Plastic and reconstructive surgery最新文献

{"title":"Predisposing Factors for Postoperative Complications in the Year following Frontoorbital Advancement and Remodeling: A Single-Institution Study of 267 Patients.","authors":"Larissa E Wietlisbach, Carlos E Barrero, Dillan F Villavisanis, Jordan W Swanson, Scott P Bartlett, Jesse A Taylor","doi":"10.1097/PRS.0000000000011364","DOIUrl":"10.1097/PRS.0000000000011364","url":null,"abstract":"<p><strong>Background: </strong>Frontoorbital advancement and remodeling (FOAR) is a common surgical approach used for craniosynostosis, conferring functional and aesthetic benefit. There are few reports examining predisposing factors for postoperative complications within the first year after surgery. This study aimed to establish complication rates and identify risk factors for inferior outcomes in a large population of patients undergoing FOAR.</p><p><strong>Methods: </strong>All patients who underwent FOAR from 2013 through 2022 at the authors' institution were retrospectively studied. Perioperative and postoperative data were collected to yield outcomes analyses. Multivariable logistic regression with backward selection was performed to identify predictors of postoperative complications.</p><p><strong>Results: </strong>A total of 267 patients underwent FOAR. The overall complication rate was 14.2%, most commonly delayed wound healing (7.4%), postoperative blood transfusion (5.8%), and infection requiring readmission (1.9%). Tense closure independently predicted delayed wound healing ( P < 0.001) and infection requiring readmission ( P = 0.03). Syndromic patients were more likely than nonsyndromic patients to have undergone previous craniofacial surgery (45.3% versus 23.8%; P = 0.003). Syndromic status and previous craniofacial surgery were associated with increased risk of developing infection requiring readmission ( P = 0.012 and P = 0.004, respectively). A greater proportion of malnourished patients experienced postoperative complications compared with patients without malnourishment (24.4% versus 12.1%; P = 0.031), although there were no significant differences in individual postoperative outcomes.</p><p><strong>Conclusions: </strong>Identified risk factors for complications included syndromic status, tense closure, and previous craniofacial surgery. Most complications were managed nonoperatively. These factors may be considered in preoperative planning and when counseling families.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"673-681"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906330","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":"Spotlight in Plastic Surgery: April 2025.","authors":"Brett T Phillips, Antonio Baez, Christine S W Best, Sahar Borna, Valeria P Bustos, Jesse Chou, Daniel De Luna Gallardo, Bianca Di Chiaro, Mayank Mandavgane, Kalinne F S Martins, Tina Moon, Dillan Villavisanis, Pooja S Yesantharao","doi":"10.1097/PRS.0000000000011910","DOIUrl":"10.1097/PRS.0000000000011910","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 4","pages":"737-740"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710963","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":"Quality of Life for Osteoradionecrosis Reconstruction in the Head and Neck: A Longitudinal Framework and Risk Factors.","authors":"Robin T Wu, Jennifer An-Jou Lin, Chun-Lin Su, Fu-Chan Wei","doi":"10.1097/PRS.0000000000011790","DOIUrl":"10.1097/PRS.0000000000011790","url":null,"abstract":"<p><strong>Background: </strong>Osteoradionecrosis (ORN) is an aggressive sequela of head and neck cancer, the treatment of which focuses on functional restoration and quality of life (QoL). In this study, the authors aimed to identify risks for poor QoL in ORN reconstruction and build a chronologic, longitudinal framework for QoL.</p><p><strong>Methods: </strong>A prospective database of reconstructions performed by the senior author (F.C.W.) was reviewed from 2015 to 2023. QoL metrics (University of Washington QoL, version 4) were administered prospectively before surgery, 1 year postoperatively, and at each yearly follow-up.</p><p><strong>Results: </strong>The study included 56 ORN patients with an average age of 58.2 years and mean radiation dose of 6412 Gy. Reconstruction was achieved most often with the fibula (55.4%) and anterolateral thigh flaps (37.5%). The total complication rate was 23.2% at a median period of 10.7 months postoperatively. Both health-related QoL in comparison with before the cancer diagnosis (62.5 versus 43.5; P = 0.030) and overall QoL during the past 7 days (50.5 versus 41.7; P = 0.029) were higher after ORN reconstruction than before. Physical QoL was rated higher before cancer reconstruction (79.0) than before ORN reconstruction (50.6; P < 0.001) and following reconstruction (52.5; P = 0.001). Social-emotional function was rated higher after ORN reconstruction compared with before reconstruction (68.7 versus 59.6; P = 0.010). Multivariate analysis showed that both postoperative social-emotional and physical function were affected by betel nut use ( P = 0.038; P = 0.025). Poor improvement in QoL from before to after ORN reconstruction was affected by maxilla involvement ( P = 0 .048) and fistula ( P = 0.004) and hardware issues ( P = 0.001).