Plastic and reconstructive surgery最新文献

{"title":"Osseous Maxillary Reconstruction with Immediate Dental Implant Placement: An Optimized Workflow for the Oncologic Patient.","authors":"Evan Matros, Leslie N Kim, Luke Poveromo, Thais Polanco, Evan Rosen, Ian Ganly, Jay Boyle, Marc Cohen, Joseph D Randazzo, Farooq Shahzad, Snehal G Patel, Jonas A Nelson, Peter G Cordeiro, Robert J Allen","doi":"10.1097/PRS.0000000000011642","DOIUrl":"10.1097/PRS.0000000000011642","url":null,"abstract":"<p><strong>Background: </strong>Maxillary reconstruction is a complex undertaking characterized by a 3-dimensional surgical site with deficiencies in multiple tissue types. Before virtual surgical planning (VSP), bony reconstruction was inaccurate and inefficient; thus, reconstructions defaulted to soft-tissue flaps or obturators. The current study describes an efficient and accurate approach to bony maxillary reconstruction with immediate dental implant placement (IDIP).</p><p><strong>Methods: </strong>A reconstructive workflow was developed for osseous reconstruction to improve functional and aesthetic outcomes. Critical aspects include VSP, 3-dimensionally printed plates, and IDIP. Review of a prospectively maintained database identified patients who underwent osseous maxillary reconstruction with a fibula flap and immediate dental implants from 2017 to 2022, with a focus on oncologic characteristics and reconstructive outcomes.</p><p><strong>Results: </strong>During the study, 20 patients underwent maxillary reconstruction with VSP and IDIP. One dental implant of 55 failed to osseointegrate, and no flaps were lost. Three patients experienced partial loss of the fibula skin island; 1 required palatal closure with a radial forearm flap, and 2 were managed with outpatient débridement. Fifteen patients achieved either an interim or final retained dental prosthesis. All prostheses achieved acceptable aesthetic results without the instability associated with non-bone-borne devices (eg, dentures/obturators). No patients experienced delays in oncologic treatment.</p><p><strong>Conclusions: </strong>VSP technology has enabled surgeons to replace like with like to achieve better outcomes with acceptable morbidity for maxillary defects. IDIP provides all patients an opportunity for a fixed prosthesis even though not all complete the process. This maxillary reconstruction workflow can be safely accomplished in oncologic patients with promising and effective early results.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"549-560"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634231","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":"Effect of Tourniquet-Related Nerve Ischemia on Response to Handheld Nerve Stimulation in Ulnar Nerve Transposition.","authors":"David M Brogan, Tony Y Lee, Yosita Beamer, Christopher J Dy","doi":"10.1097/PRS.0000000000011699","DOIUrl":"10.1097/PRS.0000000000011699","url":null,"abstract":"<p><strong>Background: </strong>Tourniquet-related nerve ischemia has been well studied in several reconstructive procedures, but the time course of impaired response to intraoperative stimulation is unclear. The present study evaluated ischemic effects on conduction during ulnar nerve transposition and examined the relationship between intraoperative and preoperative diagnostics. The authors hypothesized that intraoperative ischemia would have minimal impact on conduction.</p><p><strong>Methods: </strong>Thirty patients scheduled for anterior transposition were enrolled after preoperative examination, electrodiagnostic testing, and ultrasound. Demographic and symptom severity data were recorded. A handheld biphasic nerve stimulator was used intraoperatively to assess minimum amplitude and pulse duration needed for muscle response. Measurements were taken at 15-minute intervals after placement.</p><p><strong>Results: </strong>Changes in threshold amplitude and pulse duration were calculated between each 15-minute interval; no significant difference was found in the change of either value ( P = 0.70 and P = 0.178). A weak negative correlation existed between preoperative compound muscle action potential amplitudes and average intraoperative pulse duration, which increased to a moderate correlation when compared with 45-minute pulse duration ( r = -0.62; P < 0.01). Preoperative ulnar nerve cross-sectional area demonstrated no significant correlation with average pulse duration but a moderate correlation with pulse duration at 45 minutes ( r = 0.63; P = 0.01).