Plastic and reconstructive surgery最新文献

{"title":"\"Precision planning for tissue expansion: A three-dimensional scanning-based predictive model to guide surgical timing\".","authors":"Yujui Lai, Xing Huang, Peiyi Li, Yinghong Zhai, Mengling Chang, Shengzhou Shan, Feixue Ding, Xusong Luo","doi":"10.1097/PRS.0000000000013496","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013496","url":null,"abstract":"<p><p>Tissue expansion remains an essential reconstructive technique, yet the timing of expander removal is still largely determined by subjective clinical judgment. We developed a three-dimensional (3D) scanning-based quantitative workflow to objectively monitor expansion progress and provide a practical reference for surgical timing. In this study, serial 3D scans obtained throughout the expansion course were used to evaluate the relationship between the cumulative injected volume and incremental expansion area relative to baseline in a development cohort of 30 patients with congenital melanocytic nevi. Preliminary validation was performed in a temporally separate, independent cohort of 12 additional patients enrolled after model finalization; this cohort was not involved in model development and was not a held-out subset of the original dataset. The volume-area relationship followed a hyperbolic saturation-type pattern, with more rapid surface-area gain during the early phase of expansion and gradual approach to a plateau later in the course. Actual and predicted values showed good agreement in the validation cohort. Thus, this approach may help surgeons more objectively assess expansion progress, determine whether additional inflation is likely to yield clinically meaningful surface-area gain, and guide expander removal and second-stage reconstruction. It is intended to complement, rather than replace, surgical judgment.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183746","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":"Lymphatic Wire-Guided Identification of Proximal Collecting Lymphatic Vessels in Advanced Lower Extremity Lymphedema.","authors":"Yushi Suzuki, Hiroki Kajita, Marika Otaki, Hayato Nagashima, Nobuaki Imanishi, Kazuo Kishi","doi":"10.1097/PRS.0000000000013495","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013495","url":null,"abstract":"<p><p>In advanced lower-limb lymphedema, identifying functional lymphatic vessels suitable for lymphaticovenular anastomosis (LVA) has become increasingly complex because of vessel degeneration and depth. This study introduces the use of a novel intraluminal guidewire system (LymTracer) to identify functional collecting lymphatic vessels in patients with advanced lymphedema. Between December 2022 and December 2024, 21 patients with advanced secondary lower limb lymphedema underwent LVA. All patients had limited ICG-detectable lymphatic vessels in the distal lower legs. The LymTracer was inserted into the functional lymphatic system at the distal site and advanced proximally under fluoroscopy. If the wire advanced ≥10 cm proximally, an additional incision was made for a second LVA. The wire advanced proximally in 11 of 21 patients, allowing identification and anastomosis of previously unvisualized proximal lymphatic vessels. The LymTracer advanced an average of 11.3 ± 10.0 cm. These vessels were significantly deeper (13.2 ± 3.7 mm vs. 6.2 ± 2.2 mm, p = 0.00009) but similar in diameter. Bioimpedance showed greater water reduction in the additional group (13.0 ± 8.8% vs. 3.0 ± 9.0%, p = 0.03). In our cohort, LymTracer enabled proximal anastomosis in approximately half of advanced cases and was associated with greater limb water reduction. This technique demonstrates the feasibility of using LymTracer as an intraoperative adjunct to identify proximal collecting lymphatics beyond regions of dermal backflow. LymTracer may provide an additional option for surgical planning in advanced lymphedema when conventional imaging fails to identify suitable proximal lymphatic vessels.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183868","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 O-to-T Flap for Scalp Reconstruction: Expanding the Local Flap Algorithm.","authors":"Kiyah L Anderson, Francisco Batiz-Fabela, Waleed H Ezzat, Jorge Lujan-Hernandez","doi":"10.1097/PRS.0000000000013517","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013517","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183897","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":"Diagnostic Accuracy of Ultrasound for Localizing Lymphovenous Anastomosis Sites in Lymphedema Surgery.","authors":"Florian J Jaklin, Maxim L Oberreiter, Wolfgang J Weninger, Chieh-Han J Tzou, Stefan Meng","doi":"10.1097/PRS.0000000000013510","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013510","url":null,"abstract":"<p><strong>Background: </strong>Preoperative vessel mapping is critical for successful lymphovenous anastomosis (LVA) in supermicrosurgical lymphedema treatment. Indocyanine green lymphography is common but limited by poor depth penetration and reduced visibility in advanced disease. This study aimed to evaluate the diagnostic accuracy, measurement agreement with intraoperative findings, and procedural efficiency of preoperative ultrasound in identifying surgically compatible LVA sites.</p><p><strong>Methods: </strong>This study retrospectively analyzed prospectively collected data between April 2019 and January 2024 at a secondary care center. Consecutive patients with scintigraphically confirmed limb lymphedema underwent preoperative ultrasound to localize LVA sites, with intraoperative findings as the reference standard. Diagnostic accuracy was assessed using positive predictive value (PPV), Bland-Altman analysis, multivariable logistic regression, and subgroup testing.