Plastic and reconstructive surgery最新文献

{"title":"Blunt dissection of the axillary flap through double mini-incisions on both sides of the axilla to prevent postoperative hematoma.","authors":"Zhihua Yao,Jifeng Zhu,Min Peng,Benxu Lei,Min Li,Jie Yang,Jinyu Tang,Dongfang Chang","doi":"10.1097/prs.0000000000011731","DOIUrl":"https://doi.org/10.1097/prs.0000000000011731","url":null,"abstract":"OBJECTIVESThe purpose of this study was to investigate the clinical effect of treating axillary osmidrosis by trimming the apocrine glands under direct vision after blunt dissection of the axillary flap through double mini-incisions on both sides of the axilla to prevent postoperative hematoma.METHODSThe clinical data of 108 patients with axillary osmidrosis were retrospectively analyzed. Treatment involved blunt dissection of the axillary flap through double mini-incisions and trimming of the apocrine glands under direct vision. The surgical duration, hematoma incidence, flap necrosis rate, incision healing rate, incision VSS score, comfort level, axillary odor cure rate, and satisfaction rating were all statistically analyzed.RESULTSThe average surgical duration was 72.45±5.71 min. The cure rate of axillary osmidrosis was 100%. Postoperative complications, including delayed incision healing 12 days after surgery (1 patient), a small hematoma (2 patients), and local flap necrosis (1 patient), were minor. No infection, malodor, or recurrence was observed. The VAS score for patient comfort was 8.53±0.89, the VAS score for patient satisfaction was 8.87±0.98, and the VSS score for the incision was 0.84±0.99.CONCLUSIONThis retrospective study demonstrated that the trimming of apocrine glands after blunt dissection of the axillary flap through double mini-incisions on both sides of the axilla effectively controlled bleeding. This approach significantly reduces the complication rate of axillary osmidrosis surgery and ensures the complete trimming of apocrine glands, eradicating axillary odor and maintaining a good appearance.","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255860","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":"Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity.","authors":"Sarah A Layon,Kristina Marsack,Matthew J Parham,Heather R Burns,Larry H Hollier","doi":"10.1097/prs.0000000000011726","DOIUrl":"https://doi.org/10.1097/prs.0000000000011726","url":null,"abstract":"INTRODUCTIONAdvanced practice providers (APPs) are integral to nonsurgical and surgical fields. In surgical settings, APPs work autonomously alongside surgeons to enhance continuity of care. While small-scale studies across various surgical specialties have explored APP utilization, literature specific to the pediatric population is limited. This study assesses the impact of increased APP utilization on productivity within one of the largest pediatric surgery departments in the United States.METHODSData was sourced from the Surgery Department Executive Committee (SDEC) annual reports. Descriptive analyses were performed to delineate trends in clinical volumes, OR cases, gross charges, work relative value units (wRVUs), and provider full-time equivalents (FTEs) between October 2011 and September 2023. Secondary analyses were performed from 2016 to 2023, after APP roles were refined in each division.RESULTSSince 2012, an upward trend is observed in total clinic visits, total OR cases, and OR cases per MD. In 2016, APPs saw 1 clinic patient for every 2.2 seen by MDs, decreasing to a 1:1 ratio by 2023. The MD surgical conversion rate has increased by 20.5% since 2016, while the conversion rate per total clinic volume has decreased by 7.3% over the same period. Total wRVUs and gross charges increased across the department and per provider, despite fewer overall providers since 2021.CONCLUSIONIncreased utilization of APPs within the department of surgery may enhance procedural productivity for surgeons while ensuring continued patient access to care. This study highlights the importance of developing care models that optimize the full skillset of APPs.","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255863","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":"Embracing AI-Assisted Machine Translation to Broaden Citations in Journal Articles.","authors":"James C Yuen","doi":"10.1097/PRS.0000000000011719","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011719","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126300","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":"Effectiveness of Core Excision Technique for Keloids: A Systematic Review.","authors":"Xiaoye Ran,Xiaoshuang Guo,Yuanbo Liu,Shan Zhu,Shanshan Li,Zixiang Chen,Tinglu Han,Shengyang Jin,Mengqi Zhou,Mengqing Zang","doi":"10.1097/prs.0000000000011733","DOIUrl":"https://doi.org/10.1097/prs.0000000000011733","url":null,"abstract":"BACKGROUNDThe keloid core excision technique mitigates the risk of wound tension and promotes favorable morphological outcomes. However, whether residual keloid tissue or other factors increase the risk of recurrence remains unclear. This systematic review aimed to evaluate the therapeutic outcomes of core excision techniques for keloids.METHODSA systematic literature review was conducted by searching PubMed, Embase, Web of Science Core Collection, and Cochrane Library databases on July 30, 2023. The search terms employed were \"keloid,\" \"core excision,\" \"intralesional excision,\" \"intramarginal excision,\" \"rind flap,\" and \"fillet flap.