Plastic and Reconstructive Surgery Global Open最新文献

{"title":"Correction of Superficial Tear Trough Deformity with Autologous Septal Fascia Graft During Lower Blepharoplasty.","authors":"Yueh-Chi Tsai, Ray Yung-Chiou Lin","doi":"10.1097/GOX.0000000000008180","DOIUrl":"10.1097/GOX.0000000000008180","url":null,"abstract":"<p><p>Residual tear trough deformity (TTD) often persists after standard lower blepharoplasty because of the significant difference in skin thickness between the thin lower eyelid and thicker midface. Current treatments, such as dermal fillers or nanofat grafting, face limitations, including potential surface irregularities, the Tyndall effect, and the need for additional donor sites. This article introduces autologous septal fascia grafting as a novel technique to correct superficial TTD during lower blepharoplasty. The procedure involves harvesting a strip of the orbital septum according to the severity of the preoperative deformity using the same blepharoplasty approach, eliminating distant donor-site morbidity. This linear graft is threaded into the subdermal layer of the tear trough to structurally augment skin thickness and soften the eyelid-cheek junction. Clinical outcomes demonstrated stable improvement of superficial TTD without hypertrophic scarring, contour irregularities, or the Tyndall effect, offering an efficient and durable solution for transition zone camouflage.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8180"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virgo-inspired Periorbital Lifting Injection Technique: A Structured Multinodal, Layered Framework for Periorbital Rejuvenation.","authors":"Jiajia Li, Yongping Xue, Letian Kuang, Qianyi Wu, Wenrong Tian, Suriye Rehemutila, Jiang Ai","doi":"10.1097/GOX.0000000000008172","DOIUrl":"10.1097/GOX.0000000000008172","url":null,"abstract":"<p><p>Periorbital aging extends beyond isolated volume loss and encompasses progressive changes in structural support, contour continuity, and tissue transition. These changes often produce a segmented or fatigued appearance that may not be adequately corrected by focal filling alone. We describe the Virgo-inspired periorbital lifting injection technique as a structured, multinodal, layered framework that organizes recognized periorbital support and transition zones into a reproducible treatment sequence. Deep-anchoring nodes are used to provide distributed support, whereas superficial refinement nodes are used to improve contour continuity and optical integration. The Virgo-inspired periorbital lifting injection technique does not propose novel anatomy or previously undescribed injection points. Rather, it offers a practical framework intended to improve procedural clarity, teachability, and consistency in periorbital rejuvenation. An illustrative case is presented to demonstrate the treatment logic and clinical application of this approach.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8172"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult-onset Still Disease Flare 5 Days Following Poly-l-lactic Acid Injection: A Cautionary Tale for Aesthetic Practice.","authors":"Faris Aldaghri, Lama A Alkhwildi","doi":"10.1097/GOX.0000000000008189","DOIUrl":"10.1097/GOX.0000000000008189","url":null,"abstract":"<p><p>Adult-onset Still disease (AOSD) is a rare systemic autoinflammatory disorder characterized by quotidian fevers, evanescent rash, and polyarthritis. Minimally invasive aesthetic procedures are increasingly common, yet their immunological safety in patients with underlying autoimmune disease remains poorly characterized. We report a 57-year-old woman with AOSD, previously stable on annual rituximab (1 g), who developed a severe systemic flare temporally associated with a poly-l-lactic acid facial injection, with symptom onset 5 days after the procedure. She presented with high-grade pyrexia (40°C), extreme leukocytosis (white blood cell, 26 × 10⁹/L), C-reactive protein (230 mg/L), and acute arthritis of the hand joints, requiring inpatient intravenous corticosteroids and intravenous rituximab. This case raises the possibility that collagen-stimulating biomaterials may act as an immunological trigger for systemic autoinflammatory relapse in predisposed patients; however, causality cannot be inferred from a single observation, and the relationship described here is strictly temporal. As a conceptual, hypothesis-generating proposal, a structured preprocedural risk assessment and multidisciplinary perioperative protocol are suggested for consideration before elective aesthetic procedures in AOSD patients, pending validation in larger series.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8189"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Clinical Evaluation of Hyaluronic Acid Filler for Gluteal Augmentation: A Retrospective Study-Erratum.","authors":"Jae-Hun Hur, You-Kyoung Cho, Jong Keun Song, Jae-Young Kim, Kyu-Ho Yi","doi":"10.1097/GOX.0000000000008251","DOIUrl":"10.1097/GOX.0000000000008251","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/GOX.0000000000007962.].