</p><p><strong>Results: </strong>Eighty-seven patients (mean age, 55.8 ± 12.8 years; 75 women) underwent 109 ultrasound examinations. Of 470 ultrasound-localized sites, 285 were selected for surgery; 272 were intraoperatively confirmed (PPV, 95.4%; 95% CI: 92.3, 97.5%). The 13 false positives were independent of tissue thickness, vessel size, depth, and distance (all p > 0.17). Ultrasound diameters showed minimal bias compared with intraoperative measurements [+0.13 mm (95% CI: 0.09, 0.17) for lymphatics; -0.10 mm (95% CI: -0.17, -0.04) for veins]. Mean total examination time was 34.7 ± 9.6 minutes; per-image analysis averaged 7.2 ± 2.3 minutes and was unrelated to diagnostic accuracy (p = 0.74).</p><p><strong>Conclusions: </strong>Preoperative ultrasound enabled accurate, reproducible localization of LVA sites with strong anatomical agreement and consistent performance across participant and anatomical variables.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196252","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":"Optimizing Concentrated Growth Factor Therapy: Sodium Citrate Reduces Pain in Hair Loss Treatment.","authors":"Wenxing Pan, Xinyi Chen, Haoyang Li, Zechen Miao, Yong Miao, Yuhui Hou, Zhiqi Hu, Huahua Li, Junfei Huang","doi":"10.1097/PRS.0000000000013514","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013514","url":null,"abstract":"<p><strong>Background: </strong>Androgenetic alopecia (AGA) is a prevalent condition causing significant psychosocial distress. While concentrated growth factor (CGF) therapy has emerged as a promising regenerative treatment, the choice of anticoagulant remains a critical but underexplored variable that may affect the growth factor release, and patient experience.</p><p><strong>Objective: </strong>To compare the efficacy, procedural pain, and patient satisfaction of CGF prepared with sodium citrate, heparin sodium, or no anticoagulant in patients with AGA.</p><p><strong>Methods: </strong>This phase 2, multicenter, single-blind, randomized controlled trial enrolled 267 patients aged 18 to 50 years across three tertiary hospitals in China. Participants were randomized 1:1:1 to receive CGF prepared without anticoagulant (Group A), with 3.2% sodium citrate (Group B), or with heparin sodium (Group C). All patients underwent five intradermal injection sessions over 12 months. Primary endpoints included injection-related pain (VAS) and changes in hair density at 3, 6, and 12 months.</p><p><strong>Results: </strong>Injection pain was significantly lower in Group B (P < 0.001). At 6 and 12 months, Group B demonstrated significantly greater hair density increases and higher rates of ≥50% subjective clinical improvement (P < 0.001). In vitro analysis confirmed that sodium citrate best preserved growth factor levels and platelet function. Overall satisfaction and willingness for re-treatment were highest in Group B (87.6%).</p><p><strong>Conclusions: </strong>Sodium citrate provided the most favorable balance of procedural tolerability, delivery reliability, and clinical efficacy. These findings support sodium citrate as the preferred anticoagulant for CGF preparation in AGA, while confirmation in broader populations and phase 3 trials is warranted.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183829","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":"Association of Neoadjuvant Versus Adjuvant Chemotherapy on Pre-Pectoral Tissue Expander Based Reconstruction Outcomes Following Mastectomy.","authors":"Justin M Dang, Nisha Gupta, Tahera Alnaseri, Maral Demirjian, Lorna Kwan, Mediget Teshome, Michael DeLong","doi":"10.1097/PRS.0000000000013520","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013520","url":null,"abstract":"<p><strong>Background: </strong>Prepectoral implant-based reconstruction has reemerged as a preferred technique for breast reconstruction after mastectomy, but introduces risks of prothesis infection. With increasing reliance on neoadjuvant chemotherapy (NACT), which can modulate the immune system and induce leukopenia, it is unclear how NACT impacts surgical outcomes in prepectoral reconstruction patients. This retrospective review aims to investigate the impact of NACT and leukopenia on complication rates in patients undergoing immediate pre-pectoral TE-based breast reconstruction compared to adjuvant chemotherapy or no chemotherapy.</p><p><strong>Methods: </strong>A single-center retrospective review evaluated surgical outcomes in all two-stage immediate prepectoral breast reconstruction patients between January 2018 and September 2022. Patients were stratified by treatment type (NACT, ACT, or none) and the presence of leukopenia was delineated. Complication rates between groups were analyzed with univariate comparisons and a multivariate mixed effects logistic regression was run for major complications.</p><p><strong>Results: </strong>Of the 295 patients analyzed, those with NACT experienced fewer major complications compared to the ACT or no chemotherapy cohorts (14.1% vs 41.8% vs 28.5%, p = 0.0012) following TE placement. There were no significant differences in individual complications or outcomes following implant exchange. Patients with perioperative leukopenia experienced lower major infections rates, but higher hematoma rates following TE placement (p<0.05). Following implant exchange, they experienced lower explantation rates but higher reoperation and skin necrosis rates (p<0.05).</p><p><strong>Conclusion: </strong>This study demonstrates that ACT is associated with higher risks of major complications after prepectoral tissue expander placement in our cohort, but that NACT and perioperative leukopenia were not predictors of complications compared to no chemotherapy.