Plastic and reconstructive surgery最新文献

{"title":"Spontaneous Recovery of Active Shoulder External Rotation in Patients with Brachial Plexus Birth Injury.","authors":"Maria Hyttinen, Henrikki Rönkkö, Pasi Paavilainen, Mika Helminen, Jarkko Jokihaara","doi":"10.1097/PRS.0000000000011877","DOIUrl":"10.1097/PRS.0000000000011877","url":null,"abstract":"<p><strong>Background: </strong>Brachial plexus birth injury (BPBI) occurs as a result of a difficult delivery. External rotation (ER) of the shoulder (ER) is usually one of the last movements that may recover. There is no consensus about the predicting factors for spontaneous recovery or the optimal timing for surgical treatment of ER in BPBI patients. The aim of this retrospective study was to describe spontaneous recovery of active ER and evaluate predicting factors for the recovery.</p><p><strong>Methods: </strong>The authors screened 562 patients and identified a consecutive cohort of 103 BPBI patients, who had no active ER at the age of 3 months. The authors systematically collected clinical data on recovery. In addition, the authors assessed whether early recovery of elbow flexion, shoulder abduction, or Narakas grade at 1 month predicts ER recovery.</p><p><strong>Results: </strong>Fifty-two patients (51%) spontaneously recovered ER, 44% of whom recovered by the age of 1 year, 83% by 1.5 years, 92% by 2 years, and 98% by 3 years. A breakpoint in the slope of the curve showing proportion of recovered patients occurred at 2 years of age. Recovery of active ER was significantly associated with early elbow flexion and Narakas grade at 1 month, but not with early active shoulder abduction.</p><p><strong>Conclusions: </strong>Most spontaneous recovery of ER in patients with BPBI occurs until 2 years of age, which thus can be considered a meaningful follow-up period for spontaneous recovery of ER. This information should be considered when making decisions about peripheral nerve transfer surgery to improve ER in BPBI.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1045e-1053e"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676536","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":"Discussion: Mastectomy for Individuals with Gender Dysphoria Younger Than 26 Years: A Systematic Review and Meta-Analysis.","authors":"Loren Schechter, Jens Urs Berli, Rachel Bluebond-Langner","doi":"10.1097/PRS.0000000000011963","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011963","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 6","pages":"924-927"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161328","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":"Three Pedicle-Based Nipple-Sparing Skin-Reducing Mastectomy Combined with Prepectoral Implant-Based Breast Reconstruction: Correction.","authors":"Simone La Padula, Rosita Pensato, Rasmieh Al-Amer, Barbara Hersant, Jean Paul Meningaud, Warren Noel, Francesco D'Andrea, Nicola Rocco","doi":"10.1097/PRS.0000000000012154","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012154","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 6","pages":"1057"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161347","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":"Effects of Nanofat in Plastic and Reconstructive Surgery: A Systematic Review.","authors":"Mustafa Uguten, Martin C Harmsen, Berend van der Lei, Hieronymus P Stevens, Joris A van Dongen","doi":"10.1097/PRS.0000000000011836","DOIUrl":"10.1097/PRS.0000000000011836","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1086e-1087e"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505907","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":"Levator Advancement Surgery with or without Lateral Horn Incision: Effect of Lateral Horn Incision for Severe Involutional Blepharoptosis.","authors":"Hirotaka Suga, Asako Fukuju, Risa Murakami","doi":"10.1097/PRS.0000000000011833","DOIUrl":"10.1097/PRS.0000000000011833","url":null,"abstract":"<p><strong>Background: </strong>The lateral portion of the levator aponeurosis transforms into fibrous tissue called the lateral horn. Conventional levator advancement surgery for involutional blepharoptosis preserves the integrity of the lateral horn. The impact of incising the lateral horn has not been thoroughly studied.