Integration Questionnaire total scores (-1.50, -0.80; P < 0.001), posttraumatic stress disorder total scores (0.80, 5.62; P < 0.01), and satisfaction with life total scores (-4.12, -1.80; P < 0.001) after adjusting for sex, age, burn size, presence of the COVID-19 pandemic, and time after injury.</p><p><strong>Conclusion: </strong>Employment status may be an important social factor to consider when identifying adult burn survivors who may benefit from greater psychological, vocational, and social resources to optimize long-term recovery and quality of life.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"675-682"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Definition Magnetic Resonance Imaging of Nasal Tip Ligaments Illustrates Rationale for Ligamentous Preservation.","authors":"J Andres Hernandez, Wyatt Austin, Nicholas C Oleck, Hani I Naga, David M Stepien, G Allan Johnson, Jeffrey R Marcus","doi":"10.1097/PRS.0000000000012623","DOIUrl":"10.1097/PRS.0000000000012623","url":null,"abstract":"<p><strong>Background: </strong>Although preservation rhinoplasty was described many years ago, it has recently been brought to the forefront of the field. Skin and soft-tissue envelope preservation is of particular interest as it may prevent disassembly and reconstruction of the nasal tip. Ligamentous anatomy of the nasal tip has previously been described only through gross dissection, which is limited. The authors used high-definition magnetic resonance imaging (MRI) to provide a more complete anatomic description of the nasal tip ligamentous anatomy and applied this knowledge through their tip ligament preservation and suspension technique.</p><p><strong>Methods: </strong>Nasal specimens were harvested from cadavers and processed through a fixation and contrast protocol. Imaging of specimens was completed in a high-definition (55 µm) small-animal MRI scanner. Image analysis focused on identification of the origins, insertions, and courses of nasal tip ligaments. The group's tip ligament preservation technique was described.</p><p><strong>Results: </strong>The cartilaginous (septum and lower lateral cartilages) and ligamentous (interdomal, intercrural, and Pitanguy) structures of the nasal tip were identified. The origins, insertions, and courses of these ligaments were analyzed and described further. Segmentation of nasal tip structures was completed to create a 3-dimensional model for further study.</p><p><strong>Conclusions: </strong>This is the first study to use high-definition MRI to define the nasal tip support ligaments. A 3-dimensional model was created to better understand structural relationships. Through anatomic analysis and technique description, surgeons will be better equipped to use skin and soft-tissue envelope preservation techniques of the nasal tip.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"565-574"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434502","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":"Impact of Ultrasound-Guided Corticosteroid Injections on Intervention-Free Survival for de Quervain Tenosynovitis.","authors":"Joshua K Kim, Warren C Hammert, Suhail K Mithani","doi":"10.1097/PRS.0000000000012808","DOIUrl":"10.1097/PRS.0000000000012808","url":null,"abstract":"<p><strong>Background: </strong>De Quervain tenosynovitis is a common cause of radial wrist pain, with corticosteroid injections providing excellent relief. Ultrasound guidance may improve anatomic accuracy and symptom resolution. This study investigates the benefits of ultrasound guidance and its effects on reintervention-free survival time.</p><p><strong>Methods: </strong>Patients with de Quervain tenosynovitis receiving at least one corticosteroid injection at a single academic institution between 2014 and 2025 were included. Patients undergoing traditional and ultrasound-guided injections were propensity score matched. Primary events were repeat injections or operative release. Time to primary event was analyzed with the Kaplan-Meier product-limit method. Cox proportional hazards regression discerned the effects of ultrasound guidance while accounting for demographic characteristics and comorbidities.</p><p><strong>Results: </strong>Ninety-nine hands received an ultrasound-guided corticosteroid injection, matched to 297 hands undergoing traditional injections. After a single ultrasound-guided injection, 77.8% of cases did not require further intervention; 22.2% of patients underwent reintervention at a median of 205.5 days. The estimated incidence of freedom from reintervention was 98% at 6 weeks, 95% at 3 months, and 85% at 6 months. A subgroup analysis excluding injections performed by fellowship-trained hand surgeons did not demonstrate benefits in reintervention rates with ultrasound guidance.</p><p><strong>Conclusions: </strong>Corticosteroid injections elicited excellent responses in patients. Ultrasound guidance was not associated with reduced intervention rates or longer times between reinterventions, even among injections administered by providers lacking formal hand surgery fellowship training. Both traditional and ultrasound-guided corticosteroid injections offer significant symptom relief and reduce the likelihood of further intervention.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"623-629"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960069","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 Hamdi's Algorithm for Optimal Patient Selection for Vertical Scar Mammaplasty: A Single-Surgeon Experience.","authors":"Moustapha Hamdi, Laure Ledegen, Ayush Kapila","doi":"10.1097/PRS.0000000000012781","DOIUrl":"10.1097/PRS.0000000000012781","url":null,"abstract":"<p><strong>Background: </strong>Vertical scar mammaplasty can minimize scarring while maintaining an uncompromised aesthetic outcome, but it may result in high revision rates. In 2005, Hamdi's algorithm was introduced by the senior author (M.H.) to better define candidates for vertical scar mammaplasty. This study validates the effectiveness of Hamdi's algorithm over a 13-year period.</p><p><strong>Methods: </strong>A cohort study of consecutive breast reductions performed by a single surgeon since 2010 was conducted. Primary bilateral cases as mandated by the health care reimbursement system criteria were included. Hamdi's algorithm was based on patient age, sternal notch-to-nipple distance, and skin quality. Data on demographic characteristics, surgical details, and outcomes were collected. Patients were grouped into vertical scar mammaplasty and inverted-T procedures for comparison.</p><p><strong>Results: </strong>A total of 159 patients with complete follow-up data were included: 73 underwent vertical scar mammaplasty and 86 had inverted-T procedures, with an average follow-up of 38.8 months. Patients in the inverted-T group were significantly older and had a greater sternal notch-to-nipple distance with larger average gland reduction (680 g) compared with after vertical scar mammaplasty (450 g) ( P = 002). The inverted-T group had a significantly higher infection rate. The late scar revision rate was similar in both groups (6.3%). There were no other significant differences.</p><p><strong>Conclusions: </strong>This study demonstrates that, when guided by Hamdi's algorithm, vertical scar mammaplasty can be safely performed in appropriately selected patients without increasing the risk of complications or secondary corrections. It offers a comparable safety profile to the inverted-T technique while reducing scar burden.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"587e-597e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843958","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}