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183837","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":"Evaluating the Evidence of Nerve Surgery to Reduce Discomfort after Amputation.","authors":"Nirbhay S Jain, David Ring, Teun Teunis","doi":"10.1097/PRS.0000000000013515","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013515","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183860","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":"Beyond Perforator Size: A Novel Algorithmic Approach to Lateral Row Perforator Selection in DIEP Flap Breast Reconstruction.","authors":"Hannah Soltani, Nina Shelton, Jenna Bekeny, Christopher M Ply, Karina Charipova, Alexandra Junn, Kenneth L Fan, David H Song, Samer F Jabbour","doi":"10.1097/PRS.0000000000013506","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013506","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183903","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":"Nanofat Grafting: The Future of Regenerative Medicine? A Bibliometric Analysis and Systematic Review of Clinical Applications.","authors":"Edoardo Caimi, Emanuele Mark Ghetti, Federico Giovagnoli, Giovanni Prati, Stefano Vaccari, Roberta Comunian, Riccardo Di Giuli, Valeria Bandi, Francesco Klinger, Valeriano Vinci","doi":"10.1097/PRS.0000000000013530","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013530","url":null,"abstract":"<p><strong>Background: </strong>Nanofat grafting has evolved from a mechanically emulsified adipose-derived product into a regenerative platform used across aesthetic, reconstructive, and functional indications. However, terminology, processing methods, and clinical applications remain heterogeneous. This study combined bibliometric mapping with a systematic review to characterize the evolution, evidence base, and limitations of nanofat research.</p><p><strong>Methods: </strong>A bibliometric analysis was performed using the Web of Science Core Collection to identify nanofat-related publications relevant to plastic, reconstructive, aesthetic, and regenerative surgery. Publication trends, citation metrics, leading contributors, and keyword networks were analyzed using Bibliometrix and VOSviewer. A separate PRISMA-based systematic review was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science to identify human clinical studies evaluating nanofat-based interventions.</p><p><strong>Results: </strong>The bibliometric search identified 286 publications, including 241 after the introduction of nanofat in 2013. Output increased markedly after 2019 and peaked in 2025 with 45 publications. The corpus accumulated 4,320 citations and had an H-index of 37. China, the United States, Italy, Switzerland, and Germany were the leading contributors. The systematic review included 77 clinical studies comprising 2,737 patients, of whom 2,304 received nanofat-based or mechanically emulsified adipose-derived interventions. Clinical applications were grouped into eight domains, with scar remodeling, facial/skin rejuvenation, wound healing, and periorbital rejuvenation representing the most frequent indications.</p><p><strong>Conclusions: </strong>Nanofat research has expanded rapidly into a heterogeneous adipose-derived regenerative field. Current evidence supports broad translational interest but remains limited by variability in processing methods, adjunctive therapies, outcomes, and study design. Standardized terminology, product characterization, and indication-specific controlled trials are needed.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183910","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":"Surgical Management of Intractable Lower Eyelid Filler Induration: A 15-Year Experience and Layer-by-Layer Approach.","authors":"Shunichi Nomoto","doi":"10.1097/PRS.0000000000013528","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013528","url":null,"abstract":"<p><strong>Background: </strong>Late-onset granulomas in the lower eyelid following non-biodegradable filler injections resist conservative therapies, necessitating surgical excision. Operating in this complex anatomy carries significant risks.</p><p><strong>Methods: </strong>A retrospective review of 282 patients undergoing excision of intractable lower eyelid granulomas (2011-2026) was conducted following a minimum of 6 months of failed medical management. A systematic subciliary approach utilizing sequential layer-by-layer delamination and release of the orbital retaining and tear trough ligaments accessed deep-seated materials. High-risk patients universally received prophylactic canthal support.</p><p><strong>Results: </strong>The cohort (261 females, 21 males; mean age 36.7 years) had diverse filler materials excised. Clinical success-defined objectively as the resolution of preoperative complaints without recurrence requiring surgery-was 100% (mean follow-up 277.4 days). In a high-risk subgroup (age ≥50, prior periorbital surgery), transient ectropion occurred in 61.7% despite 100% receiving prophylactic canthal support. All resolved conservatively within a mean of 62.2 days. Routine microbiological testing was omitted due to unequivocal chronic presentations.</p><p><strong>Conclusions: </strong>Systematic layer-by-layer exploration enables the safe removal of scattered lower eyelid foreign bodies. For infiltrative materials, maximal safe debulking prevents musculocutaneous devascularization. Temporary ectropion, exacerbated by traction-induced neuropraxia, is a common but self-limiting sequela.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183891","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}