</p><p><strong>Methods: </strong>Sixty-nine patients who had undergone levator advancement surgery for involutional blepharoptosis between 2020 and 2023 were included in the study. In cases where the levator aponeurosis could not be well advanced during surgery, the authors incised the lateral horn to increase the advancement. The authors then retrospectively reviewed cases with or without the incision. The authors also measured the effect of the incision intraoperatively using a sheet with a scale grid.</p><p><strong>Results: </strong>Lateral horn incisions were performed in 32 of the 69 cases. The preoperative degree of blepharoptosis was significantly more severe in cases that necessitated the incision (margin reflex distance 1, 0.5 mm versus 1.0 mm; P < 0.05). Patients receiving the incision were significantly older than those without (73.4 years versus 61.7 years; P < 0.05). There were no significant differences between the 2 groups in postoperative margin reflex distance 1 (2.8 mm versus 3.0 mm; P = 0.20). Intraoperative measurements revealed that the levator aponeurosis was advanced 4.3 mm more caudally and 3.1 mm more medially as a result of the lateral horn incision.</p><p><strong>Conclusions: </strong>Lateral horn incision is effective in levator advancement surgery for severe involutional blepharoptosis. This technique aids in preventing undercorrection of palpebral fissures, especially in the medial region.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"937-942"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472441","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":"Prophylactic Local Antibiotics for Tissue Expansion (PLATE) Improve Breast Reconstruction Outcomes.","authors":"Robert Craig Clark, Priscila Cevallos, Benyamin Dadpey, Andrea Yessaillian, Elizabeth Turner, Augustine Kang, Brian Thornton, Rahim Nazerali, Chris M Reid","doi":"10.1097/PRS.0000000000011832","DOIUrl":"10.1097/PRS.0000000000011832","url":null,"abstract":"<p><strong>Background: </strong>Infection following tissue expander (TE) breast reconstruction is frequent and impactful. Preliminary reports demonstrate value of local antibiotic delivery for implant salvage and prophylactic potential. This article is a multiinstitutional retrospective study using surgeon-crafted tobramycin-vancomycin polymethyl methacrylate plates (prophylactic local antibiotics for tissue expansion [PLATE]) during TE implantation for infection prophylaxis. The authors hypothesized that the intervention would be associated with fewer infections compared with historical practice.</p><p><strong>Methods: </strong>In 2021, surgeons at 3 institutions began independently offering PLATE for primary TE breast reconstructions. After independent institutional review board approvals, data were retrospectively collected for PLATE subjects and preintervention cohorts of equivalent sizes. Subjects were followed up for 7 months, or to second-stage removal. The primary outcome-complication requiring readmission/reoperation-was compared between aggregated cohorts. Analysis included logistic modeling and Kaplan-Meyer survival.</p><p><strong>Results: </strong>The aggregate sample included 183 intervention subjects (292 breasts) and 183 controls (301 breasts), each with 5 ± 2-month follow-up. Overall, complications were significantly less frequent with PLATE (13.1% versus 21.9%; P < 0.01). This was driven by significantly fewer infections (4.8% versus 12.6%; P < 0.01) with no difference in rates of tissue necrosis, seroma, or other complications ( P > 0.05). In multivariable regression, the intervention was associated with significantly reduced odds of any complication (OR, 0.53; 95% CI, 0.3 to 0.93) and infection (OR, 0.22; 95% CI, 0.08 to 0.50). Kaplan-Meyer curves demonstrated significant longitudinal reduction in complication and infection ( P < 0.01) without notable rebound throughout dissipation of the antibiotic eluent.</p><p><strong>Conclusions: </strong>Prophylactic use of intraoperatively crafted PLATE during TE implantation was associated with significant infection reduction without increase in local or systemic complications. This reproducible tool may be highly valuable in alloplastic breast reconstruction.