</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8251"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clot Removal from Distal Part in Microvascular Radial Forearm Free Flap: Technical Note.","authors":"Chaim Ohayon, Yotam Shkedy, Niv Gross, Tal Capucha, Omri Emodi","doi":"10.1097/GOX.0000000000008166","DOIUrl":"10.1097/GOX.0000000000008166","url":null,"abstract":"<p><p>Microvascular reconstruction has high success rates, but up to 10% of patients experience vascular compromise, most commonly due to venous congestion or arterial thrombosis. Traditional flap salvage includes mechanical milking of the pedicle and heparinized irrigation; however, when these measures fail to restore perfusion, alternative strategies are required. In this technical note, we present a Fogarty catheter-based technique for thrombus removal, particularly in radial forearm free flaps where the distal artery is accessible. The catheter is introduced distally to extract the clot without reopening the anastomosis, allowing immediate confirmation of reperfusion. This technique is simple, time-efficient, and effective for managing arterial thrombosis in free flap surgery.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8166"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Melanocytic Nevus Mimicking a Coccygeal Pad in the Sacrococcygeal Region.","authors":"Ayato Kuroki, Kazuya Umezawa, Koichi Kobayashi","doi":"10.1097/GOX.0000000000008198","DOIUrl":"10.1097/GOX.0000000000008198","url":null,"abstract":"<p><p>Congenital melanocytic nevus (CMN) is a benign melanocytic proliferative lesion that presents at birth or in early infancy. When the lesion extends into the deep dermis or subcutaneous tissue, it can form a mass that is clinically and radiologically indistinguishable from other soft tissue tumors. We report a case of sacrococcygeal CMN mimicking a coccygeal pad. An 18-year-old man presented with a sacrococcygeal mass and tenderness. Magnetic resonance imaging and needle biopsy findings suggested a coccygeal pad. Because of persistent pain and the patient's desire for removal, the mass was excised under general anesthesia with periosteal inclusion, and the resulting 95 × 50 mm defect was reconstructed using a right superior gluteal artery perforator flap. Histopathological examination confirmed CMN without malignant features. The flap survived completely, and the postoperative course was uneventful. Tenderness resolved completely, and no local or symptomatic recurrence was observed at 6 months. CMN should be considered in the differential diagnosis of sacrococcygeal masses, and needle biopsy may be insufficient for diagnosing deeply infiltrating lesions.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8198"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvascular Reconstruction in Ballistic Injuries of the Maxillofacial Region.","authors":"Michael Maurer, Katja Himmelstoss, Nura Ahmad, Mathias Fiedler, Johannes G Schuderer, Johannes K Meier, Torsten E Reichert, Tobias Ettl","doi":"10.1097/GOX.0000000000008202","DOIUrl":"10.1097/GOX.0000000000008202","url":null,"abstract":"<p><strong>Background: </strong>Ballistic injuries to the maxillofacial region pose a major reconstructive challenge due to complex anatomy and the need to restore both aesthetic appearance and essential functions such as speech and swallowing. This study evaluates microvascular reconstruction strategies and associated complications in these injuries.</p><p><strong>Methods: </strong>A retrospective descriptive study was performed, including patients treated at a level I trauma center during a 10-year period. Inclusion criteria were (1) ballistic injury to the lower face or midface, (2) tissue loss requiring microvascular reconstruction, and (3) complete clinical and radiological documentation. Data collected included demographics, injury characteristics, reconstructive techniques, complications, and microbiological findings.</p><p><strong>Results: </strong>Nine patients underwent microvascular reconstruction between 2015 and 2025, with a total of 15 free flap procedures performed, including 10 fibula free flaps. One flap loss occurred due to infection 3 months postoperatively. Reconstruction was delayed in 7 cases. War-related injuries and delayed reconstruction were significantly associated with preoperative wound infection and detection of multidrug-resistant Gram-negative (MDRGN) organisms (<i>P</i> = 0.018 and <i>P</i> = 0.023, respectively). The presence of MDRGN organisms was significantly associated with the occurrence of surgical site infections (<i>P</i> = 0.016).</p><p><strong>Conclusions: </strong>Microvascular free flap reconstruction remains the gold standard for complex maxillofacial ballistic injuries, even under adverse conditions. War-related trauma and delayed reconstruction are strongly associated with infectious complications, particularly involving MDRGN, and should be carefully considered in perioperative management.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8202"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process-dependent Analytical Differences Among Commercial Botulinum Neurotoxin Type A Formulations.","authors":"Hyunjung Choi, Se Na Kim, Chang Ki Lee, Eunbee Jeong, Kyoung Yeol Park, Donghoon Oh, Seung Jun Shin","doi":"10.1097/GOX.0000000000008161","DOIUrl":"10.1097/GOX.0000000000008161","url":null,"abstract":"<p><strong>Background: </strong>Manufacturing-related factors may influence measurable compositional and functional characteristics of botulinum neurotoxin type A (BoNT/A) formulations beyond structural subtype equivalence. However, comparative analytical data on commercially available products remain limited.