Plastic and reconstructive surgery最新文献

{"title":"Long-term Outcomes of a Modified Straight-line Palate Repair Technique: Low Speech Correcting Surgery and Fistula Rates.","authors":"Sasha Lasky, Naikhoba C O Munabi, Marah Jolibois, Idean Roohani, Tayla Moshal, Zachary Collier, Priyanka Naidu, Eric S Nagengast, Erin M Wolfe, William P Magee","doi":"10.1097/PRS.0000000000011905","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011905","url":null,"abstract":"<p><strong>Background: </strong>The goal of cleft palate (CP) repair is to restore normal speech, however, rates of velopharyngeal insufficiency (VPI) after palatoplasty remain high. We present a modified straight-line palate repair (SLR) technique that facilitates velum length to alleviate VPI. The technique releases nasal mucosa with the levator muscle off the hard palate. This study assesses speech outcomes of this modified SLR technique. Secondary aims are to assess fistula outcomes.</p><p><strong>Methods: </strong>A retrospective review evaluated non-syndromic patients with Veau III or IV CP ± cleft lip who underwent SLR from 1993-2023. Patients undergoing modified SLR were compared to those receiving traditional SLR. Outcomes included postoperative palatal fistula, fistula location, fistula repair rates, and velopharyngeal insufficiency (VPI) correcting surgery rates. Multivariable logistic regression was performed.</p><p><strong>Results: </strong>Overall, 343 patients were included (160 modified SLR, 183 traditional SLR). Average length of follow-up from palatoplasty was 6.4±5.3 years. Modified SLR was associated with fewer fistulas than traditional SLR (3.1% vs 15.3%, Odds Ratio [OR]: 0.19; p=0.001), lower fistula repair rates (0.6% vs 13.1%, OR: 0.26; p=0.022), and lower secondary speech surgery rates (0.8% vs 16.0%, OR: 0.046; p=0.003).</p><p><strong>Conclusion: </strong>The modified SLR technique resulted in lower rates of VPI surgery, as well as fewer fistulas and lower rates of fistula repairs compared to traditional SLR at six years postoperatively. We hypothesize that releasing the nasal mucosa off the hard palate facilitates more posterior positioning of the levator muscle and less restricted medial mobilization of the oral mucosa, which lengthens the velum to alleviate VPI.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731838","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 Pre-Operative 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":"https://doi.org/10.1097/PRS.0000000000011907","url":null,"abstract":"<p><strong>Background: </strong>Electrodiagnostic (EDX) studies are critical for surgical decision-making in nerve injuries. Surgeons typically rely on the electrodiagnostician's reports and lack formal training in EDX interpretation. This knowledge gap highlights a need for accessible and effective educational resources for surgeons to improve their understanding of EDX and enhance patient care.</p><p><strong>Methods: </strong>The educational module consisted of a pre-lecture knowledge assessment, a 42-minute video lecture on interpreting electrodiagnostic studies, and a post-lecture knowledge assessment. Knowledge retention was assessed via an additional survey distributed three 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 EDX interpretation. Median scores increased from 7 to 9 (p<0.001), with improvement persisting at three months (median retention score of 11, p<0.025). Notably, among surgeons completing the three-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 EDX 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":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","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":"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":"https://doi.org/10.1097/PRS.0000000000011877","url":null,"abstract":"<p><strong>Background: </strong>Brachial plexus birth injuries (BPBI) occur as a result of a difficult delivery. External rotation of shoulder (ER) is usually one of the last movements which 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 our retrospective study was to describe spontaneous recovery of active ER and evaluate predicting factors for the recovery.</p><p><strong>Methods: </strong>We screened 562 patients and identified a consecutive cohort of 103 BPBI patients, who had no active ER at the age of 3 months. We systematically collected clinical data on recovery. In addition, we 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 (51%) patients spontaneously recovered ER, 44% of whom were 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 decision about peripheral nerve transfer surgery to improve ER in BPBI.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Surgical Outcomes of Intermediate Cleft Rhinoplasty.","authors":"Jinggang J Ng, Liana Cheung, Benjamin B Massenburg, Daniel Y Cho, Meagan Wu, Dominic J Romeo, Jordan W Swanson, Oksana A Jackson, David W Low, Jesse A Taylor","doi":"10.1097/PRS.0000000000011878","DOIUrl":"10.1097/PRS.0000000000011878","url":null,"abstract":"<p><strong>Background: </strong>The risk/benefit ratio of operating on the cleft nasal deformity in the period of mixed dentition remains debated. This study characterizes our 18-year experience with intermediate cleft rhinoplasties to add data and nuance to the discussion.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of patients who underwent intermediate cleft rhinoplasty from 2006 to 2023. Demographic information and operative details were collected. Primary outcomes were operative complications and need for subsequent rhinoplasty.