Plastic and reconstructive surgery最新文献

{"title":"The Eaton-Littler Ligament Reconstruction in Thumb Carpometacarpal Joint Instability: Outcomes and Prognostic Factors in 74 Patients.","authors":"Niek J Nieuwdorp, Isabel C Jongen, Caroline A Hundepool, Mark J W van der Oest, Thybout M Moojen, Ruud W Selles, J Michiel Zuidam","doi":"10.1097/PRS.0000000000011709","DOIUrl":"10.1097/PRS.0000000000011709","url":null,"abstract":"<p><strong>Background: </strong>The Eaton-Littler ligament reconstruction is widely used for thumb carpometacarpal instability, yet the existing literature lacks a thorough analysis of the outcomes for nontraumatic instability. This study aimed to assess the outcomes of the Eaton-Littler ligament reconstruction and to identify prognostic factors associated with postoperative pain.</p><p><strong>Methods: </strong>Patients with nontraumatic carpometacarpal joint instability, unresponsive to conservative treatment, were included in this prospective study. The visual analog scale (range 0 to 100) for pain and the Michigan Hand Outcome Questionnaire (MHQ; range 0 to 100) total score were measured at intake and 3 and 12 months postoperatively. Multivariable linear regression was used to analyze the association between preoperative variables and the 12-month MHQ pain score.</p><p><strong>Results: </strong>Seventy-four patients undergoing Eaton-Littler ligament reconstruction were included. The median visual analog scale pain score improved significantly ( P < 0.001) from intake (70 [interquartile range, 63 to 78]) to 12 months postoperatively (27 [interquartile range, 7 to 56]). The mean MHQ total score also improved significantly ( P < 0.001) from intake (52; SD, 13) to 12 months (74; SD, 17). All thumbs were stable at follow-up with preserved range of motion. Grip and pinch strength also improved significantly after surgery. Undergoing a concurrent surgery during ligament reconstruction and a better MHQ pain score at intake were found to be predictors of a favorable postoperative MHQ pain score.</p><p><strong>Conclusions: </strong>Patient- and clinician-reported outcomes improved significantly at 3 and 12 months after Eaton-Littler ligament reconstruction. The authors advise concurrent hand pathologies resulting from instability (eg, tendinitis, synovitis) to be treated simultaneously during ligament reconstruction.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"533e-542e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126302","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":"P Value Reporting and Reliability in Plastic and Reconstructive Surgery: A Primer for Readers and Investigators.","authors":"Joseph N Fahmy, Amy S Colwell, Kevin C Chung","doi":"10.1097/PRS.0000000000011519","DOIUrl":"10.1097/PRS.0000000000011519","url":null,"abstract":"<p><strong>Summary: </strong>The P value is ubiquitous in research. However, misuse and misinterpretation are common. This article aims to demystify the P value for researchers, students, physicians, and experienced investigators alike. To accomplish this aim, the origins of the P value, what it represents, and principles of application are described through use of examples from real data sets. Developing understanding of the true meaning of this statistical measure has the power to improve and inform clinical research.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"579-584"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899257","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: Nasal Tip Deprojection in Rhinoplasty.","authors":"Jeffrey Lisiecki","doi":"10.1097/PRS.0000000000011819","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011819","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 3","pages":"445-446"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503338","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: A National Analysis of Targeted Muscle Reinnervation following Major Upper Extremity Amputation.","authors":"Roland Zama, Aviram M Giladi","doi":"10.1097/PRS.0000000000011596","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011596","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 3","pages":"574-575"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503331","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":"Trends in Blood Mosaicism and Clinical Phenotype Score in Patients with Beckwith-Wiedemann Syndrome Evaluated for Tongue Reduction Surgery.","authors":"Dominic J Romeo, Connor S Wagner, Benjamin B Massenburg, Neil Reddy, Meagan Wu, Jinggang J Ng, Madison DeMarchis, Eric C Liao, Jennifer M Kalish, Jesse A Taylor","doi":"10.1097/PRS.0000000000011404","DOIUrl":"10.1097/PRS.0000000000011404","url":null,"abstract":"<p><strong>Background: </strong>Most patients with Beckwith-Wiedemann syndrome (BWS) have macroglossia, with some requiring tongue reduction surgery (TRS). This study reports correlations between levels of affected cells (mosaicism) and BWS clinical score in patients evaluated for TRS. The authors also show correlations of clinical score and mosaicism with obstructive sleep apnea (OSA) severity.</p><p><strong>Methods: </strong>Blood mosaicism levels and BWS clinical score were recorded in patients with macroglossia referred to plastic surgery for evaluation. Associations among blood mosaicism, BWS clinical score, TRS, and OSA were assessed with appropriate statistics.