</p><p><strong>Conclusions: </strong>Tourniquet use did not prevent effective intraoperative stimulation of the ulnar nerve for at least 45 minutes. The window for meaningful stimulation with tourniquet use appears to be greater than previously thought. Preoperative nerve compound muscle action potential amplitude and cross-sectional area does appear to influence pulse duration required after 45 minutes of ischemia, suggesting that injured nerves are more susceptible to ischemia.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"505-512"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110866","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":"Topical Tranexamic Acid Does Not Reduce Hematoma in Reduction Mammaplasty: A Double-Blind Randomized Controlled Trial.","authors":"Stav Brown, Rod J Rohrich","doi":"10.1097/PRS.0000000000011707","DOIUrl":"10.1097/PRS.0000000000011707","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"643e-644e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110879","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":"Barbie Deformity after Edge Labiaplasty: Classification and Repair Algorithm.","authors":"Zenan Xia, Xinran Zhang, Yuanbo Kang, Guojing Chang, Lin Zhu, Xiao Long","doi":"10.1097/PRS.0000000000011720","DOIUrl":"10.1097/PRS.0000000000011720","url":null,"abstract":"<p><strong>Background: </strong>Influenced by the popularity of the \"Barbie\" labia minora shape, edge labiaplasty has become the preferred option among patients and surgeons alike. However, excessive or inappropriate resection of labial free edges may lead to morphologic deformities and dysfunctional symptoms, termed the \"Barbie deformity.\" This study aimed to classify the Barbie deformity and provide a repair algorithm to help surgeons select appropriate surgical methods.</p><p><strong>Methods: </strong>A total of 216 patients with Barbie deformity were classified into 3 groups. Among these, 119 patients underwent repair operations using different methods based on the degree of deformity. The surgical outcomes of 87 patients were assessed by means of follow-up questionnaires. Preoperative and postoperative levels of general psychological distress and self-esteem were compared for 46 patients using standard scales.</p><p><strong>Results: </strong>Barbie deformity was identified on 338 sides: 158 were grade I, 106 were grade II, 74 were grade III, and 187 had vestibular mucosa exposure. Repair operations were performed on 189 sides: 53 by means of edge trimming, 99 by means of wedge excision, 32 with an island clitoral hood flap, and 5 with the Gress composite method. The complication rate was 4.8%. Genital appearance was improved in 96.6%, preoperative discomfort was resolved or significantly reduced in 74.2%, and overall satisfaction was 86.2%. The general psychological distress and self-esteem scores also improved significantly after surgery.</p><p><strong>Conclusions: </strong>The goals of repairing the Barbie deformity are to improve the appearance of the genitals and restore the position and function of the mucosa. Preventing Barbie deformity is much more important than repairing it.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"479-489"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126299","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":"Long-Term Outcomes of 1989 Immediate Implant-Based Breast Reconstructions: An Analysis of Risk Factors for Failure and Revision Surgery.","authors":"Merel M L Kooijman, Annelotte C M van Bommel, Frederieke H van Duijnhoven, Astrid N Scholten, Carolien H Smorenburg, Leonie A E Woerdeman, Corstiaan C Breugem","doi":"10.1097/PRS.0000000000011744","DOIUrl":"10.1097/PRS.0000000000011744","url":null,"abstract":"<p><strong>Background: </strong>Nipple- or skin-sparing mastectomy and immediate implant-based breast reconstruction (IBR) is potentially associated with long-term unfavorable outcomes, such as revision surgery and reconstruction failure. This large patient cohort study aimed to provide long-term data on the incidence of these outcomes and to identify predictive risk factors.</p><p><strong>Methods: </strong>Between 2012 and 2019, 1989 mastectomies with IBR were performed in 1512 women in the authors' institute. A direct-to-implant method was used in 93% and a 2-staged method with tissue expander in 7%. Logistic regression analysis was used to identify patient- and treatment-related risk factors associated with revision surgery or reconstructive failure.