</p><p><strong>Conclusions: </strong>The authors' longitudinal experience trended toward a decline in QoL at ORN diagnosis, with gradual improvement following reconstruction and eventual significant improvement in social-emotional, pain, anxiety, chewing, and global QoL following surgery. Betel nut use was a risk factor for poor postoperative QoL. Maxillary involvement and postoperative fistula and hardware issues were risks for nonimprovement in QoL.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"695-705"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366142","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 Comparison of Textured versus Smooth-Surfaced Implants in Subfascial Breast Augmentation.","authors":"Tim Brown","doi":"10.1097/PRS.0000000000011587","DOIUrl":"10.1097/PRS.0000000000011587","url":null,"abstract":"<p><strong>Background: </strong>Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. This study examined the differences in outcomes between textured and smooth implants.</p><p><strong>Methods: </strong>A total of 385 patients underwent subfascial breast augmentation in 2 cohorts. The initial series ( n = 209) used textured implants and the second ( n = 176) used smooth implants. In all other respects, patient management was identical. Adverse outcomes, changes in breast morphometry, and patient satisfaction were compared between the 2 groups.</p><p><strong>Results: </strong>The follow-up period ranged from to 74 to 272 weeks for smooth implants (mean ± SD, 164 ± 50.6 weeks) and from 78 to 279 weeks for textured implants (mean ± SD, 186 ± 54 weeks). The incidence of capsular contracture was the same for smooth and textured implants (4.7% and 6.2%; P = 0.64). Changes in breast shape at the lower pole, patient satisfaction, and the incidence of other adverse outcomes were the same in both groups.</p><p><strong>Conclusion: </strong>Subfascial placement of smooth and textured breast implants yielded similar outcomes.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"639-645"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420386","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 Mission and Vision of Plastic and Reconstructive Surgery.","authors":"Amy S Colwell, Kevin C Chung","doi":"10.1097/PRS.0000000000011875","DOIUrl":"10.1097/PRS.0000000000011875","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 4","pages":"735-736"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710966","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":"Comparative Study of Adipose-Derived Stem Cells from Localized Scleroderma Patients and Healthy Donors in Treating Skin Fibrosis.","authors":"Zhujun Li, Yiding Xiao, Lin Kang, Yunzhu Li, Hayson Chenyu Wang, Ziming Li, Yuemei Yang, Jiuzuo Huang, Nanze Yu, Xiao Long","doi":"10.1097/PRS.0000000000011779","DOIUrl":"10.1097/PRS.0000000000011779","url":null,"abstract":"<p><strong>Background: </strong>Localized scleroderma (LoS) is an autoimmune disease characterized by fibrosis of the skin and atrophy of the subcutaneous fat tissue. Use of adipose-derived mesenchymal stem cells (ASCs) is a promising treatment approach for LoS. However, ASCs from scleroderma patients (LoS ASCs) have been shown to exhibit altered characteristics compared with ASCs from healthy donors (healthy ASCs). This study aimed to compare the abilities of LoS ASCs and healthy ASCs in treating skin fibrosis.</p><p><strong>Methods: </strong>The paracrine ability of ASCs was tested with cytokine array. Bleomycin-challenged mouse models received subcutaneous injection of LoS ASCs and healthy ASCs. Pathologic staining and Western blotting of collagenase type I and α-smooth muscle actin was performed. Fibroblasts derived from LoS lesions (LoS FB) were co-cultured with ASCs, and subjected to RNA sequencing to further explore the similarities and differences in the treatment mechanism.