</p><p><strong>Results: </strong>Of the 225 patients included, BWS blood testing was available in 128 (56.9%). Mosaicism levels were higher in those who underwent TRS compared with those who did not (85.9% [56.5 to 95.9] versus 29.7% [2.8 to 73.1]; P < 0.001). BWS clinical score was also higher in those requiring TRS (9.0 [8.0 to 11.0] versus 7.0 [6.0 to 9.0]; P < 0.001). There was a positive correlation between clinical score and obstructive apnea-hypopnea index ( r = 0.320, P = 0.011). Receiver operating characteristic curve analysis showed that a clinical score of 11 or greater had 100% specificity and 36.4% sensitivity for detecting patients requiring TRS. Blood mosaicism of 80% or greater had 63.6% sensitivity and 83.6% specificity for predicting surgery. A combined criteria of BWS clinical score of 11 or greater or mosaicism of 80% or greater had 72.7% sensitivity and 83.6% specificity for predicting TRS.</p><p><strong>Conclusions: </strong>Blood mosaicism levels and higher BWS clinical scores seem to be associated with a greater frequency of having surgery in patients with macroglossia referred for surgical evaluation. Elevations in BWS clinical scoring are associated with increased OSA severity; increased blood mosaicism is not.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"573e-580e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175992","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":"Attenuated Angiogenesis and Macrophage Infiltration during Adipose Tissue Regeneration in Megavolume Human Fat Grafting.","authors":"Xin Bi, Weizi Wu, Jialiang Zou, Jing Zhao, Zhousheng Lin, Ye Li, Feng Lu, Jianhua Gao, Bin Li, Ziqing Dong","doi":"10.1097/PRS.0000000000011606","DOIUrl":"10.1097/PRS.0000000000011606","url":null,"abstract":"<p><strong>Background: </strong>Survival and regeneration mechanisms of large (>250 mL) fat grafts remain incompletely understood. In fat grafts from volunteers with megavolume fat transfer breast augmentation, neovascularization and inflammatory cell infiltration decreased within 7 days according to histologic analysis. The authors further investigated this phenomenon using a nude mouse model.</p><p><strong>Methods: </strong>To simulate clinical contexts, chambers containing 1 mL of human fat were implanted into nude mice. Chambers allowed selective transfer of tissue fluid from recipient nude mice into chambers, but not capillaries or macrophages. Seven days later, fat was removed from the chamber and reimplanted into a new nude mouse in the open-chambered fat group (OCFG) ( n = 45). Adipose samples from volunteers and explanted grafts from OCFG were subjected to histologic analyses. Graft weight, vascularization, and immune response were also compared between the OCFG and conventional direct fat grafting (control group [CG]).</p><p><strong>Results: </strong>Percentage tissue integrity, percentage fibrosis, adipocyte viability, and neovascularization did not significantly differ between volunteer samples and OCFG grafts at day 7. On day 90, OCFG retention rate was decreased relative to the CG, and the fibrosis area was larger in the OCFG than in the CG. However, the macrophage and capillary counts were lower in the OCFG group relative to the CG at days 7 and 14 after transplantation.</p><p><strong>Conclusions: </strong>The present study provides histologic analyses of megavolume fat grafts sampled from clinical breast augmentation tissues and a xenograft nude mouse model. However, these preliminary results in a small clinical cohort should be further assessed in large allogeneic animal models.</p><p><strong>Clinical relevance statement: </strong>The results of this study will help surgeons understand the early regeneration of transplanted fat after large volume fat grafting for breast augmentation.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"491-503"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534983","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":"Cost Comparison of Digital Nerve Repair Techniques.","authors":"Kevin Hu, Mica C G Williams, Alexander J Kammien, Joseph Canner, Thayer Mukherjee, Elspeth Hill, David Colen","doi":"10.1097/PRS.0000000000011662","DOIUrl":"10.1097/PRS.0000000000011662","url":null,"abstract":"<p><strong>Background: </strong>Direct cost comparisons of nerve allograft with other techniques for repairing short digital nerve gaps are lacking. This study compares the costs of various techniques for digital nerve repair, anticipating significant cost increases for allograft implants.</p><p><strong>Methods: </strong>The State Ambulatory Surgery and Services Databases for Florida, New York, and Wisconsin from 2015 through 2020 were used. Patients with primary repair, short autograft, conduit, and allograft were compared along total, surgical supply, operating room, and anesthesia charges.</p><p><strong>Results: </strong>Among 5009 patients, there were 2967 primary nerve repairs (59.2%), 77 autografts (1.5%), 1647 conduits (32.9%), and 318 allografts (6.3%). A total of 2886 patients were male (57.6%), and the mean patient age was 40.4 ± 16.3 years. Over the study period, primary repairs decreased (from 63.9% in 2015 to 56.3% in 2020), whereas allografts increased significantly (from 8.8% in 2018 to 12.6% in 2020). Median total charges varied significantly across procedures, with the most expensive being allograft ($35,295), followed by conduit ($25,717), autograft ($24,749), and primary repair ($18,767). On multivariable regression, allografts were significantly more expensive than autografts in total charges of $11,224 (95% CI, $4196 to $18,252) and supply charges of $10,484 (95% CI, $6073 to $14,896), but not in operating room or anesthesia charges. Flexor tendon repair was associated with greater total, operating room, and anesthesia charges, but had similar supply charges.