Plastic and reconstructive surgery最新文献

{"title":"Discussion: Eyelid and Brow Rejuvenation: Technical Pearls and Outcomes of Upper Blepharoplasty with or without Ptosis Correction and Brow Lift.","authors":"Alexander Gougoutas, Kiya Movassaghi","doi":"10.1097/PRS.0000000000011638","DOIUrl":"10.1097/PRS.0000000000011638","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 6","pages":"1208-1209"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716869","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":"Interposing Rectus and Gracilis Muscle Flaps for Pelvic Reconstruction in Bladder Exstrophy after Bladder Neck Closure.","authors":"Thomas G W Harris, Chad B Crigger, Visakha Suresh, Ahmad Haffar, Tamir N Sholklapper, Isam W Nasr, John P Gearhart, Robin Yang, Richard J Redett","doi":"10.1097/PRS.0000000000011315","DOIUrl":"10.1097/PRS.0000000000011315","url":null,"abstract":"<p><strong>Background: </strong>The exstrophy-epispadias complex is a spectrum of ventral wall malformations including classic bladder exstrophy and cloacal exstrophy (CE). Patients undergo multiple soft-tissue procedures to achieve urinary continence. If unsuccessful bladder neck closure (BNC) is performed, muscle flaps may be used to reinforce BNC or afterward for fistula reconstruction. In this study, patients reconstructed using a rectus abdominis or gracilis muscle flap were reviewed.</p><p><strong>Methods: </strong>A retrospective cohort study of patients with exstrophy-epispadias complex who underwent BNC and had a muscle flap was performed. Indication for flap use; surgical technique; and risks for BNC failure, including mucosal violations (MVs), were reviewed. MVs were previous bladder mucosa manipulation for exstrophy closure, repeat closures, and bladder neck reconstruction. Success was defined as BNC without fistula development.</p><p><strong>Results: </strong>Thirty-four patients underwent reconstruction. Indications included fistula prophylaxis during BNC ( n = 13), fistula closure after BNC ( n = 17), fistula prophylaxis after BNC during open cystolithotomy ( n = 1), or fistula closure after open cystolithotomy ( n = 3). A vesicourethral fistula developed most frequently in classic bladder exstrophy (88.9%) and vesicoperineal fistula in CE (87.5%). Thirty-three rectus flaps and 3 gracilis flaps were used, with success achieved in 97.1% and 66.7%, respectively. All 34 patients achieved success, and 2 patients with CE required a second flap.</p><p><strong>Conclusions: </strong>The rectus flap is preferred as it covers the anteroinferior bladder and pelvic floor to prevent urethral, cutaneous, and perineal fistula formation. The gracilis flap only reaches the pelvic floor to prevent urethral and perineal fistula development. Increased MVs increase the risk of fistula formation and may influence the need for prophylactic flaps.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1322-1330"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642767","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: Effects of Cutting Planes on Costal Cartilage Warping.","authors":"David Mattos, Richard G Reish","doi":"10.1097/PRS.0000000000011631","DOIUrl":"10.1097/PRS.0000000000011631","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 6","pages":"1229-1230"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716868","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 LIMB-Q: Reliability and Validity of a Novel Patient-Reported Outcome Measure for Patients with Lower Extremity Trauma.","authors":"Lily R Mundy, Anne F Klassen, Andrea L Pusic, Tim deJong, Scott T Hollenbeck, Mark J Gage","doi":"10.1097/PRS.0000000000011293","DOIUrl":"10.1097/PRS.0000000000011293","url":null,"abstract":"<p><strong>Background: </strong>The LIMB-Q is a novel patient-reported outcome measure for patients with lower extremity trauma. The aim of this study was to perform a psychometric validation of the LIMB-Q based on the Rasch measurement theory.</p><p><strong>Methods: </strong>An international, multisite convenience sample of patients with lower extremity traumatic injuries distal to the midfemur was recruited from clinical sites in the United States and the Netherlands and online platforms (in English; Trauma Survivors Network patient support group and the Prolific academic research platform). A cross-sectional survey of the LIMB-Q was conducted with test-retest reliability analysis performed 1 to 2 weeks after initial completion in a subgroup of patients.