\" The inclusion criteria for the studies were established in advance and evaluated by multiple investigators.RESULTSOverall, 20 studies involving 926 keloid cases managed through core excision were included. Adjuvant therapies were used in 19 studies, with radiotherapies and steroid injections emerging as the predominant methods. The recurrence rates ranged from 0% to 28.6%. Residual scar tissue after core excision and complications, such as flap necrosis and hematoma, are the major factors contributing to recurrence.CONCLUSIONThe core excision technique is a surgical treatment of keloids with a low recurrence rate when combined with adjuvant therapies. However, randomized controlled trials and conclusive quantitative studies are necessary to further investigate the effects of the core excision technique on keloids.","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255862","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 \"Barbie\" shape of labia minora, edge labiaplasty has become the preferred option among patients and surgeons alike. However, excessive or inappropriate resection of labial free edges may lead to morphological deformities and dysfunctional symptoms termed as \"Barbie deformity\". This study aims to report a classification of Barbie deformity and 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 degrees. Among these, 119 patients underwent repair surgeries by different methods corresponding to the degree of deformity. The surgical outcomes of 87 patients were assessed via 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 surgeries were performed on 189 sides: 53 via edge trimming, 99 via wedge excision, 32 with an island clitoral hood flap, and 5 with Gress's 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>Conclusion: </strong>The goal of repairing Barbie deformity is not only to improve the appearance of the genitals but to also restore the position and function of the mucosa. Preventing Barbie deformity is much more important than repairing it.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","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":"\"Disparities in Post-Mastectomy 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":"https://doi.org/10.1097/PRS.0000000000011730","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","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":"Reconstructing Failure: Assessing Surgical and Patient Reported Outcomes Following Loss of Initial Breast Reconstruction.","authors":"Minji Kim, Nima Khavanin, Charles Z Jiang, Joshua M Barnett, Lillian A Boe, Robert J Allen, Carrie S Stern, Babak J Mehrara, Jonas A Nelson","doi":"10.1097/PRS.0000000000011717","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011717","url":null,"abstract":"<p><strong>Background: </strong>Breast reconstruction failure, defined as the removal of a prosthetic device or flap without immediate replacement, can be traumatic for patients. We aim to describe the progression of patients who experience tissue expander (TE), implant, or autologous breast reconstructive failure and assess the patient reported outcomes (PROs) among patients who undergo additional reconstruction.</p><p><strong>Method: </strong>Patients undergoing TE, implant, or autologous breast reconstruction between 2017 and 2022 were included, and patients with reconstructive failures were identified. Outcomes of interests included (1) receipt of additional reconstruction and (2) BREAST-Q scores 1-year after reconstructive failure. We also performed a propensity-matched analysis between patients who undergo secondary reconstruction and patients who had an uncomplicated reconstruction.</p><p><strong>Results: </strong>4,258 TE, 4,420 implant, and 1,545 autologous breast reconstruction patients were included. Of patients who experienced reconstructive failures, 49.5% of TE, 4.8% of implant, and 53.8% of autologous patients underwent secondary reconstruction. Age, psychiatric diagnosis, chemotherapy, radiation, and mastectomy type were associated with increased likelihood of secondary reconstruction. Between patients with and without additional reconstruction, higher Psychosocial Well-being trended towards the former cohort (61 [Interquartile Range: 56, 80] vs 50 [46, 65], p=0.085). Propensity-matched analysis demonstrated comparable PROs at 1-year after definite reconstruction.</p><p><strong>Conclusion: </strong>Less than half of reconstructive failure patients undergo an additional reconstruction. Patients with secondary reconstruction may have improved Psychosocial Well-being than those who do not and comparable PROs to those who had uncomplicated initial reconstruction. Surgeons should counsel patients with reconstructive failures that although traumatizing, secondary reconstruction may be beneficial.