</p><p><strong>Results: </strong>Three-hundred and forty-two patients undergoing 372 intermediate rhinoplasties were included: 150 (40.3%) with no graft/implant, 165 (44.4%) with iliac crest cartilage graft, 36 (9.7%) with ear cartilage, 19 (5.1%) with a resorbable plate, and 3 (0.8%) with nasal cartilage. Use of iliac crest graft predicted fewer subsequent rhinoplasties independent of age at surgery, age at most recent follow-up, sex, race, syndromic status, cleft severity, intranasal stenting duration, and surgeon (β=-0.234, p=0.012). Employment of a V-Y chondromucosal flap in the unilateral cleft lip group (β=-0.401, p=0.002) and placement of a columellar strut graft in the bilateral cleft lip group (β=-0.450, p=0.028) predicted fewer subsequent rhinoplasties. The proportion of rhinoplasties utilizing iliac crest grafts increased over time (r(372)=0.806, p<0.001). Most (55.0%) patients with follow-up beyond age 18 (n=60) did not require subsequent rhinoplasty.</p><p><strong>Conclusions: </strong>Iliac crest cartilage grafting as a columellar strut in bilateral clefts and a chondromucosal V-Y advancement in unilateral clefts were associated with a decreased need for future rhinoplasty. Further work is needed to understand the risk/benefit ratio, surgical burden, and patient-reported outcomes of intermediate rhinoplasty.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668680","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 Racial Representation of Cosmetic Minimally Invasive Procedure Patients and Physicians on Social Media.","authors":"Evan Rothchild, Eliana R Weinstein, Joshua Cohen, Geena Jung, Joseph A Ricci","doi":"10.1097/PRS.0000000000011876","DOIUrl":"10.1097/PRS.0000000000011876","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668682","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":"Predictors of Facial Synkinesis Severity.","authors":"Benjamin Rail, Natalie A Gault, Anthony J Dragun, Sahejbir S Bhatia, Chaia S Geltser, MinJae Lee, Shai M Rozen","doi":"10.1097/PRS.0000000000011888","DOIUrl":"10.1097/PRS.0000000000011888","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of studies exploring factors influencing synkinesis severity. This study aims to identify factors that may contribute to variations in severity of facial synkinesis.</p><p><strong>Methods: </strong>Patients with a diagnosis of facial synkinesis presenting between 2009 and 2024 were reviewed. The synkinesis score of the eFACE Facial Nerve Clinician-Graded Scale was analyzed for associations with patient characteristics and facial palsy history using univariable and multivariable analysis.</p><p><strong>Results: </strong>Two-hundred-forty-nine synkinesis patients were included in the study. The etiology of facial palsy was infectious or idiopathic in 185 patients (74%), tumor resection in 40 patients (16%), trauma in 17 patients (7%), and compression of the facial nerve by a benign tumor in seven patients (3%). Factors independently associated with more severe synkinesis scores included age of facial palsy onset over 50 years (-7.4, 95% CI, [-10.9, -3.9]; p < 0.001), diabetes (-8.6, 95% CI, [-14.9, -2.3]; p = 0.007), smoking (-4.9; 95% CI, [-8.0, -1.8]; p = 0.003), and intratemporal facial nerve injury (-19.4; 95% CI, [-27.8, -10.8]; p < 0.001). Other variables including sex, race, hypertension, and etiology were not found to be independently associated with synkinesis severity.</p><p><strong>Conclusions: </strong>Older age at facial palsy onset, diabetes, smoking, and intratemporal facial nerve injury were found to be independently associated with more severe synkinesis. These findings are novel and may aid in prognostication and treatment selection.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668681","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 effectiveness of pre-epiglottic baton plates and mandibular distraction in infants with Robin sequence.","authors":"Cory M Resnick, Jens de Gijsel, Snigdha Jindal, Mirja Quante, Christian Poets, Eliot Katz, Cornelia Wiechers","doi":"10.1097/PRS.0000000000011887","DOIUrl":"10.1097/PRS.0000000000011887","url":null,"abstract":"<p><strong>Background: </strong>Mandibular distraction osteogenesis (MDO) and pre-epiglottic baton plates (PEBP) are both effective for early management of upper airway obstruction (UAO) in infants with Robin sequence (RS), but have not been directly compared. The purpose of this study was to compare early airway, feeding and growth outcomes between these treatments.</p><p><strong>Methods: </strong>This is a bicentric retrospective cohort study from 2015-2021 including infants with RS treated with MDO or PEBP before 6 months-of-age with pre- and post-treatment sleep studies and follow-up at least through age 1-year. The primary outcome was immediate post-intervention UAO, measured as obstructive apnea-hypopnea index (oAHI) or obstructive apnea index (oAI), as available. Latest follow-up sleep studies, feeding and growth characteristics were also assessed.</p><p><strong>Results: </strong>114 subjects were included: MDO, n=31 and PEBP, n=83. Pre-treatment UAO was similar between groups (p=0.61). PEBP was initiated at a younger age (median [IQR] 31 [14,53] vs. 41 [28,84] days-of-life, p<0.05). Significant reduction of oAHI/oAI was achieved in both groups, but greater with MDO (98%) compared to PEBP (94%, p<0.05). PEBP demonstrated better early feeding and growth outcomes compared to MDO, with fewer surgical feeding tubes (p<0.001) and more rapid early growth (p=0.038). When stratified by pre-intervention UAO, infants starting with moderate UAO experienced similar airway outcomes with both treatments (p=0.11), while those with severe UAO had greater resolution with MDO (p<0.001).