</p><p><strong>Results: </strong>The LIMB-Q was field-tested in 713 patients. The mean age was 41 years (SD, 17 years; range, 18 to 85 years), the mean time from injury was 7 years (SD, 9 years; range, 0 to 58 years), and there were various injury and treatment characteristics (39% fracture surgery only, 38% flap or graft, 13% amputation, 10% amputation and flap or graft). Out of 382 items tested, 164 were retained across 16 scales. Reliability was demonstrated with person separation index values of 0.80 or greater in 14 scales (0.78 to 0.79 in the remaining 2 scales), Cronbach alpha values 0.83 or greater, and intraclass correlation coefficient values 0.70 or greater. Each scale was unidimensional, measurement invariance was confirmed across clinical and demographic factors, test-retest analysis showed adequate reliability, and construct validity was demonstrated.</p><p><strong>Conclusion: </strong>The LIMB-Q is a patient-reported outcome measure with 16 independently functioning scales (6 to 15 items per scale) developed and validated specifically for patients with lower extremity trauma with fractures, reconstruction, or amputation.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1332-1340"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485955","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":"Risk Factors for Tissue Expander-Related Infections in Pediatric Scar Reconstruction: A 10-Year Retrospective Study.","authors":"Chunjie Fan, Peilong Li, Ning Yan, Guobao Huang","doi":"10.1097/PRS.0000000000011390","DOIUrl":"10.1097/PRS.0000000000011390","url":null,"abstract":"<p><strong>Background: </strong>Tissue expansion addresses limited soft-tissue availability and provides natural-looking skin for scar reconstruction. However, infection is a common complication in expander surgery. This 10-year retrospective cohort study was performed to investigate the infection risk factors in pediatric scar reconstruction.</p><p><strong>Methods: </strong>This single-center observational cohort study was conducted at the Central Hospital Affiliated with Shandong First Medical University, China, and analyzed data from pediatric patients undergoing tissue expander surgery for scar reconstruction from January of 2012 to June of 2022. Patients were selected, were divided into groups with or without infection, and their demographic and clinical data were analyzed. Propensity score matching ensured balanced comparisons, and logistic regression identified infection risk factors.</p><p><strong>Results: </strong>Among the 4539 patient records, 1756 eligible pediatric patients were included (142 with infections; 1614 without infections). Multivariate analysis revealed that factors increasing infection risk included having 3 or more expanders (OR, 2.39, P < 0.05), a total expander volume of 300 cc or more (OR, 2.33, P < 0.05), back or gluteal implants (OR, 1.33, P < 0.05), lack of antibiotic prophylaxis (OR, 0.65, P < 0.05), and absence of hematoma evacuation (OR, 3.29, P < 0.05). Microbiological analysis found no significant bacterial differences among antibiotic prophylaxis groups, with Staphylococcus aureus being the predominant bacterium in infections.</p><p><strong>Conclusions: </strong>Patients with multiple expanders, larger expander volumes, back or gluteal implants, lack of antibiotic prophylaxis, and hematoma evacuation absence have higher infection risks. Short-term (<24 hours) use of S. aureus -sensitive antibiotics after surgery may benefit pediatric infection risk reduction.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1200e-1208e"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028723","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":"(Epi)genotype and Timing of Tongue Reduction Predict Safety and Long-Term Outcomes in Beckwith-Wiedemann Syndrome.","authors":"Connor S Wagner, Matthew E Pontell, Lauren K Salinero, Carlos E Barrero, William A Drust, Madison Demarchis, Eric C Liao, Jennifer M Kalish, Jesse A Taylor","doi":"10.1097/PRS.0000000000011112","DOIUrl":"10.1097/PRS.0000000000011112","url":null,"abstract":"<p><strong>Background: </strong>Macroglossia is a cardinal feature of Beckwith-Wiedemann syndrome (BWS) with a clinical spectrum where the indication and timing for surgery remain to be validated. This study leverages a cohort of molecularly characterized patients with BWS to correlate epigenetic diagnosis with phenotype and treatment outcome.</p><p><strong>Methods: </strong>Patients with BWS seen in consultation for macroglossia from 2009 to 2022 were reviewed for phenotype, molecular diagnosis, tongue reduction status, timing of surgery (early, less than 12 months), and perioperative complications.</p><p><strong>Results: </strong>A total of 237 patients were included. Imprinting control region 2 loss of methylation was the most common epigenotype (61%). Paternal uniparental isodisomy for chromosome 11 included a larger proportion of patients undergoing tongue reduction (18%) than those not undergoing surgery (8%; P = 0.024) and was associated with need for repeated surgery (OR, 4.49; 95% CI, 1.06 to 18.98; P = 0.041). Complications including wound dehiscence, ventilator-associated pneumonia, and unplanned extubation were more common in patients undergoing early surgery (20%) than late surgery (4%; OR, 5.70; 95% CI, 1.14 to 28.55; P = 0.034).