Plastic and reconstructive surgery最新文献

{"title":"Cleft Presurgical Infant Orthopedics: Evolution from Analog to Digital Appliances-Will It Increase Accessibility?","authors":"Winston R Owens, Vamsi C Mohan, Krishnamurthy Bonanthaya, Alvaro A Figueroa","doi":"10.1097/PRS.0000000000012376","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012376","url":null,"abstract":"<p><strong>Summary: </strong>In the present day, presurgical infant orthopedic (PSIO) treatment is routinely implemented by cleft providers to reduce the space between cleft segments before surgical repair as well as to address the coexisting cleft nasal deformity. Since the inception of PSIO treatment, various modifications in both appliances and techniques have developed to improve treatment efficiency, postoperative outcomes, and access. Early PSIO appliances solely addressed alveolar malformations. In the early 1990s, Grayson introduced and popularized the technique of nasoalveolar molding. Following the device and protocol developed by Grayson, successive appliances, such as the modification introduced by Figueroa, have mitigated the risk of complications. Currently, advancements in 3-dimensional technology have revolutionized presurgical cleft care with increased treatment accuracy, efficiency, and reproducibility. Modern PSIO devices have harnessed 3-dimensional technology, including growth and treatment simulation through time, and can play a critical role in increasing accessibility of care in low- and middle-income countries. Nongovernmental organizations such as Smile Train operate to deliver comprehensive cleft care to low- and middle-income countries while helping develop local and national initiatives to create sustainable solutions. In collaboration with national and local health authorities and providers, as well as private industry, nongovernmental organizations can continue to work toward providing sustainable, high-quality comprehensive cleft care across the globe.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4S-2","pages":"72S-80S"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150284","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":"Financial Disclosure Appendix for \"Fillers: The State of the Science-A Multispecialty, Evidence-Based Initiative\".","authors":"","doi":"10.1097/PRS.0000000000012378","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012378","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4S-1","pages":"4S"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150302","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":"Introduction to \"Advances in Cleft Care\".","authors":"Larry H Hollier, Richard A Hopper, Roberto L Flores","doi":"10.1097/PRS.0000000000012371","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012371","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4S-2","pages":"1S-2S"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150432","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 Sphincter Pharyngoplasty and Long-Term Maxillary Hypoplasia in Patients with Cleft Palate.","authors":"Nghiem H Nguyen, Madeline G Chin, Kelly X Huang, Kaavian Shariati, Jeremiah M Taylor, Juliana Panchura, Kriya Gishen, Justine C Lee, Libby F Wilson","doi":"10.1097/PRS.0000000000012040","DOIUrl":"10.1097/PRS.0000000000012040","url":null,"abstract":"<p><strong>Background: </strong>The current literature on orthognathic growth outcomes after velopharyngeal insufficiency surgery is limited by cohort size or short follow-up duration after surgery. This study evaluates the relationship between sphincter pharyngoplasty and long-term maxillomandibular growth.</p><p><strong>Methods: </strong>All patients with cleft lip and palate (CLP) or isolated cleft palate (iCP) greater than or equal to 15 years of age who underwent sphincter pharyngoplasty from 1992 to 2023 were retrospectively reviewed. An age- and diagnosis-matched control group with CLP/iCP was also identified. Postoperative outcomes include clinical diagnosis of maxillary and mandibular hypoplasia, indication for Le Fort surgery, and sella-nasion-A point and sella-nasion-B point angles.</p><p><strong>Results: </strong>A total of 200 CLP/iCP patients with a mean age of 20.0 ± 3.2 years were included ( n = 114 with pharyngoplasty and n = 86 controls). Within the surgery cohort, pharyngoplasty occurred at a mean age of 12.0 ± 4.5 years with a follow-up duration 9.2 years (interquartile range, 3.5 to 12.2 years) after surgery. Maxillary hypoplasia was diagnosed twice as frequently in pharyngoplasty patients compared with controls (60.5% versus 33.7%; P < 0.001), corresponding to a higher incidence of Le Fort I surgery (45.6% versus 15.1%; P < 0.001) and smaller sella-nasion-A point angles (75.4 ± 4.5 degrees versus 78.2 ± 5.4 degrees; P = 0.03). There were no differences in mandibular hypoplasia or sella-nasion-B point angles. Multivariable analysis indicated that pharyngoplasty was independently associated with a 3-fold increase in later diagnosis of maxillary hypoplasia (OR, 3.8; 95% CI, 1.9 to 7.5; P < 0.001).</p><p><strong>Conclusion: </strong>Patients with a history of pharyngoplasty were 3.8 times more likely to be subsequently diagnosed with maxillary hypoplasia, highlighting the need for longitudinal follow-up of patients after velopharyngeal insufficiency surgery, as there may be long-term orthognathic consequences.