Plastic and reconstructive surgery最新文献

{"title":"Barriers to Care Associated with Pediatric Orofacial Clefts Global Disease Burden.","authors":"Erin K O'Connor, Adee J Heiman, Kexin Li, Lu Wang, Arun K Gosain, Kevin C Chung","doi":"10.1097/PRS.0000000000012749","DOIUrl":"10.1097/PRS.0000000000012749","url":null,"abstract":"<p><strong>Background: </strong>Orofacial clefts disproportionately affect low-income and middle-income countries. This study aimed to identify barriers to seeking, accessing, and receiving cleft care that are associated with increased pediatric cleft disease burden and repair rates globally.</p><p><strong>Methods: </strong>Live birth, incidence, prevalence, disability-adjusted life year (DALY), and mortality rates of pediatric orofacial clefts were extracted from the 2021 Global Burden of Disease database for each country. Cleft repair rates were estimated based on these data. Multivariable linear regression was used to determine associations between log-transformed DALYs and cleft repair rates with several global developmental indicators.</p><p><strong>Results: </strong>Unrepaired cleft prevalence, DALYs, and mortality were highest in low- and middle-income countries, although incidence per live birth was not statistically different across different income groups. Compared with prevalence in 2019, global prevalence remained unchanged, whereas DALYs decreased as a result of lower mortality rates across all income groups. LogDALYs were associated most closely with fewer doctors, decreased internet use, and lower road density. Repair rates were closely associated with greater surgeon volume, mobile phone (or internet) use, and health expenditure. Presence of nongovernmental organizations was not significantly associated with repair rates after adjustment for other variables.</p><p><strong>Conclusions: </strong>Decreased internet use, lower road density, and decreased physician workforce were independently associated with increased cleft burden. Lower surgical workforce was associated with decreased rates of cleft repair. Efforts to address these barriers to care include using alternative methods of information dissemination, spreading telehealth efforts in areas with adequate technological infrastructure, and bolstering surgical and physician workforce.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"633-645"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820478","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":"Major Anatomic Variations of the Upper Extremity Superficial Lymphatic System.","authors":"James E Fanning, Madeleine Givant, Angela Chen, Sarah Thomson, Elizabeth Tillotson, Aaron Fleishman, Kevin Donohoe, Dhruv Singhal","doi":"10.1097/PRS.0000000000012827","DOIUrl":"10.1097/PRS.0000000000012827","url":null,"abstract":"<p><strong>Background: </strong>Lymphatic anatomy has traditionally been described through cadaveric dissections. Mapping of the upper extremity superficial lymphatic system with indocyanine green (ICG) lymphography provides functional insights and reveals major anatomic variations.</p><p><strong>Methods: </strong>Healthy women underwent lymphatic mapping of the upper extremities with ICG lymphography. ICG was injected in 6 standard sites in the hand/wrist and upper arm. Major anatomic variations of 4 main forearm pathways and connectivity to 4 upper arm pathways were revealed.</p><p><strong>Results: </strong>Ninety arms of 45 participants were included. The posterior radial channel predominantly courses in the dorsal forearm (98%). The posterior ulnar forearm pathway courses in the dorsal forearm in the majority of arms (70%). The anterior radial and anterior ulnar forearm channels exclusively course in the volar forearm (100%). The posterior radial pathway connects to the bicipital (80%), lateral (48%), medial (9%), and tricipital (7%) upper am pathways. The posterior ulnar pathway connects to the lateral (54%), tricipital (51%), medial (21%), and bicipital (14%) upper arm pathways. The anterior radial pathway connects to the medial (50%) and bicipital (60%) pathways. The anterior ulnar pathway connects to the medial (54%) and bicipital (59%) pathways.</p><p><strong>Conclusions: </strong>Upper extremity lymphatic drainage to the lateral and tricipital pathways is enabled exclusively by the dorsal forearm channels, suggesting their importance in breast cancer-related lymphedema risk. Variations of upper extremity lymphatic anatomy are relevant to the risk, prevention, and treatment of breast cancer-related lymphedema risk and warrant further study.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"554e-564e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019241","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":"Indocyanine Green Angiography Predicts Postoperative Volume Changes in DIEP Flap Breast Reconstruction.","authors":"Jeeyoon Kim, Byeol Kim, Daiwon Jun, Jiyoung Rhu, Pill Sun Paik, Miju Park, Jung Ho Lee","doi":"10.1097/PRS.0000000000012776","DOIUrl":"10.1097/PRS.0000000000012776","url":null,"abstract":"<p><strong>Background: </strong>Deep inferior epigastric artery perforator (DIEP) flaps are commonly used in breast reconstruction due to their muscle-sparing nature. However, postoperative volume changes can affect long-term breast symmetry. This study evaluates the predictive value of intraoperative indocyanine green (ICG) angiography findings for postoperative volume changes in DIEP flaps.