</p><p><strong>Conclusions: </strong>This study presents one of the largest cohorts correlating molecular diagnosis with clinical course of macroglossia treatment in BWS. Macroglossia in patients with paternal uniparental isodisomy for chromosome 11 is associated with higher rates of reoperation. Relief of obstructive sleep apnea with early tongue reduction must be weighed against the risk of perioperative complications, most of which are nonsurgical. This study highlights how molecular diagnosis advances clinical care by risk stratifying clinical outcomes in a center providing integrated multidisciplinary care for the BWS population.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1269-1277"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41143463","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":"Microneedling Radiofrequency Enhances Poly-L-Lactic Acid Penetration That Effectively Improves Facial Skin Laxity without Lipolysis.","authors":"Xianglei Wu, Qingqing Cen, Xue Wang, Ping Xiong, Xiujuan Wu, Xiaoxi Lin","doi":"10.1097/PRS.0000000000011232","DOIUrl":"10.1097/PRS.0000000000011232","url":null,"abstract":"<p><strong>Background: </strong>Microneedle fractional radiofrequency (MFR) is commonly used for skin laxity treatment, and poly-L-lactic acid (PLLA) can stimulate collagen synthesis in the body. However, the synergy of their combination for skin rejuvenation has not been proven. The authors aimed to evaluate the combined efficacy of PLLA and MRF and the potential mechanism underlying skin laxity.</p><p><strong>Methods: </strong>This prospective, randomized study included C57BL/6 mice treated with MFR, MFR plus PLLA, and carbon dioxide laser plus PLLA and 32 patients who underwent split-face treatments with MFR or MFR plus PLLA twice every 2 months. The Global Aesthetic Improvement Scale, Facial Laxity Rating scale of the whole face, the Echelle d'Evaluation Clinique des Cicatrices d'Acne grading scale of acne scars, and VISIA parameters on both treated sides were evaluated. Dermatologic changes were measured by ultrasonography in the submental space, and adverse events were documented.</p><p><strong>Results: </strong>PLLA was delivered by channels produced by MFR but not carbon dioxide laser in the mouse model. Thirty patients were treated with split-face MFR plus PLLA or MFR, revealing an improvement in VISIA wrinkle percentile (0.020) compared with the age-matched controls (0.000). The thickness of the dermis increased, whereas the fat layer did not change significantly. No adverse effects were observed.</p><p><strong>Conclusions: </strong>PLLA can be delivered through microchannels produced by MFR. PLLA enhances the efficacy of MFR for skin laxity without lipolysis.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1189-1197"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138488273","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":"Coverage of Congenital Anomalies: Ensuring Lasting Smiles Act in Legislation.","authors":"Marina A Lentskevich, Alice Yau, Emily Chwa, Narainsai K Reddy, Arun K Gosain","doi":"10.1097/PRS.0000000000011379","DOIUrl":"10.1097/PRS.0000000000011379","url":null,"abstract":"<p><strong>Summary: </strong>The Ensuring Lasting Smiles Act (ELSA) is a federal bill that would require all health federally regulated insurance products to cover the full treatment of a congenital anomaly or congenital disability until complete restoration of normal function or appearance. ELSA has been a key federal priority for the Legislative Advocacy Committee of the American Society of Plastic Surgeons since the 115th Congress in 2018. Although it has gained momentum, particularly in the 117th Congress, the bill remains stalled. Congressional Budget Office review, conducted in March of 2022, appears to have overestimated this bill's cost for the private sector, secondary to an alleged lack of data on the prevalence of the conditions, extent of treatments and their costs, and the current extent of private sector coverage. The present review highlights the progress of the ELSA bill and serves to illustrate the hurdles involved in passing significant health care bills. This review emphasizes the need for health care professionals to provide their congressional representatives with accurate information on realistic cost of currently covered treatments of congenital defects, the necessary treatments not currently covered by insurance, and additional out-of-pocket costs covered by patients. A concerted effort by plastic surgeons should provide tools for ELSA legislative champions to reintroduce and pass the bill during the 118th Congress. This process highlights the essential role of organized medicine in advocating for the successful passage of health care legislation.