Plastic and reconstructive surgery最新文献

{"title":"HAND PERFORATORS: AN ANATOMICAL STUDY.","authors":"Murat S Alagoz, Ahmet C Uysal, Atakan Sahiner, Eray Tuccar, Hakan Orbay, Ayhan Comert, Ibrahim Tekdemir, Ceyhun Uzun, Mehmet Yilmaz, Yusuf B Cinar","doi":"10.1097/PRS.0000000000012063","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012063","url":null,"abstract":"<p><strong>Background: </strong>Perforator flaps, now used in various parts of the body, serve as a crucial option for the reconstruction of defects in the hand region, often caused by tumor resections, trauma, or burns. Understanding the anatomy of hand perforators allows for the design of flaps closer to the defect, improving tissue compatibility without requiring the sacrifice of major arteries.</p><p><strong>Methods: </strong>The study was conducted on 22 hands from 11 cadavers fixed in a 10% formaldehyde solution. The radial and ulnar arteries were dissected in the distal third of the forearm. Following cannulation, dyed latex solution was injected into each artery. During the dissection, skin perforators were measured with a digital micrometer and the exit points were recorded.</p><p><strong>Results: </strong>At least one perforator vessel was found in every palmar subregion examined during cadaver dissections. The proximal hypothenar region, distal thenar region, and midpalmar region allow for the design of safe, defect-adjacent flaps with more perforators compared to other palmar regions. On the dorsal side, the middle part of the dorsum had the fewest perforators, and in some hands, no perforators were found in this region.</p><p><strong>Conclusions: </strong>This study details the anatomy of skin cutaneous perforators of hand. Knowing the perforator anatomy of the hand enables surgeons to design flaps of appropriate location and size for the defect, achieving maximum surgical benefit with minimal morbidity.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625674","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":"Letter to the Editor \"Low Strip Unifying Hybrid Rhinoseptoplasty: A Novel Classification in Dorsal Preservation Surgery\".","authors":"Anil Demiroz, Sukru Yazar, Zekeriya Tosun, Sakir Unal, Ahmet Demir, Sinan Oksuz, Cetin Duygu","doi":"10.1097/PRS.0000000000012081","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012081","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649929","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 Role of Local Flaps in Foot and Ankle Reconstruction: An Assessment of Outcomes across 206 Patients with Chronic Wounds.\"","authors":"Changkai Zhou, Tie Xiang","doi":"10.1097/PRS.0000000000012083","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012083","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649919","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":"\"Letter to the Editor: Medical Weight Management Considerations in Plastic Surgery\".","authors":"Zachary A Koenig, Halil Safak Uygur","doi":"10.1097/PRS.0000000000012082","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012082","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649917","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":"Pre-expanded perforator flaps for neo-esophageal reconstruction: A salvage procedure for the treatment of bipolar upper-GI tract exclusion.","authors":"Nicolas Bertheuil, Damien Bergeat, Bernard Meunier, Maximilien Thoma, Yanis Berkane, Benoit Lengelé","doi":"10.1097/PRS.0000000000012077","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012077","url":null,"abstract":"<p><strong>Background: </strong>Total esophageal reconstruction after failure of conventional techniques is a significant surgical challenge, particularly in fragile, multi-operated patients. Traditional options, including gastroplasties, colon transfers, and free jejunal flaps, carry high morbidity, failure rates, or surgical complexity.</p><p><strong>Material and methods: </strong>We report an innovative four-step strategy for esophageal reconstruction using a presternal skin tube created with tissue expanders and perforator flap techniques. Six patients with prior definitive esophageal exclusion underwent reconstruction between 2009 and 2023. The procedure involved patients with a complex medical history and multiple reconstruction failures, including gatroplasties, coloplasties, and/or ileocoloplasties, and consisted of i) Chest skin expansion with tissue expanders; ii) Tubularization of a perforator flap based on internal mammary vessels; iii) Anastomosis of the distal skin tube with a jejunal \"Y\" loop; and iv) Proximal anastomosis to the native cervical esophagus.</p><p><strong>Results: </strong>The entire reconstructive process was completed over 17.5±7.3 months. All patients achieved restoration of digestive tract continuity. Minor complications, including wound dehiscence and fistulas, were observed in all patients but resolved without major intervention. Functional outcomes were favorable with a maximum follow-up of 15 years, with patients tolerating liquids, semi-solids, and eventually solid foods after 2-3 months. Imaging and endoscopy confirmed lumen integrity, absence of strictures, and static skin-like epithelium without ulceration.</p><p><strong>Conclusion: </strong>This staged reconstruction offers a viable and safe alternative for total esophageal replacement in complex, high-risk patients, avoiding additional extensive intrathoracic procedures. The presternal neo-esophagus provides acceptable function with manageable complications.