</p><p><strong>Methods: </strong>This retrospective cohort study included 44 patients who underwent unilateral breast reconstruction with unipedicled DIEP flaps between September of 2019 and February of 2024. Intraoperative flap perfusion was assessed using ICG angiography, and the ICG flow inset ratio was calculated. Flap volume was measured intraoperatively and about 1 year postoperatively using magnetic resonance imaging. Multivariable linear regression and receiver operating characteristic analysis were performed to identify predictors of volume preservation.</p><p><strong>Results: </strong>The average flap volume at 1 year was 85.2% of the initial volume. Higher ICG flow inset ratios were significantly associated with better volume preservation (β = 0.083; P = 0.047); radiotherapy was correlated with increased volume loss (β = -0.155; P < 0.001). The optimal ICG flow inset ratio cutoff for predicting above-average volume maintenance was 1.325 (area under the receiver operating characteristic curve = 0.700).</p><p><strong>Conclusions: </strong>ICG angiography can guide intraoperative decision-making to optimize postoperative volume outcomes in breast reconstruction. Higher intraoperative ICG flow inset ratios predict improved long-term volume preservation in DIEP flap breast reconstruction. Targeting a ratio above 1.325 and careful flap design may support better symmetry, particularly in patients undergoing radiotherapy.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"598e-606e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844026","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":"Relapse to Presurgical Condition after Lymphovenous Anastomosis: Analysis of Risk Factors in a Cohort of 90 Patients.","authors":"Carmen Higueras, Jan Xarrié Planas, Maria Del Río, Cristian Carrasco López, Marc Blasi Brugué, Joon Pio Hong, Paloma Malagón López","doi":"10.1097/PRS.0000000000012780","DOIUrl":"10.1097/PRS.0000000000012780","url":null,"abstract":"<p><strong>Background: </strong>Secondary lymphedema in patients with breast cancer is a debilitating condition that adversely affects quality of life. Lymphovenous anastomosis (LVA) has shown promising results, but its long-term effectiveness is a subject of ongoing investigation. This study was performed to evaluate relapse to a presurgical condition and associated risk factors in patients with breast cancer-related lymphedema (BCRL) treated with LVA. This is the first study to analyze lymphedema relapse after LVA, providing valuable insights for managing patient expectations.</p><p><strong>Methods: </strong>Between 2018 and 2023, 90 patients who underwent LVA for BCRL were included in this retrospective study. The authors evaluated relapse and potential risk factors, along with changes in limb circumference, subjective improvement, and frequency of infection episodes.</p><p><strong>Results: </strong>Relapse to the presurgical condition occurred in 11 patients (12.2%), with a mean time to relapse of 27.4 months after surgery. Patients with International Society of Lymphology stage 3 lymphedema (hazard ratio, 9.88; P < 0.05) and a history of infections (hazard ratio, 3.99; P < 0.05) had a higher incidence of relapse. Two out of 3 patients without regular use of preoperative compressive therapy experienced relapse ( P < 0.05). No significant associations were found between relapse and after surgery compression therapy, previous radiotherapy, duration of lymphedema, age, or body mass index.</p><p><strong>Conclusions: </strong>The low relapse rate suggests that LVA is an effective long-term treatment for BCRL. However, advanced stage lymphedema and history of infections in the affected limb may influence long-term effectiveness. Further studies are needed to identify additional risk factors for relapse.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"553-561"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844028","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":"Preventing Cheesewire and Hump Recurrence in Low Strip Preservation Rhinoplasty.","authors":"Rubén Guilarte, Ignacio Romero-López","doi":"10.1097/PRS.0000000000012653","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012653","url":null,"abstract":"<p><strong>Background: </strong>Hump recurrence represents a potential complication of preservation rhinoplasty. In the low septal strip technique, the quadrangular cartilage functions as a rotational advancement flap anchored to the anterior nasal spine. Proper fixation is crucial to prevent hump recurrence caused by backward rotation of the flap.</p><p><strong>Methods: </strong>All primary preservation rhinoplasties performed by the same surgeon with the low septal strip septoplasty technique between January of 2021 and December of 2023 were analyzed retrospectively, comparing conventional fixation with mattress sutures to a novel technique, referred to as kite fixation. The primary outcome variables were the presence or absence of hump recurrence and the need for revision surgery.