Plastic and reconstructive surgery最新文献

{"title":"Simulation in Cleft Care: Evolution, Evidence, and Training the Future Surgeon.","authors":"Allison L Diaz, Rami Kantar, Dale J Podolsky, Roberto L Flores","doi":"10.1097/PRS.0000000000012373","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012373","url":null,"abstract":"<p><strong>Summary: </strong>Strict trainee work-week hour restrictions, increased complexities of surgical care, and shifting hospital policies have posed challenges to operating room training for residents in high-resource regions. A shortage of cleft-trained surgeon educators and inconsistent training curricula further limit exposure to cleft operative education in low-resource settings. Furthermore, teaching cleft surgery can be difficult given the confined space of the infant oral cavity and the small, delicate flaps used for reconstruction. In the face of these challenges, the role of simulation has expanded in surgical education to supplement intraoperative training and increase resident preparedness. Smile Train, a nonprofit cleft-focused organization, in partnership with the technology companies BioDigital (New York, NY) and Simulare Medical (Toronto, Ontario, Canada), and academic plastic surgeons, has developed and globally distributed a variety of simulation resources for cleft surgery. This work provided a comprehensive review of Smile Train-distributed simulator modalities, including surgical training videos, a digital simulation platform, high-fidelity physical simulators, and virtual reality models. This review described the evolution of these models, the effects on learner experience, knowledge, and surgical performance, as well as directions for future development.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4S-2","pages":"56S-71S"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150374","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":"Plastic and Reconstructive Surgery Best Paper Awards 2025.","authors":"Kevin C Chung, Aaron Weinstein, Joseph J Disa, Bernard L Markowitz, Samuel J Lin, Amy S Colwell, Justine C Lee, Kyle R Eberlin, Larry Hollier, Edward I Chang, John P Fischer, Matthew M Hanasono, Ash Patel, John Y S Kim","doi":"10.1097/PRS.0000000000012340","DOIUrl":"https://doi.org/10.1097/PRS.0000000000012340","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4","pages":"663-669"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150453","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 Study of Inflammatory and Fibrotic Reactions Induced by Silicone Implants with Different Hardness.","authors":"Da Woon Lee, Si-Hyong Jang, Hyun Kim, Taek Kyun Kim, Je Yeon Byeon, Hwan Jun Choi","doi":"10.1097/PRS.0000000000012055","DOIUrl":"10.1097/PRS.0000000000012055","url":null,"abstract":"<p><strong>Background: </strong>Silicone nasal implants have been widely used in rhinoplasty. However, research on the correlation between implant hardness and the development of fibrosis and inflammation is lacking. This study investigated how the hardness of silicone implants influences fibrosis and inflammation through an experimental investigation.</p><p><strong>Methods: </strong>Three types of nasal silicone implants with varying hardness levels were implanted bilaterally on the backs of 15 Wistar rats. Ten weeks after implantation, clinical aspects-such as differences in immune reactions and formation of peri-implant capsules-were analyzed. The intratissue response of the host was assessed by quantitative real-time polymerase chain reaction using 11 markers. Specific markers were investigated by immunohistochemical staining. Pathologic grading was performed to investigate inflammation and fibrosis in the peri-implant tissues. Quantification and statistical analysis of these parameters were conducted to derive scores for intergroup comparisons.</p><p><strong>Results: </strong>Histologic analysis of the 45 capsules obtained revealed lower levels of fibrosis and acute inflammation in the group with lower hardness. This result was confirmed by immunohistochemical staining. Hematoxylin and eosin staining showed that the capsule thickness was less in the low-hardness group. In addition, inflammation resolved quickly in the low-hardness group, and mature fibrotic tissue was observed.</p><p><strong>Conclusions: </strong>When silicone implants are stably positioned within the body, less-rigid implants exhibit lower inflammatory or fibrotic responses. This is directly related to the adverse effects associated with capsule formation. These findings contribute to our understanding of the behavior of heterotopic materials in the nasal dorsum and their effects on the skin and soft-tissue envelope.</p><p><strong>Clinical relevance statement: </strong>This study highlights the impact of implant hardness on rhinoplasty outcomes, with softer implants reducing inflammation and fibrosis. Plastic surgeons should prioritize softer silicone implants to lower complication risks and improve long-term results.