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"974e-985e"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505910","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 Video-Based Learning Module Is an Effective Way to Teach the Interpretation of Preoperative Electrodiagnostic Studies.","authors":"Ruby L Taylor, Justin K Zhang, J Megan M Patterson, Noah S Llaneras, Stahs Pripotnev, Kitty Y Wu, Susan E Mackinnon","doi":"10.1097/PRS.0000000000011907","DOIUrl":"10.1097/PRS.0000000000011907","url":null,"abstract":"<p><strong>Background: </strong>Electrodiagnostic studies are critical for surgical decision-making in nerve injuries. Surgeons typically rely on the electrodiagnostician's reports and lack formal training in electrodiagnostic study interpretation. This knowledge gap highlights a need for accessible and effective educational resources for surgeons to improve their understanding of electrodiagnostic studies and enhance patient care.</p><p><strong>Methods: </strong>The educational module consisted of a prelecture knowledge assessment, a 42-minute video lecture on interpreting electrodiagnostic study results, and a postlecture knowledge assessment. Knowledge retention was assessed by means of an additional survey distributed 3 months after module completion.</p><p><strong>Results: </strong>This study, involving 119 participants (79% attending surgeons, 8% fellows, 9% surgical residents, and 2% who described their position as \"other\"), demonstrated that a 42-minute video-based learning module significantly improved knowledge of electrodiagnostic study interpretation. Median scores increased from 7 to 9 ( P < 0.001), with improvement persisting at 3 months (median retention score, 11; P < 0.025). Among surgeons completing the 3-month assessment, 65.5% reported that knowledge gained from the module had changed their clinical practice.</p><p><strong>Conclusion: </strong>This study demonstrates that a concise, video-based learning module can effectively enhance surgeon knowledge of electrodiagnostic study interpretation and may serve as a valuable tool for surgical education and improving patient selection in nerve surgery.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1024-1032"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731833","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 correction of mild blepharoptosis: balancing the effect of Hering's law\".","authors":"Xin Li, Lu Yu, Elan Yang, Xiaoning Yang, Jiaqi Wang, Jiguang Ma, Tailing Wang","doi":"10.1097/PRS.0000000000012230","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012230","url":null,"abstract":"<p><strong>Background: </strong>Disregarding the influence of Hering's law in blepharoptosis correction leads to unsatisfactory surgical outcomes. The authors report a systemic assessment and surgical method to balance the effect of Hering's law in mild blepharoptosis.</p><p><strong>Methods: </strong>Comprehensive assessment included a detailed examination, ptosis correction sequence, levator complex plication, and repeated intraoperative adjustments. Surgical efficacy and symmetry differences were assessed by comparing margin reflex distance1 (MRD1) between patients with and without Hering's law.</p><p><strong>Results: </strong>83 patients with mild ptosis were evaluated, and the average follow-up was 5.3months. In evaluating the need for secondary blepharoplasty, 23.1% (9/39) of patients in the Hering's (+) group were dissatisfied with prior surgery, while only 6.8% (3/44) in the Hering's (-) group sought revision. Due to continuous intraoperative adjustments, ptosis and eyelid symmetry showed significant improvement in both groups, as effects of Hering's law were effectively balanced intraoperatively.</p><p><strong>Conclusions: </strong>Hering's law plays a critical role in the aesthetic correction of mild ptosis. Neglecting the effect of Hering's law can result in revision surgery. A systemic approach to assessment and surgery, comprising a comprehensive examination, a structured ptosis correction sequence, levator complex plication, and repeated intraoperative adjustments, is essential for effectively balancing the effects of Hering's law. Due to continuous intraoperative adjustments, ptosis and eyelid symmetry showed significant improvement in both Hering's (+) and Hering's (-) group.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258621","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":"\"Perfusion Assessment of Healthy and Injured Hands Using Video-Based Deep Learning Models\".","authors":"Vineet R Shenoy, Carly Q Kingston, Mantej Singh, Ike C Fleming, Nicholas J Durr, Rama Chellappa, Aviram M Giladi","doi":"10.1097/PRS.0000000000012225","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012225","url":null,"abstract":"<p><strong>Background: </strong>Assessing in-field hand trauma is challenging, and inaccurate perfusion assessment can substantially impact the patient and health system. Technology that enhances perfusion assessment could improve in-field triage. We present non-contact, video-based deep learning methods to classify perfused and ischemic fingers in control and acute trauma settings.