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1353-1358"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028720","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":"Further Refinements in Otoplasty Surgery: A Modified Approach to Prevent Suture Extrusion in Cartilage-Suturing Otoplasty Using a Postauricular Dermofascial Flap.","authors":"Neil W Bulstrode, Elsa M Ronde, Ahmed S Mazeed","doi":"10.1097/PRS.0000000000011342","DOIUrl":"10.1097/PRS.0000000000011342","url":null,"abstract":"<p><strong>Background: </strong>Suture extrusion has been reported to be the most common complication after cartilage-sparing otoplasty. Several studies have described various designs of postauricular flaps to cover the cartilage sutures and reduce the incidence of suture extrusion.</p><p><strong>Methods: </strong>A total of 100 consecutive patients with prominent ears were operated on between January of 2018 and February of 2023 using a deepithelialized postauricular dermofascial flap that is performed as an adjunct to the authors' cartilage-sparing otoplasty technique, which is essentially a combined modified Mustardé and Furnas technique. The flap is used to cover the cartilage-holding sutures with an extra layer of vascularized tissue to avoid the scar being directly over these sutures.</p><p><strong>Results: </strong>The median age of patients was 12 years (interquartile range, 9 to 15). One out of the 100 patients (1%) developed a postauricular skin infection requiring surgical removal of sutures. Primary suture extrusion did not occur; in an earlier study of cartilage-sparing technique without the postauricular flap, 17 out of 200 patients had suture extrusion ( P = 0.001). No hematoma occurred that necessitated return to the theater. Skin necrosis and wound dehiscence did not occur in any case. No patient developed cartilage deformities or relapse requiring surgical correction.</p><p><strong>Conclusions: </strong>Combining cartilage-sparing otoplasty using sutures and the described postauricular dermofascial flap is simple to perform and has significantly reduced the complication rate and improved the outcome compared with cartilage-sparing otoplasty alone. This flap is recommended for both primary and revisional otoplasty.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1191e-1199e"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493030","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":"Longitudinal Experience Using Pedicled Buccal Fat Pad Flaps in Cleft Palatoplasty: Mitigating Velopharyngeal Insufficiency Risk and Severity.","authors":"Nathan T Sheppard, Melissa C Daniel, Megan L Dietze-Fiedler, James D Vargo, Marissa Habeshy, Natalie R Wombacher, Christian J Vercler, Steven J Kasten, Steven R Buchman, Raquel M Ulma","doi":"10.1097/PRS.0000000000011394","DOIUrl":"10.1097/PRS.0000000000011394","url":null,"abstract":"<p><strong>Background: </strong>Cleft palatoplasty commonly results in denuded maxillary bone in the lateral gutters and a posterior void between oral and nasal closures. Bony exposure of the anterior palate subjects the maxilla to scarring and growth restriction; scar contracture of the posterior void may result in velopharyngeal insufficiency and fistula formation. Use of the buccal fat pad flap (BFPF) at the time of palatoplasty provides vascularized tissue over these critical areas, thereby reducing the rate of secondary surgery for speech and fistula revision.</p><p><strong>Methods: </strong>A single-center, retrospective review identified patients who underwent palatoplasty with or without BFPF between 1995 and 2015. Data collected included cleft type, surgical technique, follow-up duration, and complications. Outcomes included rate of speech surgery and palatal fistula development. Veau phenotype index was computed on a scale of 2 to 4 as a weighted mean to reflect the frequency of cleft type (Veau II through IV) in BFPF and non-BFPF groups.</p><p><strong>Results: </strong>Charts of 866 patients were reviewed; 212 met inclusion criteria. Of these, 101 received a BFPF. Mean follow-up duration was 11.4 years. Despite a selection bias for more severe clefts, the BFPF group had lower incidence of speech surgery (9.9% versus 36.9%; P = 0.0072). The BFPF group had milder cases treatable with fat injection (7.9% versus 2.7%; P = 0.0346) and developed fewer fistulas (6.9% versus 18.0%; P = 0.0280).</p><p><strong>Conclusions: </strong>Despite the presence of more severe clefts, the BFPF group had a significantly lower rate of speech surgery. The BFPF is a valuable adjunct in primary palatoplasty, reducing velopharyngeal insufficiency and fistula formation.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1209e-1219e"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111140","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}