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625686","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":"Action Research on Combining the Teach-back Method to Optimize the Perioperative Clinical Care Pathway for Hair Transplant Patients.","authors":"Jingjing Huang, Wei Zhou, Jing Liu, Yulin Cao, Liang Guo, Jia Guo","doi":"10.1097/PRS.0000000000012076","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012076","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to optimize the perioperative clinical care pathway for hair transplantation patients by integrating action research and the teach-back method, and to validate its clinical application.</p><p><strong>Methods: </strong>A total of 116 hair transplantation patients were divided into control and experimental groups based on time periods.The control group followed the conventional care, while the experimental group utilized action research combined with the teach-back method for training and assessment.. After two iterative cycles of problem identification, planning, action, reflection, and implementation, the care pathway was refined. Outcomes measured included hair follicle survival rate, complication incidence, secondary transplantation rates within 12 months, postoperative self-management, and satisfaction.</p><p><strong>Results: </strong>The experimental group showed higher follicle survival rates (Z=8.788, P=0.001), lower complication incidence (χ²=3.940, P=0.047), improved postoperative self-management (Z=3.426, P=0.001), and greater satisfaction (χ²=4.245, P=0.039).There was no significant difference between the two groups in the occurrence of secondary hair transplantation within 12 months post-operation (P=0.618).</p><p><strong>Conclusion: </strong>By combining action research with the teach-back method, we significantly optimized perioperative care, achieving notable improvements in the survival rate of hair follicle units post-operation, a reduction in the incidence of complications, and enhancements in both postoperative self-management capabilities and patient satisfaction.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625657","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 Confluence Point: a new incision strategy for lymphaticovenular anastomosis in peripheral lymphedema.","authors":"Giuseppe Visconti, Akitatsu Hayashi, Joon Pio Hong","doi":"10.1097/PRS.0000000000012075","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012075","url":null,"abstract":"<p><strong>Background: </strong>In the last five years, many advances has been made in terms of preoperative planning using new imaging technologies. The high case load of lymphaticovenular anastomosis (LVA) performed using ultrahigh frequency ultrasound bring us to find a new incision site, the confluence point, where two major functional lymphatic channels merges into one than becomes sclerotic soon after.</p><p><strong>Patients and methods: </strong>From October 2021 to May 2022, 60 consecutive patients affected by extremity lymphedema who underwent LVA were prospectively assessed. Preoperative planning included ICG lymphography (ICG-L) and Ultra-high frequency ultrasound (UHFUS). The LVAs at the confluence points were evaluated in terms of operative time and LVA dynamics after the anastomosis, and compared to the incisions without confluence points.</p><p><strong>Results: </strong>The confluence point was preoperatively detected in 26 (43%) cases. The lymphatics proximal to the confluence point showed similar calibers to the distal ones, with no significant size increase, and underwent a lumen obstruction 0.5 to 1 cm after the confluence point in 22 (92%) cases. The mean operative times for LVA at the confluence points was 39 ± 8 minutes in ULL and 42 ± 6 minutes in LLL, significantly lower compared to the incisions with 2 anastomoses that was 57 ± 8 minutes for ULL (p<0.0001) and 69 ± 15 minutes for LLL (p<0.0001).</p><p><strong>Conclusion: </strong>The LVA of confluence points derives from the ultimate anatomical findings detectable by Ultra High-Frequency Ultrasound, and showed to be an effective method to minimise the number of LVA while maintaining the maximal lymph flow and the best dynamics through the anastomosis.Level of Evidence: IV, therapeutic study.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624697","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":"Assessing the Shift: Increasing Rates of Immediate Breast Reconstruction by Non-Plastic Surgeons - Insights from a Nationwide Analysis.","authors":"Lee Kilmer, Jessica Pawly, Hibo M Wehelie, Sadie English, Amanda K Silva, David Martin, Scott Hollenbeck","doi":"10.1097/PRS.0000000000012068","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012068","url":null,"abstract":"<p><strong>Background: </strong>Breast reconstruction techniques have advanced significantly over the last 50 years and are some of the most common services plastic surgeons provide in the United States. A growing perception exists that these procedures are increasingly performed by non-plastic surgeons, but the validity of this trend and its underlying drivers remain unknown.</p><p><strong>Methods: </strong>A national insurance database was queried to identify patients who underwent partial and total mastectomy between 2010-2021. Immediate reconstructive procedures, including breast reduction, tissue expander/implant placement, and autologous tissue transfers, were then captured and stratified by physician specialty: General or Plastic Surgery. Demographics, annual trends, and distance to Comprehensive Cancer Centers and plastic surgery residency programs were compared.