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126301","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":"Contemporary Management of Distal Radius Fractures: What All Plastic Surgeons Should Know.","authors":"Rachel C Hooper, Steven C Haase, Suhail K Mithani, Michelle Palazzo, Kevin C Chung","doi":"10.1097/PRS.0000000000011715","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011715","url":null,"abstract":"<p><strong>Summary: </strong>Distal radius fractures are extremely common. Plastic surgery trainees and practicing surgeons who encounter these patients should be familiar with the various treatment options. Although the volar locking plate has revolutionized treatment of these fractures, we believe it is important to highlight the anatomy, diagnosis, and contemporary management of specific fracture patterns that may require techniques beyond volar plating.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140801","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":"\"Craniometric and Volumetric Analyses of Normocephalic and Scaphocephalic Patients with Nonsyndromic Single-Suture Sagittal Craniosynostosis\".","authors":"Alexander Velazquez, Michael S Lebhar, Johnny Yang, Martin McCandless, David Pitre, Mason Shiflett, Kristen Weaver, Todd Nichols, Ian C Hoppe, Laura S Humphries","doi":"10.1097/PRS.0000000000011712","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011712","url":null,"abstract":"<p><strong>Purpose: </strong>Non-syndromic single-suture sagittal craniosynostosis presentation spans scaphocephalic and normocephalic head shapes. Herein, we studied craniometric differences between scaphocephalic and normocephalic patients with sagittal synostosis.</p><p><strong>Methods: </strong>Head CT scans of 20 scaphocephalic and 20 normocephalic sagittal synostosis patients and their age- and sex-matched controls were analyzed, including cranial base angles, distances-from-midline, and intracranial volumes.</p><p><strong>Results: </strong>Cranial index was significantly decreased in index groups compared to controls (p<0.001, respectively). Right external acoustic meatus angle (EAMA) was significantly larger in scaphocephalic (p<0.001) and left EAMA was significantly smaller in normocephalic patients (p=0.002) when compared with controls. Midline angular analysis showed that bifrontal angle was significantly smaller amongst scaphocephalic patients versus controls (p=0.026). Cranial base distances-from-midline were longer to the right and left internal acoustic meatus and shorter to the euryon-to-zygomaticofrontal suture for both groups of cases than their controls (p<0.05). Scaphocephalic patients had a larger anterior cranial volume ratio (18% vs 13%, p<0.001) and normocephalic patients had a larger posterior volume ratio (42% vs 33%, p<0.001) than controls. Scaphocephalic patients had larger anterior volume ratios than normocephalic patients (1.66 vs 1.16, p=0.025, but smaller posterior compartment volume ratios (0.90 vs 1.53, p<0.001).</p><p><strong>Conclusion: </strong>There are rightward asymmetries of the linear and angle cranial base measurements in both index groups. Intracranial volume distribution lies anteriorly in scaphocephalic patients but posteriorly in normocephalic patients. These data show craniometric evidence that although normocephalic and scaphocephalic patients share the diagnosis of \"sagittal synostosis,\" they are morphometrically different than each other and controls.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140800","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 Quantitative Evaluation of the Effects of Radiation Therapy on the Post-Surgical Breast.","authors":"Miriam Becker,McKay Reese,Andrea Yessaillian,Kelli Lopes,Cyril Harfouche,Garrison Leach,Sarah Blair,Catheryn Yashar,Haydee Ojeda-Fournier,Chris M Reid","doi":"10.1097/prs.0000000000011732","DOIUrl":"https://doi.org/10.1097/prs.0000000000011732","url":null,"abstract":"BACKGROUNDRadiation (RT) effects on breast volume may impact breast-conserving therapy (BCT) outcomes, but quantitative information is lacking regarding the extent/timing of volume loss. This study aimed to quantify volume loss by assessing changes in irradiated breasts.METHODSBreast volume changes were calculated for 113 patients (115 breasts) following T1 tumor lumpectomies. From preoperative baseline to seven years post-radiation, volumes were calculated from mammograms using π/3* height*radius2. Paired t-tests assessed change over time, with subset analyses of tumor/breast volumes of ≤ 10% (n=67) and > 10% (n=48). Multivariable regression assessed volume change as a function of age, smoking history, diabetes, radiation dosage, fractions, technique, treatment length, boost dose, chemotherapy (hormonal or cytotoxic), baseline breast volume, and time since treatment.RESULTSPatients lost 8.3% of breast volume during surgery. One year following BCT/RT, volume loss was 19.3%. By year five, total volume loss was 26.6%.Subset analyses demonstrated that in addition to lumpectomy defects, five-year volume loss was 21.7% for tumor/ breast volume > 10% and 29.5 % for tumor/ breast volume ≤ 10%. Volume loss between subgroups was not significantly different (p=0.37). Larger breast volume was a significant predictor of greater volume loss for all five years (p<0.001), followed by diabetes and smoking history.CONCLUSIONPatients with T1 tumors undergoing BCT/RT may lose approximately 20% of breast volume (beyond specimens) within a year, with continued loss for five years. Volume change did not differ significantly according to baseline breast volume, although larger breasts may experience comparatively larger volume changes.","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255864","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}