</p><p><strong>Conclusions: </strong>Nerve allografting is the most expensive digital nerve repair technique, most likely due to the cost of the implant. To minimize health care expenditure and ensure equitable patient access, surgeons should consider this cost along with clinical factors when choosing digital nerve repair techniques.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"543e-552e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860600","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":"Cultural Influences on the Receipt of Breast Reconstruction: A Scoping Review.","authors":"Joey Liang, Ann Marie Flusche, Samantha Kaplan, Kristen Rezak, Geoffroy C Sisk, Ash Patel","doi":"10.1097/PRS.0000000000011714","DOIUrl":"10.1097/PRS.0000000000011714","url":null,"abstract":"<p><strong>Background: </strong>Postmastectomy breast reconstruction can provide breast cancer patients with lasting psychosocial, functional, and body image benefits. Although sociodemographic factors affecting the receipt of breast reconstruction have been well studied, the cultural factors influencing patients' decisions to undergo breast reconstruction remain unclear. There are currently no reviews on cultural factors influencing breast reconstruction decision-making. This scoping review aimed to broadly evaluate the current literature on cultural factors that influence the receipt of breast reconstruction in breast cancer patients who have undergone mastectomies.</p><p><strong>Methods: </strong>A combination of keywords and subject headings was used to search for articles related to breast reconstruction and decision-making. Databases were searched from inception to November 20, 2023. Screening was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, and quantitative studies examining the receipt of breast reconstruction in breast cancer patients following mastectomy were evaluated for inclusion.</p><p><strong>Results: </strong>Of the 4520 studies that were screened, 61 were included in the final review. The majority of studies included in the review were retrospective and performed in the United States. Included studies were evaluated for cultural influences on the receipt of breast reconstruction. Six themes emerged across the included studies: race and ethnicity, language and communication barriers, education and literacy, cultural competency, patient perceptions, and family and relationships.</p><p><strong>Conclusion: </strong>In addition to well-established influences on breast reconstruction such as race and ethnicity, this review broadly identified additional cultural factors that influence patients' decisions to undergo breast reconstruction.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"456e-466e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110865","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 Algorithmic Approach to Dual-System Venous Drainage for DIEP Flap Breast Reconstruction.","authors":"Chiara Camilloni, Beniamino Brunetti, Dario Melita, Paolo Persichetti, Mario Cherubino, Giuseppe A G Lombardo","doi":"10.1097/PRS.0000000000011746","DOIUrl":"10.1097/PRS.0000000000011746","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"644e-646e"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293216","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 Orbito-Ocular Outcomes following Le Fort III and Monobloc Distraction Osteogenesis in Patients with Syndromic Craniosynostosis.","authors":"Matthew E Pontell, Connor S Wagner, Neil Reddy, Lauren K Salinero, Carlos E Barrero, Jordan W Swanson, Scott P Bartlett, Jesse A Taylor","doi":"10.1097/PRS.0000000000011354","DOIUrl":"10.1097/PRS.0000000000011354","url":null,"abstract":"<p><strong>Background: </strong>Exorbitism in patients with syndromic craniosynostosis is often managed by Le Fort III (LF3) or monobloc (MB) distraction osteogenesis (DO). This study compared short- and long-term orbital craniometrics after LF3DO/MBDO and related these findings to symptom relief.</p><p><strong>Methods: </strong>Patients undergoing LF3DO or MBDO from 2000 to 2021 with preoperative and postoperative imaging were included. Postoperative computed tomographic (CT) scans were categorized as early (<1 year) or late (>1 year), and age-matched control CT scans were compared with late postoperative scans. Superoinferior orbital rim position, relative globe position, and orbital volume were analyzed. Symptoms were assessed by a patient-reported outcome analysis.</p><p><strong>Results: </strong>Thirty-four patients (LF3DO, n = 16; MBDO, n = 18) were matched by age at surgery, sex, syndrome, and age at imaging. Time to late CT scan was 6.2 years (LF3DO) and 7.5 years (MBDO). Between early and late postoperative time points, LF3DO patients experienced no change in inferior rim position. MBDO patients experienced a decrease in inferior orbital rim position of 4.7 mm ( P = 0.005), but superior orbital rim distance remained stable. Comparison of late scans and age-matched controls revealed no difference in inferior or superior orbital rim position in LF3DO patients, but the superior orbital rim distance was longer in MBDO patients ( P = 0.015). Patient-reported outcome response rate was 76% with a median follow-up of 13.7 years. Most (81%) symptomatic patients improved, 19% remained symptomatic, and no patients worsened.</p><p><strong>Conclusions: </strong>LF3DO and MBDO achieved stable orbital craniometric changes, with improved stability at the inferior orbital rim after LF3DO. Craniometric changes were associated with long-term exorbitism symptom relief.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"523-533"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723660","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}