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"567-577"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516397","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":"Artificial Intelligence Risk Prediction Tools for Alloplastic Breast Reconstruction.","authors":"Jonlin Chen, Ariel Gabay, Minji Kim, Uchechukwu Amakiri, Lillian A Boe, Carrie Stern, Babak J Mehrara, Chris Gibbons, Jonas A Nelson","doi":"10.1097/PRS.0000000000012124","DOIUrl":"10.1097/PRS.0000000000012124","url":null,"abstract":"<p><strong>Background: </strong>Accurate risk prediction for patients undergoing breast reconstruction with tissue expanders (TEs) can improve patient counseling and shared decision-making. This study aimed to develop and evaluate traditional statistical and machine learning (ML) approaches to predicting complications in alloplastic breast reconstruction.</p><p><strong>Methods: </strong>Patient characteristics, surgical techniques, and complications were collected for all women undergoing immediate TE placement from 2017 to 2023 at Memorial Sloan Kettering Cancer Center. Multivariable logistic regression and ML models were developed to predict TE loss, infection, and seroma. ML model performance was optimized using 10-fold cross-validation with hyperparameter tuning. Evaluation metrics included area under the receiver operating curve (AUC), sensitivity, specificity, and Brier score.</p><p><strong>Results: </strong>This study included 4046 women undergoing 6513 immediate TE placements. TE loss occurred in 7.6% of patients (4.8% of TEs), infection in 10% of patients (7.2% of TEs), and seroma in 11.5% of patients (6.2% of TEs). Traditional multivariable regression demonstrated AUCs of 0.63 to 0.69 and ML models demonstrated AUCs of 0.71 to 0.73 in predicting TE complications. Shapley Additive Explanations analysis highlighted body mass index, prepectoral placement, and chemotherapy as key predictors of TE complications. Top-performing models were built into nomograms and a web-based prediction application to provide real-time risk estimates based on patient-specific information.</p><p><strong>Conclusions: </strong>Accurate risk prediction tools using nomograms and ML models were developed to predict complications in alloplastic breast reconstruction. These findings support incorporating both traditional statistics and ML analyses into preoperative assessments of patients undergoing alloplastic breast reconstruction to enhance data-driven, personalized care.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"639-650"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773058","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":"Targeted Muscle Reinnervation for the Treatment of Painful Neuromas: A Prospective Cohort Study.","authors":"Mirte Langeveld, Caroline A Hundepool, A J M Luijsterburg, Dominic Power, Liron S Duraku, J Michiel Zuidam","doi":"10.1097/PRS.0000000000012152","DOIUrl":"10.1097/PRS.0000000000012152","url":null,"abstract":"<p><strong>Background: </strong>Peripheral neuromas commonly occur after nerve injuries. Targeted muscle reinnervation (TMR) has been gaining popularity in the treatment of painful neuromas. The aim of this study was to prospectively evaluate the effectiveness of TMR in the treatment of symptomatic neuromas.</p><p><strong>Methods: </strong>The study prospectively observed patients treated for a symptomatic neuroma in the upper or lower extremity with TMR. Data were collected preoperatively and 3 and 12 months after surgery. The primary outcome was the pain score at rest on the 0 to 10 visual analog scale (VAS). Secondary outcomes included pain during activity, the percentage of patients with a postoperative VAS score of 3 or below, and quality of life.</p><p><strong>Results: </strong>Forty patients underwent TMR for a neuroma in the extremity. VAS pain levels at rest improved for 29 out of 40 participants (72.5%). Mean VAS pain score at rest improved significantly from 6.6 ± 2.2 preoperatively to 4.3 ± 2.7 at 3-month follow-up and 3.7 ± 2.8 at 12-month follow-up ( P < 0.001). Time interval from nerve injury to TMR was positively correlated with VAS pain score at 12-month follow-up ( r = 0.35, P = 0.026). Quality of life improved significantly, from a EuroQoL 5D-5L index score of 0.43 ± 0.26 preoperatively to 0.55 ± 0.30 at 12-month follow-up ( P = 0.016).</p><p><strong>Conclusions: </strong>TMR reduces limb pain in more than 70% of patients with symptomatic neuromas and is associated with an improvement in quality of life. Further research is needed to identify prognostic factors for the success of TMR as well as to establish its effectiveness in comparison with other surgical treatments.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"585e-592e"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978130","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 Influence of the Pitanguy Ligament on the Supratip Break Point in Open Rhinoplasty.","authors":"Stav Brown, Rod J Rohrich","doi":"10.1097/PRS.0000000000012093","DOIUrl":"10.1097/PRS.0000000000012093","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4","pages":"547-548"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150464","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: Deep Plane Face Lift in Asian Patients.","authors":"Bernard L Markowitz","doi":"10.1097/PRS.0000000000012181","DOIUrl":"10.1097/PRS.0000000000012181","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4","pages":"497e-498e"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150481","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":"Bridging the Gap: Challenges and Opportunities for Advancing Cleft Nursing in Sub-Saharan Africa.","authors":"Vamsi C Mohan, Winston R Owens, Rona J Breese","doi":"10.1097/PRS.0000000000012367","DOIUrl":"10.1097/PRS.0000000000012367","url":null,"abstract":"<p><strong>Background: </strong>Nurses are integral members of the multidisciplinary cleft team, providing care throughout a child's treatment course. However, in resource-limited regions, such as sub-Saharan Africa (SSA), unique challenges can hinder the delivery of high-quality nursing care, while also presenting opportunities to advance cleft nursing practice. This article highlights the challenges nurses face and explores opportunities to improve nursing care in SSA.