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"597-604"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449760","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":"Cleft Photo Mirror Combining Self-Retraction, Scaling, and Antifogging Features for Cleft Palate Documentation.","authors":"Prasad Nalabothu, José Wittor de Macêdo Santos, Benito K Benitez, Yoriko Lill, Sebastian Tapia Coron, Andreas A Mueller","doi":"10.1097/PRS.0000000000012099","DOIUrl":"10.1097/PRS.0000000000012099","url":null,"abstract":"<p><strong>Summary: </strong>Documentation of patients with cleft lip and palate presents a significant challenge due to the necessity for consistent, high-quality imaging throughout the extended treatment period. The use of traditional intraoral mirrors typically necessitates an assisting person for retraction of the lips and cheeks, as well as mirror fog cleaning. This results in variable fields of view and requires extensive resources. Distance measurements are not possible on conventional photographs, limiting their use for objective treatment analysis. To address these 3 challenges at once, the authors developed a customized intraoral mirror incorporating self-retraction, a reference scale, and an antifogging option. The mirror design features lateral extensions for effective lip and cheek retraction and 2 small laser-engraved black triangles, spaced 2 cm apart at the end of the mirror, to measure the width of the cleft, enabling a single operator to capture clear images independently. The mirror is designed in 4 sizes to accommodate patients from newborn babies to adults. Clinical implementation demonstrated that the mirror allows the acquisition of high-quality standardized images without additional assistance, enhancing workflow efficiency and consistency in documentation. By overcoming the limitations of traditional mirrors, the authors' mirror provides a practical and efficient solution for cleft lip and palate documentation and facilitates accurate follow-up of treatment progress beyond orthodontic and surgical evaluation.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"563e-566e"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649921","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":"Cost Effectiveness of Prophylactic Mastectomy and Autologous Flap Reconstruction in BRCA1/2 -Positive Patients.","authors":"Reid W Smith, Sneha Subramaniam, Jagmeet S Arora, Isabelle T Smith, Neil Tanna, Clifford C Sheckter, Mark L Smith","doi":"10.1097/PRS.0000000000012094","DOIUrl":"10.1097/PRS.0000000000012094","url":null,"abstract":"<p><strong>Background: </strong>Patients diagnosed with having the breast cancer gene ( BRCA1 or BRCA2 ) face a critical choice between prophylactic mastectomy and serial surveillance screening. This study aimed to evaluate the cost effectiveness of prophylactic mastectomy with autologous reconstruction compared with surveillance strategies for this patient population.</p><p><strong>Methods: </strong>Markov chain Monte Carlo simulations comprising 100,000 patients were used. All models assumed a baseline of women aged 25 years with BRCA1 or BRCA2 mutations. In the standard-of-care model, patients underwent annual screening (magnetic resonance imaging plus mammography) until age 75 years. Positive screenings led to mastectomy followed by 2-stage breast reconstruction using tissue expanders and implants. This approach was compared with prophylactic mastectomy with autologous flap reconstruction (free transverse rectus abdominis myocutaneous, gluteal, thigh, or deep inferior epigastric perforator [DIEP] flaps) at ages 30, 35, or 40 years. Evaluation parameters included cost, quality of life, and incremental cost-effectiveness ratios.</p><p><strong>Results: </strong>The incremental cost-effectiveness ratios of all autologous flaps were below the willingness-to-pay threshold of $50,000, suggesting cost effectiveness, with DIEP flaps being the lowest. Prophylactic mastectomy with autologous reconstruction was more cost effective for BRCA1 patients than for BRCA2 patients, and sensitivity analysis revealed that prophylaxis became cost effective earliest for DIEP flaps (ages 50 to 63 years) and latest for gluteal flaps (ages 58 to 73 years).</p><p><strong>Conclusions: </strong>Prophylactic mastectomy with autologous reconstruction performed at ages 30, 35 or 40 years, was found to be a cost-effective alternative to breast cancer surveillance and disease treatment in women with BRCA1/2 mutations. DIEP and free transverse rectus abdominis myocutaneous flaps were the most cost-effective techniques, and prophylaxis was more cost effective in BRCA1 patients than in BRCA2 patients.