</p><p><strong>Conclusion: </strong>Both treatments effectively relieve moderate UAO in infants with RS, but MDO is more effective for infants with severe respiratory compromise.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668679","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":"Clinical Features of Conduction Block in Ulnar Neuropathy at the Elbow: The Surgery of the Ulnar Nerve (SUN) Multicenter Clinical Trial.","authors":"Kevin C Chung, Matthew M Florczynski, Sandra L Hearn, Hyungjin M Kim, Patricia B Burns, Sunitha Malay","doi":"10.1097/PRS.0000000000011859","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011859","url":null,"abstract":"<p><strong>Background: </strong>In ulnar neuropathy at the elbow, weakness is classically a sign of severe disease. Weakness is associated with motor axonal loss as measured by decreased distal compound muscle action potential (CMAP) amplitude. Conduction block, a demyelinating phenomenon that recovers readily, can also cause weakness, creating ambiguity for the treating clinician.</p><p><strong>Methods: </strong>This cross-sectional study evaluated baseline blinded data collected from 2020-2023 from the Surgery of the Ulnar Nerve randomized controlled trial comparing in-situ decompression versus transposition procedures. Adult patients underwent electrodiagnostic testing, clinical motor and sensory testing, and completed the Michigan Hand Questionnaire and Carpal Tunnel Questionnaire.</p><p><strong>Results: </strong>177 patients were categorized into 3 distinct groups based on normal distal CMAP amplitudes (77 patients), presence of conduction block with or without distal CMAP amplitude loss (37 patients), or pure axonal loss with distal CMAP amplitude loss in the absence of conduction block (63 patients). Compared to the normal group, patients with conduction block had significantly decreased pinch strength and worse function domain scores on the Michigan Hand Questionnaire and Carpal Tunnel Questionnaire, but shorter duration of disease. Patients with pure axonal loss had decreased pinch strength, worse 2-point discrimination, and worse overall, function and aesthetics domain scores on the Michigan Hand Questionnaire. There was a significant interaction between the effects of conduction block and distal CMAP amplitude on pinch strength, indicating that higher degrees of conduction block resulted in more pronounced loss of pinch strength in patients with relatively preserved distal CMAP amplitude.</p><p><strong>Conclusions: </strong>Our findings support the paradigm that ulnar neuropathy at the elbow presenting with conduction block represents a distinct and intermediate pathophysiology, distinguished by quicker onset with less advanced neurological deficits.</p><p><strong>Level of evidence: </strong>Prognostic Level II.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625972","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":"Correction of Microtia with Constricted Ear Features Using Helix Costal Cartilage Scaffold and Postauricular Flap Advancement.","authors":"Chenglong Wang, Dejin Gao, Pan Luo, Yue Wang, Qingguo Zhang","doi":"10.1097/PRS.0000000000011853","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011853","url":null,"abstract":"<p><strong>Background: </strong>Microtia with constricted ear features represents a challenging congenital deformity characterized by the variable shape and large volume of the remnant cartilage and skin involved. This study aims to evaluate the efficacy and safety of a method using helix costal cartilage scaffold and postauricular flap advancement for the correction.</p><p><strong>Methods: </strong>This retrospective study analyzed the clinical and postoperative data of 121 patients diagnosed with microtia and constricted ear features, treated at our institution between January 2020 and January 2023. All patients underwent helix reconstruction using the eighth or ninth costal cartilage combined with postauricular flap advancement. Outcomes were assessed based on the incidence of postoperative complications and auricular aesthetic scores. The aesthetic evaluation of the reshaped auricle was based on a four-point Likert scale (i.e. 1 = poor, 2 = fair, 3 = good, 4 = excellent).</p><p><strong>Results: </strong>The postoperative follow-up period ranged from 12 months to 3 years (mean 18.5 months). All patients achieved successful helix expansion, with reconstructed ears showing improved symmetry and shape comparable to the contralateral normal ears. The average aesthetic score was 3.4 out of 4. Complications included suture exposure in 8.3% of cases and cartilage protrusion in 4.1%, both managed without significant issues. There were no instances of skin necrosis, costal cartilage exposure, or infection.</p><p><strong>Conclusions: </strong>The combination of helix costal cartilage scaffold and postauricular advancing flap offers a reliable and effective method for correcting microtia with constricted ear features, providing satisfactory aesthetic outcomes with minimal complications.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625976","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":"Representation of Asian American, Native Hawaiian, and Pacific Islander Patients in Plastic Surgery Literature.","authors":"Dylan K Kim, Luisa Taverna, Christine H Rohde","doi":"10.1097/PRS.0000000000011856","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011856","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625979","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}