</p><p><strong>Results: </strong>A total of 823 patients were included in the study, with 405 in the conventional fixation group and 418 in the kite-shaped fixation group. Demographic characteristics were comparable between the groups. Statistically significant differences were observed in terms of hump recurrence (4.6% versus 1.2%) and the necessity of revision surgery (4.3% versus 1.1%).</p><p><strong>Conclusions: </strong>Hump recurrence and minihumps remain significant drawbacks in preservation rhinoplasty. Proper fixation of the rotated septal flap is crucial to achieving long-term postoperative stability. Redistributing the tension of the suture loops into a triangular configuration, known as the kite-shaped method, has proven to be a simple, effective, and reproducible technique.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"158 4","pages":"607e-614e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081775","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":"An End to the Research Arms Race? How Changes to the Electronic Residency Application Service May Affect Plastic Surgery Applicants.","authors":"Atharva M Bhagwat, Rohun Gupta, Brian A Mailey, Sumesh Kaswan, Michael L Bernstein","doi":"10.1097/PRS.0000000000013077","DOIUrl":"10.1097/PRS.0000000000013077","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"744e-745e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147531827","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: The Tipping Point: Predictors of Implant Flipping in Staged Breast Reconstruction.","authors":"Allen Gabriel, G Patrick Maxwell","doi":"10.1097/PRS.0000000000013170","DOIUrl":"https://doi.org/10.1097/PRS.0000000000013170","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"158 4","pages":"519-520"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081764","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":"\"Graduating\" from Cleft Care and the Illusion of Finality.","authors":"Ethan J Richlak, Canice E Crerand","doi":"10.1097/PRS.0000000000013069","DOIUrl":"10.1097/PRS.0000000000013069","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"741e-742e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503934","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":"Application of a Microsuction Background Device for Microanastomosis in a Rat Femoral Vessel Model: Retraction.","authors":"","doi":"10.1097/PRS.0000000000013378","DOIUrl":"10.1097/PRS.0000000000013378","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"158 4","pages":"711"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081374","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":"Do Long-Term Thoracic Adaptations Occur in Pediatric Microtia Patients after Costal Cartilage Harvesting?","authors":"Jisu Kim, Chanwoo Park, Kap Sung Oh, So Young Lim","doi":"10.1097/PRS.0000000000012687","DOIUrl":"10.1097/PRS.0000000000012687","url":null,"abstract":"<p><strong>Background: </strong>Among the various reconstructive options for congenital microtia, autologous rib cartilage grafting is widely used due to its favorable long-term aesthetic outcomes. However, concerns persist regarding postoperative chest wall deformities following costal cartilage harvest. This study assesses long-term morphological changes using 3-dimensional chest computed tomography scans, specifically focusing on patients who have reached full skeletal maturity.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent microtia reconstruction using rib cartilage graft. Only those who had follow-up computed tomography scans taken at least 5 years postoperatively and were older than 18 years at the time of the scan were included. Thoracic morphology at the costochondral junction midpoint (fifth to ninth ribs) was analyzed using key measurements, including transverse, anteroposterior, and sagittal dimensions, as well as modified Haller indices.</p><p><strong>Results: </strong>A total of 21 male patients were included, with a mean follow-up period of 101 months. In the operative hemithorax, the costochondral junction midpoint shifted medially (fifth to ninth ribs), posteriorly (sixth rib), and exhibited less descent (sixth to ninth ribs) compared with the nonoperative hemithorax, with significant differences ( P < 0.05). In addition, the operative hemithorax had a smaller cross-sectional area than the nonoperative side (fifth to ninth ribs, P < 0.05). Although significant differences in the modified Haller Index were noted at the xiphisternal level, differences in thoracic height were minimal.</p><p><strong>Conclusions: </strong>Despite perichondrium-preserving techniques, rib cartilage harvest leads to permanent thoracic asymmetry, particularly in transverse and sagittal dimensions. However, longitudinal compensatory growth appears to mitigate height differences after skeletal maturity. These potential deformities should be discussed with patients during preoperative counseling to ensure informed decision-making.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"675e-683e"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678366","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}