</p><p><strong>Results: </strong>The mean follow-up was 62.2 months. IBR failed in 6.7% of all breasts; thus, a breast was present in 93.3%. Age older than 44 years yielded a 2.6-fold, and radiotherapy, a 1.7-fold increased risk for reconstruction failure. Revision surgery was performed in 60% of all breasts. The mean number of revisions of all IBRs was 1.2 (range, 0 to 8; SD, 1.37). Factors associated with significantly higher rates of revision surgery were age older than 44 years (OR, 1.23), smoking (OR, 1.53), specimen weight greater than 492 g (OR, 1.39), implant volume greater than 422 g (OR, 1.95), and radiotherapy (OR, 1.51). Nipple preservation was protective for both outcomes (OR, 0.71 and 0.42, respectively). Direct-to-implant procedures did not require any surgical revision in 43% of these patients.</p><p><strong>Conclusions: </strong>Despite the necessity of revision surgery in the majority of IBRs, nearly half of the breasts did not require any revision surgery, and long-term reconstruction failure rates are extremely low. Therefore, IBR should be offered to all eligible women undergoing mastectomy, while understanding the risks.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"469e-478e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308330","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":"Has Propranolol Eradicated the Need for Surgery in the Management of Infantile Hemangioma?","authors":"Julien Coulie, Valérie Dekeuleneer, Alexander Gerdom, Mieke Roggen, Anne-Christine Bataille, Stéphane Moniotte, Maude Coyette, An-Katrien De Roo, Laurence M Boon","doi":"10.1097/PRS.0000000000011532","DOIUrl":"10.1097/PRS.0000000000011532","url":null,"abstract":"<p><strong>Background: </strong>The authors assessed the impact of propranolol as the first-line treatment of infantile hemangioma (IH) on the need for surgery in the management of IH.</p><p><strong>Methods: </strong>In this retrospective study, 420 patients with IH referred to a multidisciplinary center between January of 2005 and August of 2014 were included. Clinical data, including sex; age at first consultation and at treatment initiation; location, size, number, aspect, and complications of IH; and type of treatment were collected. Statistical analyses were conducted considering each patient and each tumor independently.</p><p><strong>Results: </strong>A total of 625 IHs (420 patients) were reviewed; 113 patients had more than 1 IH (26.91%). Median age at first consultation was 7 months. Overall, 243 patients were treated (57.86%) using surgery ( n = 128 patients, 141 IHs), propranolol ( n = 79 patients, 89 IHs), corticosteroids ( n = 51 patients, 56 IHs), or laser ( n = 34 patients, 36 IHs). Propranolol was effective in all but 2 infants with IH. Seven of 79 patients (8.86%) initially treated with propranolol still required surgery, in contrast to 18 of 51 patients (35.29%) initially treated with corticosteroids and 103 of 290 patients (35.51%) with no medical treatment. Since the availability of propranolol, patients were less likely to undergo surgery (48 versus 80 patients; P < 0.001). This demonstrated that the use of propranolol reduced the need for surgery ( P < 0.001; OR, 0.177; 95% CI, 0.079 to 0.396).</p><p><strong>Conclusions: </strong>Propranolol dramatically reduced the need for surgery, regarding indications and number of patients. Surgical correction remains important for sequelae management, nonresponders, or strawberry-like IH.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"539-546"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916988","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":"Medial Epicanthoplasty with the Skin-Redraping Technique: Technical Refinements for Predictable Outcomes.","authors":"Chin-Ho Wong, Michael Ku Hung Hsieh","doi":"10.1097/PRS.0000000000011533","DOIUrl":"10.1097/PRS.0000000000011533","url":null,"abstract":"<p><strong>Summary: </strong>The epicanthus is a common feature of Asian eyes. A prominent medial epicanthal fold gives the impression of blunted affect. Medial epicanthoplasty for its removal is commonly requested by Asian patients. This may be performed as an isolated procedure or, more commonly, in combination with upper blepharoplasty. Many conventional medial epicanthoplasty