</p><p><strong>Methods: </strong>We obtained iPhone video from two cohorts of subjects. The first group were control participants, some of whom were evaluated during cycles of tourniquet-induced ischemia. The second group were acutely injured patients in our emergency department(ED). For both groups, imaging photoplethysmography (iPPG) waveforms were extracted using a deep learning model, after which the waveform's spectrogram was classified as either perfused or ischemic using a ResNet-18 classifier. This was then compared to clinical ground-truth labels.</p><p><strong>Results: </strong>We captured videos of 48 controls including 14 evaluated during tourniquet-induced ischemia, and 15 acutely injured patients. Over five-fold cross-validation of control subjects, our algorithms correctly classified ischemic finger regions with a sensitivity of 72%, a positive predictive value (PPV) of 74%, and an accuracy of 90%. We then tested on videos of acutely injured patients, without controlling hand pose, skin cleanliness, or other variables, and achieved a sensitivity of 33%, a PPV of 24%, and an accuracy of 77%.</p><p><strong>Conclusions: </strong>Under controlled settings, deep learning methods for perfusion classification performed well. In hospital settings - with uncontrolled lighting, hand pose, and injuries - classification performance degraded. This technology is promising but additional approaches that account for acute trauma-related variables are needed for clinical applicability as a triage tool.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258622","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 Outcomes of Proton versus Photon Post-Mastectomy Radiation Therapy in Pre-Pectoral Implant-Based Breast Reconstruction.","authors":"Anshumi Desai, Carolina Padilla, Seraphina Choi, Sunwoo Han, Danielle Cerbon, Devinder P Singh, John C Oeltjen, Cristiane Takita, Isildinha M Reis, Juan Rodolfo Mella-Catinchi","doi":"10.1097/PRS.0000000000012232","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012232","url":null,"abstract":"<p><strong>Introduction: </strong>The rising popularity of pre-pectoral implant-based breast reconstruction (PP-IBBR) and proton radiation lacks outcomes data. We aim to compare complications in PP-IBBR with photon (XRT) versus proton (PRT) post-mastectomy radiotherapy (PMRT).</p><p><strong>Methods: </strong>A single-institution retrospective cohort study included breast cancer patients undergoing mastectomy and PP-IBBR with PMRT (January 2020-October 2022) with two-year follow-up after surgery. We assessed for minor infection (requiring oral antibiotics), major infections (requiring intravenous antibiotics), wound complications, flap necrosis, seromas, re-operations, capsular contracture, and implant failures (requiring implant removal for any of the aforementioned complications, except for rupture) including implant exposure.</p><p><strong>Results: </strong>116 PP-IBBR receiving PMRT were analyzed dividing into two cohorts: Photon (XRT) (n=75, 64.7%) and Proton (PRT) (n=41, 35.3%). Overall, XRT showed more complications compared to PRT. Major infection, minor infection, delayed wound healing, partial flap necrosis, seroma development, re-operations, implant failure, and capsular contracture of all grades as well as grade 3 and 4 capsular contracture were seen more in XRT compared to PRT. Compared to PRT, XRT was significantly associated with higher risk of ≥2 complications in univariable analysis (OR: 3.71, 95% CI: 1.02-13.53, p=0.047) and in the multivariable model adjusting for the stage (OR: 4.84, 95% CI: 1.27-18.46, p=0.021). Compared to stages 1-2, stages 3-4 were significantly associated with higher risk of ≥2 complications (OR: 3.40, 95% CI: 1.21-9.57, p=0.021) adjusting for radiation type.</p><p><strong>Conclusion: </strong>Compared to traditional XRT, PRT had fewer complications in patients with PP-IBBR. PRT is a safer option, warranting larger studies and broader utilization in clinical practice.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258638","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}