</p><p><strong>Results: </strong>In vivo comparison revealed that healthy ASCs had a stronger proliferation ability and secreted higher levels of growth factors and cytokines, including vascular endothelial growth factor A, platelet-derived growth factor fibroblasts, and interleukin-10. Pathologic staining of the skin in mouse models treated with ASCs demonstrated that healthy ASCs were more effective in reducing dermal thickness and collagen deposition, and increasing microvessel density and the proportion of M2 macrophages. Co-culture with both healthy ASCs and LoS ASCs reduced the proliferation and migration abilities of LoS FB, and the protein expression of α-smooth muscle actin and collagenase type I. RNA sequencing and validation revealed potential difference in the canonical Wnt pathway.</p><p><strong>Conclusion: </strong>Healthy ASCs exhibited stronger proliferation, paracrine, antifibrosis, proangiogenesis, and immunomodulation abilities in treating skin fibrosis in scleroderma mouse models.</p><p><strong>Clinical relevance statement: </strong>Allogenic ASCs obtained from healthy donors are more efficient in treating skin fibrosis, and could serve as a potential alternative for patients who are not suitable candidates for liposuction surgery in the future.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"716e-726e"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352030","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":"Aesthetic Specialization: A Comparative Study across Medical and Surgical Specialties.","authors":"Abigail Katz, Olachi Oleru, Anya Wang, Nargiz Seyidova, Max Mandelbaum, Eitan Melamed, Peter J Taub","doi":"10.1097/PRS.0000000000011793","DOIUrl":"10.1097/PRS.0000000000011793","url":null,"abstract":"<p><strong>Background: </strong>Postresidency fellowship training has become increasingly popular as a career option. Specifically, the subspecialty of aesthetic surgery has grown tremendously over the past 2 decades within several fields, including plastic and reconstructive surgery (PRS), otolaryngology, dermatology, and ophthalmology. However, the popularity of aesthetic specialization through fellowship remains unknown. The present study aims to analyze trends in aesthetic specialization across these specialties and compare its popularity to other fellowships.</p><p><strong>Methods: </strong>A retrospective review of data from the San Francisco Match, National Resident Matching Program, American Society for Dermatologic Surgery, and the Accreditation Council for Graduate Medical Education was performed. Data on graduating residents and applicants to fellowship were collected. Analysis of variance and t tests were used to compare differences between groups.</p><p><strong>Results: </strong>Significant disparities were observed in applicants and matched applicants to aesthetic fellowships among the 4 residencies ( P < 0.001). Aesthetic fellowship was the most popular option after otolaryngology residency (12.5% to 27%, depending on the year) and the second most popular choice after PRS (8% to 17%) and dermatology (2% to 5%). A comparison between PRS and otolaryngology demonstrated a significantly higher percentage of the latter choosing aesthetic fellowship over time ( P < 0.001). However, no significant difference in applicants to aesthetic fellowship was found between dermatology and ophthalmology ( t test, P = 0.060).</p><p><strong>Conclusions: </strong>The number of applicants to aesthetic fellowship has increased over time across all eligible residencies with the more surgery-heavy specialties (otolaryngology and PRS) having the highest percentage of applicants. Differences in aesthetic training between fields was also observed, which may reflect underlying variations in training and residency exposure.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"704e-713e"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366232","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 Intraflap Anastomosis of Conjoined Bilateral DIEP Flap for Breast Reconstruction: Planning, Execution, and Outcomes in 201 Patients.","authors":"Ju Hee Kim, Kyeong-Tae Lee, Goo-Hyun Mun","doi":"10.1097/PRS.0000000000011770","DOIUrl":"10.1097/PRS.0000000000011770","url":null,"abstract":"<p><strong>Background: </strong>Conjoined bilateral deep inferior epigastric perforator (DIEP) flap with intraflap anastomosis is an efficient approach for breast reconstruction, enabling the use of almost the entire abdominal tissue. Variations in bilateral deep inferior epigastric artery (DIEA) anatomy may make it challenging to apply this technique consistently. This study aimed to derive optimal strategies for achieving reliable conjoined bilateral DIEP flap with intraflap anastomosis universally.</p><p><strong>Methods: </strong>For all consecutive patients undergoing conjoined bilateral DIEP flap-based breast reconstruction from 2009 to 2023, preoperative planning and intraoperative execution for the pedicle configurations were reviewed. Their postoperative outcomes were evaluated.