</p><p><strong>Methods: </strong>Commercial-scale BoNT/A formulations were subjected to analytical and biofunctional evaluation. Residual nucleic acid clearance was characterized across multiple production batches of letibotulinumtoxinA to assess purification robustness within that manufacturing process. Total neurotoxin protein content was measured by enzyme-linked immunosorbent assay (ELISA), and biological potency was determined using the mouse LD₅₀ assay. Specific potency was calculated by normalizing biological activity to total neurotoxin mass. Statistical comparison of specific potency among products was performed using one-way analysis of variance followed by the Dunnett multiple comparisons test.</p><p><strong>Results: </strong>Residual nucleic acid removal in letibotulinumtoxinA exceeded 99.9% across the evaluated batches, indicating efficient impurity clearance within the assessed manufacturing process. In the mouse LD₅₀ assay, no statistically significant differences in potency per vial were observed among the 3 evaluated products. When biological activity was normalized to total neurotoxin protein mass, numerical variation in mean specific potency was observed among products; however, these between-product differences did not reach statistical significance.</p><p><strong>Conclusions: </strong>This study provides an analytical characterization of commercially available BoNT/A formulations with respect to impurity clearance and protein-normalized biological activity. The findings support the relevance of manufacturing quality to product characterization, but do not establish clinical superiority, product preference, or direct implications for clinical outcomes. Further clinical and translational investigation is required to determine the potential relevance of these observations in practice.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8161"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurotized DIEP Breast Reconstruction: A Feasibility Report of a Gap Length-Based Algorithm.","authors":"Christoph Wallner, Felix Reinkemeier, Marcus Lehnhardt, Maxi von Glinski","doi":"10.1097/GOX.0000000000008176","DOIUrl":"10.1097/GOX.0000000000008176","url":null,"abstract":"<p><p>Neurotization improves sensation after deep inferior epigastric perforator (DIEP) flap breast reconstruction. However, although individual nerve reconstruction techniques are established, no published decision algorithm currently integrates postinset gap measurement with explicit gap-length thresholds for bridging strategy selection. Current intraoperative decision-making remains subjective and inconsistently documented, limiting reproducibility and cross-center comparison. We present a gap length-based decision algorithm and standardized nerve coaptation technique for neurotized DIEP flap breast reconstruction. After final inset, the tension-free gap is measured in millimeters in semisitting Fowler's position. Reconstruction is guided by defined thresholds: 10 mm or less, direct coaptation; 10-25 mm, nerve conduit (NerveTube, Integra; ~550 €); 25-70 mm, processed nerve allograft (Avance, Axogen; ~1200 €); and greater than 70 mm, autograft/cable-graft strategies. Each threshold is grounded in the established peripheral nerve reconstruction literature. In 13 consecutive patients (mean follow-up 10 mo), the algorithm was applied without neuroma formation, graft-site infection, or coaptation-related complications. This algorithm provides a reproducible, evidence-informed framework for intraoperative bridging decisions in DIEP neurotization. Preliminary data support feasibility and safety. Prospective sensory outcome validation is in preparation.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8176"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Philosophy of Microsurgery.","authors":"Jeremy V Lynn, Christine S W Best, Theodore A Kung","doi":"10.1097/GOX.0000000000008183","DOIUrl":"10.1097/GOX.0000000000008183","url":null,"abstract":"<p><p>A philosophy is defined as a set of guiding principles that informs thought and behavior. In some cases, the expression of a philosophy and its specific tenets can be experienced through the practice and perfection of a skill. We believe that microsurgery should be appreciated not only as a technical expertise used to help solve complex reconstructive problems but also as a philosophy that can be applied to both microsurgical and nonmicrosurgical situations. This article conceptualizes microsurgery as a philosophy using 5 principal tenets: mindfulness, vascularity, improvisation, unconscious competence, and devotion to habit. These principles establish a unique way of thinking that can influence how plastic surgeons operate, solve problems, and teach.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8183"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}