</p><p><strong>Results: </strong>The rate of oncoplastic breast reductions increased over time, with more general surgeons performing oncoplastic breast reductions in 2021 compared to plastic surgeons (53.3% vs. 46.7%, p < 0.001). There was an increase in general surgeons performing implant-based breast reconstruction, which eclipsed that of plastic surgeons in 2021 (50.9% vs. 49.1%, p=0.028). Proximity to the closest NCI Cancer Center and plastic surgery residency programs was not significantly different amongst the groups (39.5 vs. 42.1 miles, p=0.66).</p><p><strong>Conclusion: </strong>General surgeons are performing an increasing number of breast reconstruction procedures. This shift from specialized plastic surgery care to non-specialized care is highly variable across the United States but not significantly associated with distance to specialty centers. Efforts are needed to determine the factors driving this shift and to develop strategies to ensure patients have access to specialized breast reconstruction care.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625668","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":"Is Preoperative Happiness Influencing BREAST-Q Outcomes?","authors":"Christian X Lava, Daisy L Spoer, Karen R Li, Ilana G Margulies, John Corbett, Lauren E Berger, Parhom N Towfighi, Niloofar Ghyasi, Sami Ferdousian, David H Song, Kenneth L Fan","doi":"10.1097/PRS.0000000000012070","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012070","url":null,"abstract":"<p><strong>Background: </strong>BREAST-Q captures quality of life implications of breast reconstruction but may draw influence from the patients' psychosocial circumstances. This study aims to test: 1) positive affect is associated with higher breast satisfaction and well-being, and 2) socioeconomic status (SES) impacts this relationship.</p><p><strong>Methods: </strong>This prospective study included breast reconstruction patients from August 2020 to October 2022. Cantril Ladder of Happiness (CLH) assessed happiness (1-5: unhappy, 6-10: happy). BREAST-Q was sent preoperatively and one, three, six, and 12 months postoperatively. Patient characteristics, oncologic treatments, perioperative details, and outcomes were collected.</p><p><strong>Results: </strong>A total of 49 (65.3%) identified as \"happy\" and 26 (34.8%) identified as \"unhappy\". \"Happy\" patients were more likely to have current employment (73.5% vs. 57.7%, p=0.039) and \"a lot\" of social network support (53.1% vs. 50.0%, p=0.045). \"Happy\" patients reported higher satisfaction with their breasts at baseline (53.7±23.9 vs. 40.±40.1, p=0.029) and three months (61.1±20.1 vs. 47.8±8.5, p=0.003); higher psychosocial well-being at baseline (69.8±17.3 vs. 52.8±18.8, p<0.001) and three months (73.8±20.5 vs. 60.4±18.8, p=0.047); and higher sexual well-being at three months (57.5±28.0 vs. 33.4±17.7, p=0.007) and one year (63.1±24.0 vs. 34.6±21.8, p=0.043). Patients with higher CLH scores reported higher psychosocial (β=12.9, p<0.001) and sexual well-being (β=16.94, p<0.001).</p><p><strong>Conclusion: </strong>\"Happy\" patients demonstrated higher satisfaction levels and improved psychosocial and sexual well-being compared to \"unhappy\" patients. SES played a role in patient satisfaction and overall well-being. Further research is warranted to identify suitable interventions, such as screening and early referral, that can help improve patient-reported outcomes for breast reconstruction patients.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625685","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":"Modification of Low-Septal-Strip Septoplasty to Reduce Hump Recurrence in Dorsal Preservation Rhinoplasty.","authors":"Vasfi Çelik, Yavuz Tuluy","doi":"10.1097/PRS.0000000000011640","DOIUrl":"10.1097/PRS.0000000000011640","url":null,"abstract":"<p><strong>Background: </strong>Among the problems encountered in dorsal preservation rhinoplasty are residual hump and hump recurrence. In this study, the authors performed a modification to lower strip resection and fixation of the septum, and investigated the clinical results of these modifications on hump recurrence.</p><p><strong>Methods: </strong>The study included 231 patients who underwent dorsal preservation rhinoplasty with low-septal-strip septoplasty between November of 2021 and February of 2023. Closed dorsal preservation rhinoplasty was performed with low-septal-strip septoplasty in 72 patients (31.2%), and modified low-septal-strip septoplasty was performed in 159 patients (68.8%). All cases were primary rhinoplasty. Demographic data, complication rates, revision operations, and follow-up periods were analyzed retrospectively.</p><p><strong>Results: </strong>The mean follow-up period was 9.68 ± 4.02 months (range, 3 to 16 months). Patient sex and age did not differ statistically significantly between the groups ( P > 0.05). Complications were observed in 8 of 231 of the patients (3.5%). The complications in the low-septal-strip septoplasty group ( P = 0.012) were statistically significantly higher than in those in the modified low-septal-strip septoplasty group ( P < 0.05). The incidence of recurrent hump complications in the low-septal-strip septoplasty group ( P = 0.029) was statistically significantly higher than in the modified group ( P < 0.05).</p><p><strong>Conclusions: </strong>Septum fixation is one of the most important parts of dorsal preservation rhinoplasty surgery and must be performed properly. In the authors' modification, the risk of recurrent hump is reduced, as sufficient septum fixation is achieved.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"448-456"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634229","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}