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"521-528"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658203","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":"Over 10 Years' Follow-Up Experience after Inverted-T Superior Pedicle Breast Reduction with the Modified Ribeiro Flap.","authors":"Barbara Cagli, Andrea Aniello Cimmino, Iside Vignapiano, Daniela Porso, Francesco Sofo, Carlo Mirra, Luca Savani, Annalisa Cogliandro, Andrea Tarantino, Paolo Persichetti","doi":"10.1097/PRS.0000000000012108","DOIUrl":"10.1097/PRS.0000000000012108","url":null,"abstract":"<p><strong>Background: </strong>Several techniques have been developed to address cases of macromastia. The primary objective remains achieving optimal aesthetic outcomes and reducing breast volume, but concerns persist regarding the stability of results over time. In particular, as far as the superior pedicle inverted-T breast reduction with an inferiorly based dermal flap is concerned, long-term reported results stop at 5 years' follow-up. This work investigates the outcome of this at greater than 10 years' follow-up, considering intrinsic and extrinsic factors that may contribute to ptosis recurrence.</p><p><strong>Methods: </strong>A total of 70 patients were included and examined in a long-term consultation, more than 10 years postoperatively. Physical measures, including standard breast distances, skin distention test for elasticity assessment, and BREAST-Q scores, were collected at the time of consultation and compared with preoperative and intraoperative data.</p><p><strong>Results: </strong>The authors' study sample shows a mean age of 42 years. Mean follow-up was 13 years, with 18 years as the longest follow-up registered. Mean amount breast tissue volume removed was 1134 g. A positive correlation between smoking habit and inferior pole elongation is shown ( P = 0.031), and between smoking habit and inferior pole skin distention ( P = 0.002). A significant positive correlation between age and almost all the BREAST-Q scales is reported. Smoking patients had a higher sternal notch-to-nipple distance distance variation over time and superior pole skin distention.</p><p><strong>Conclusions: </strong>Intrinsic and extrinsic factors may affect outcome and satisfaction irrespective of the age. This versatile procedure demonstrates reliability across time, offering enduring results.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"472e-480e"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658188","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: Cost Effectiveness of Prophylactic Mastectomy and Autologous Flap Reconstruction in BRCA1/2-Positive Patients.","authors":"Danielle H Rochlin, Evan Matros","doi":"10.1097/PRS.0000000000012235","DOIUrl":"10.1097/PRS.0000000000012235","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4","pages":"529-530"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150474","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: Artificial Intelligence Risk Prediction Tools for Alloplastic Breast Reconstruction.","authors":"Lacey Foster, Justin J Cordero, Samuel J Lin","doi":"10.1097/PRS.0000000000012208","DOIUrl":"10.1097/PRS.0000000000012208","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4","pages":"651-652"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150496","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 Perioperative Anesthesia Protocols for Global Delivery of Safe Cleft Surgery.","authors":"Vamsi C Mohan, Winston R Owens, Zipporah Gathuya","doi":"10.1097/PRS.0000000000012368","DOIUrl":"10.1097/PRS.0000000000012368","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this article is to highlight the nuances in the perioperative anesthetic management of a patient with a cleft lip and/or palate (CL/P) through underscoring the importance of nutrition and fasting guidelines in the preoperative period, airway and pain management intraoperatively, and feeding and pain management in the immediate postoperative period.</p><p><strong>Methods: </strong>The authors outline key concepts in the perioperative anesthetic management of patients with CL/P through a literature review and the senior author's (Z.G.) experience providing anesthetic care in a low- or middle-income country.</p><p><strong>Results: </strong>A comprehensive preoperative examination is required to identify concurrent morbidities or anomalies and implement appropriate treatment before surgical repair. Patient optimization is critical for favorable outcomes after CL/P repair and begins in the preoperative period and ends after patient stabilization postoperatively. Anesthesia providers contribute to perioperative management through the assessment, monitoring, and treatment of malnutrition; safe feeding and fasting times preoperatively and postoperatively; using reliable pain scales and regimens intraoperatively and postoperatively; and being in clear and constant communication with all members of the cleft care team to maintain patient safety.</p><p><strong>Conclusions: </strong>A patient with a CL/P undergoing surgical repair requires a thorough preoperative history and physical examination, nutritional assessment, and a nil per os protocol that mitigates prolonged fasting. Intraoperatively, intubation and extubation with the assistance of a video laryngoscope and adherence to a throat pack protocol are essential. Postoperatively, a standardized pain management protocol with nonopioid medications and early reinitiation of feeding are integral for optimizing outcomes.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4S-2","pages":"23S-29S"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150371","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}