techniques are based on skin flap transposition and excisions, usually variations of the V-Y, W, or Z-plasties. Although these have been variably successful at correcting the epicanthal fold, scarring in the medial canthal and lower eyelid regions is common. This is particularly problematic in Asian patients, who have greater tendencies for hypertrophic scarring and scar hypopigmentation or hyperpigmentation. Recently, the skin redraping method, designed with incisions limited within the margins of the medial canthus and precise and targeted disruption of the underlying fibromuscular tissues, has emerged as the preferred surgical technique for many surgeons in Asia because of its effectiveness and superior aesthetic outcomes. This technique delivers the most inconspicuous incisions and is advantageous because it is effective in eliminating epicanthal folds of various severities. Precise execution of this technique is difficult, given the complex 3-dimensional anatomy of the epicanthus. The authors present a detailed explanation of surgical concepts of the skin redraping epicanthoplasty and provide a step-by-step guide to performing this procedure in a safe and effective manner.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"517e-522e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922865","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":"Facial Symmetry Enhancement and Brain Network Modifications in Facial Palsy Patients after Botulinum Toxin Type A Treatment.","authors":"Hao Ma, Yu-Lu Zhou, Wen-Jin Wang, Gang Chen, Chen-Hao Zhang, Ye-Chen Lu, Wei Wang","doi":"10.1097/PRS.0000000000011689","DOIUrl":"10.1097/PRS.0000000000011689","url":null,"abstract":"<p><strong>Background: </strong>Facial palsy, often resulting from trauma or iatrogenic treatments, leads to significant aesthetic and functional impairment. Surgical interventions, such as masseteric-to-facial nerve transfer combined with static suspension, are frequently recommended to restore facial nerve function and symmetry.</p><p><strong>Methods: </strong>This study examined the impact of botulinum toxin type A (BoNT-A) treatment on the unaffected side with regard to facial symmetry and brain connectivity in patients with severe oral commissure droop from facial nerve damage. Patients were divided into 2 groups: 1 group received BoNT-A injections on the unaffected side, and the other did not.</p><p><strong>Results: </strong>The authors' findings revealed that BoNT-A treatment not only improved facial symmetry but also induced significant modifications in brain functional network connectivity. These modifications extended beyond the sensorimotor network, involving high-level cognitive processes, and exhibited a significant correlation with the degree of facial asymmetry.</p><p><strong>Conclusions: </strong>These results provide valuable insights into the mechanisms underlying the positive effects of BoNT-A intervention on motor recovery and brain plasticity in facial palsy patients. Furthermore, the study emphasizes the importance of a multidisciplinary approach to facial palsy rehabilitation. Understanding these intricate interactions between facial symmetry restoration and brain network adaptations may pave the way for more effective treatments and improved quality of life for individuals dealing with facial palsy.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, II.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"586e-596e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110867","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":"Disparities in Postmastectomy Reconstruction Use among American Indian and Alaska Native Women.","authors":"Lyndsay A Kandi, Tamee E Livermont, Tony L Weaver","doi":"10.1097/PRS.0000000000011730","DOIUrl":"10.1097/PRS.0000000000011730","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"642e-643e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293215","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: Comparing Wise Pattern to Non-Wise Pattern Skin-Sparing Mastectomy: A Critical Evaluation of Patient Demographics and Surgical Outcomes.","authors":"Jay Arthur Jensen","doi":"10.1097/PRS.0000000000011789","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011789","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 3","pages":"432-434"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503334","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}