</p><p><strong>Results: </strong>In total, 201 patients were included, with no cases requiring conversion to extraflap anastomosis. In preoperative planning, candidates for recipient vessels for intraflap anastomosis were typically selected on the basis of DIEA branching patterns, identified through computed tomographic angiography: type 1 (single trunk) prioritizing the superior continuation, type 2 (2 main trunks) considering a side branch, and type 3 (3 main trunks) favoring the first bifurcating branch. Comparing candidates from bilateral DIEA, the primary pedicle was determined, providing larger recipient vessels. Most cases followed the planned approach smoothly; however, 28 required intraoperative changes, mostly aimed at securing larger recipients by changing the primary pedicle or harvesting more caudally located perforators to obtain larger superior continuations. Four perfusion-related complications developed, which were resolved successfully without flap failure.</p><p><strong>Conclusion: </strong>The authors' results suggest an efficient strategy for securing a reliable recipient vessel, tailored to patient anatomy, in conjoined bilateral DIEP flap breast reconstruction with intraflap anastomosis, leading to achieving optimal outcomes.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"608-616"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352036","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 after 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":"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. The authors describe the progression of 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 receipt of additional reconstruction and BREAST-Q scores 1 year after reconstructive failure. The authors also performed a propensity-matched analysis between patients who underwent secondary reconstruction and patients who had an uncomplicated reconstruction.</p><p><strong>Results: </strong>A total of 4258 patients receiving TEs, 4420 patients receiving implants, and 1545 patients receiving autologous breast reconstruction were included. Of patients who experienced reconstructive failures, 49.5% of patients with TEs, 4.8% of patients with implants, and 53.8% of patients with autologous reconstruction 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 toward the former cohort (61 [interquartile range, 56, 80] versus 50 [46, 65]; P = 0.085). Propensity-matched analysis demonstrated comparable PROs at 1 year after definite reconstruction.</p><p><strong>Conclusions: </strong>Fewer than half of patients with reconstructive failure undergo an additional reconstruction. Patients who receive secondary reconstruction may have greater Psychosocial Well-being scores than those who do not and comparable PROs to those who had uncomplicated initial reconstruction. Surgeons should counsel patients with reconstructive failures that secondary reconstruction, although traumatizing, may be beneficial.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"649e-659e"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","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":"The U-SMAS Lift.","authors":"Kiya Movassaghi, Janna Check, Alexander Gougoutas","doi":"10.1097/PRS.0000000000011673","DOIUrl":"10.1097/PRS.0000000000011673","url":null,"abstract":"<p><strong>Summary: </strong>Manipulation of the superficial musculoaponeurotic system (SMAS) has become a mainstay of face-lifting procedures. The various surgical approaches to the SMAS traditionally have been classified as either \"low\" or \"high\" SMAS techniques, the former of which, although expeditious, have been criticized for suboptimal upper midface rejuvenation. High SMAS techniques, by contrast, are lauded for their ability to improve upper midface contours, but they may carry increased surgical risk, particularly in the hands of less experienced aesthetic surgeons. The authors present the U-SMAS lift: an imbricating approach to the SMAS that builds upon well-described low SMAS techniques with the addition of a malar flap of mobile-only SMAS for orbitomalar rejuvenation. This novel, hybrid technique harnesses the advantages of traditional low and high SMAS techniques while mitigating surgical risk. Of 61 U-SMAS lifts performed, a minor complication rate of 16.4% was observed. No major complications were observed. The mean follow-up period was 371 days. The U-SMAS lift is a safe and powerful facial rejuvenation technique for both beginning surgeons with advanced aesthetic training and well-versed aesthetic surgeons.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"632-636"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875621","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}