</p><p><strong>Methods: </strong>A literature review, recorded feedback from Smile Train's Nursing Care Saves Lives program (a cleft-specific nursing training program), and the senior author's (R.J.B.) experience were used to depict the challenges encountered and the subsequent opportunities to enhance nursing care in SSA.</p><p><strong>Results: </strong>Challenges preventing optimal delivery of cleft-specific nursing care include workforce shortages, nursing education and professional development, resource limitations, and health care hierarchy. However, improvements in interprofessional education and collaboration, nurse availability, medical equipment allocation, and professional empowerment can mitigate the obstacles nurses encounter, allowing for enhanced comprehensive cleft care within SSA.</p><p><strong>Conclusions: </strong>Overcoming the obstacles that nurses experience in providing care to patients with a cleft lip and/or palate requires discussions on expectations for nursing practice (eg, nurse to patient ratios, frequency of monitoring, and required skill sets) that must occur at the highest levels of hospital and national planning. While workforce shortages are a well-documented challenge in SSA and will require long-term, multisectoral solutions, it remains essential to prioritize safe care delivery. Targeted improvements in nurse staffing allocation, even within resource-constrained systems, can make a measurable difference in cleft surgical outcomes.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"156 4S-2","pages":"5S-13S"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150296","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":"Relation between Preoperative Orbital Morphology and Long-Term Ophthalmologic Outcome Up to 15 Years of Age in Unicoronal Synostosis.","authors":"Hanna Lif, Romain Touzé, Johan Vegelius, Evangelia Ntoula, Giovanna Paternoster, Eva Larsson, Roman Khonsari, Daniel Nowinski","doi":"10.1097/PRS.0000000000012051","DOIUrl":"10.1097/PRS.0000000000012051","url":null,"abstract":"<p><strong>Background: </strong>Long-term ophthalmologic manifestations constitute the main functional issue in unicoronal synostosis, with large interindividual variability. The relation between preoperative orbital morphology and long-term functional outcome is not fully understood.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients with nonsyndromic unicoronal synostosis treated with fronto-orbital advancement and remodeling (FOAR) between 2014 and 2023 at Necker Hospital, Paris, France, or Uppsala University Hospital, Sweden, were included and paired with controls. Preoperative computed tomography (CT) and all ophthalmologic follow-up examinations 1 year or later after surgery were included. Objective 3-dimensional measurements on CT scans were used to analyze symmetry and local and global shape differences. The degree of severity in preoperative orbital morphology was correlated to long-term outcomes of oculomotor disorders, amblyopia, anisometropia, and astigmatism.</p><p><strong>Results: </strong>Thirty-six patients and 36 controls were included. The mean ages were 8.5 ± 7 months (range, 0.3 to 34 months) at CT examination, 12 ± 7 months (range, 8 to 36 months) at FOAR, and 6 ± 3 years (range, 2 to 15 years) at last ophthalmologic examination. Ipsilateral large global shape deformity of the orbit was related to strabismus (vertical strabismus in particular) and pseudotrochlear palsy at long-term follow-up. Neither preoperative contralateral morphology nor age at FOAR was associated with ophthalmologic outcomes.</p><p><strong>Conclusions: </strong>Ipsilateral oculomotor disorders at follow-up correlate with the degree of global orbital deformity primarily caused by the synostosis, suggesting that preoperative ipsilateral morphology might constitute a predictive factor for poor ophthalmologic outcome, whereas neither age at FOAR nor contralateral morphology influenced long-term ophthalmologic outcome. FOAR does not seem to prevent or reduce strabismus.</p><p><strong>Clinical question/level of evidence: </strong>Risk, II.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"553e-562e"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573517","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":"LigaSure-Assisted Submandibular Gland Excision in Deep-Plane Neck Lift: Review of 83 Patients.","authors":"Jure Pupić-Bakrač, Ana Pupić-Bakrač","doi":"10.1097/PRS.0000000000012047","DOIUrl":"10.1097/PRS.0000000000012047","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"623e-625e"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573514","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}