Plastic and Reconstructive Surgery Global Open最新文献

{"title":"Multicenter Study on the Surgical Treatment of Suprascapular Nerve Entrapment Syndrome.","authors":"Maurilio Bruno, Giuseppe Basile, Massimiliano Leigheb, Claudio Cannistrà, Domenico Tripodi, Felice Moccia, Marcello Molle, Mario Faenza, Federico Amadei","doi":"10.1097/GOX.0000000000008136","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008136","url":null,"abstract":"<p><strong>Background: </strong>Suprascapular nerve entrapment syndrome is a rare but increasingly recognized cause of shoulder pain and dysfunction, particularly among young or middle-aged men involved in overhead sports or physically demanding occupations. The suprascapular nerve, primarily motor but also containing sensory fibers, may become compressed due to anatomical variations, ossified ligaments, or space-occupying lesions such as paralabral ganglia. Diagnosis is challenging due to nonspecific symptoms and overlapping pathologies and often relies on clinical evaluation supported by electromyography (EMG) and magnetic resonance imaging.</p><p><strong>Methods: </strong>Between 2008 and 2018, a total of 10 patients (8 men, 2 women; mean age 31.1 y) with suprascapular nerve entrapment underwent open surgical decompression. All patients experienced chronic shoulder pain unresponsive to conservative treatment. Surgical exposure followed a scapular spine incision, allowing visualization and decompression of the nerve at the suprascapular notch and infraspinatus fossa. Follow-up (mean 15.4 mo) assessed pain (visual analog scale), muscle strength (Medical Research Council Scale), and EMG findings.</p><p><strong>Results: </strong>Most patients had delayed diagnosis (mean 7 mo). At follow-up, all but 1 showed significant pain reduction during exertion (mean visual analog scale score from 4.2 to 2.7) and improved strength (mean Medical Research Council Scale score from 2.6 to 4.2). EMG demonstrated normalization in 6 patients, partial recovery in 3, and persistent myogenic changes in 1 case, possibly due to neuralgic amyotrophy.</p><p><strong>Conclusions: </strong>Open surgical decompression proved to be an effective treatment for suprascapular nerve entrapment, particularly in cases unresponsive to conservative therapy or associated with secondary compression.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8136"},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113623","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":"Treatment Strategy for Oral-Ocular Synkinesis Following Facial Nerve Palsy: A Clinical Classification Based on the Palpebral Fissure Ratio.","authors":"Daiki Kitano, Masaya Aoyama, Yuki Komatsu, Makoto Omori","doi":"10.1097/GOX.0000000000008134","DOIUrl":"10.1097/GOX.0000000000008134","url":null,"abstract":"<p><strong>Background: </strong>Oral-ocular synkinesis is a disabling sequela of facial nerve palsy, characterized by involuntary orbicularis oculi contraction during oral movements. To better guide clinical management, we developed a novel classification system based on the palpebral fissure ratio with oral movement (mPFR).</p><p><strong>Methods: </strong>This retrospective analysis considered 10 cases of oral-ocular synkinesis between April 2022 and March 2024. Patients were categorized into 4 types: type I (mild; mPFR, 90%-100%), type II (moderate; mPFR, 30%-89%), type III (severe; mPFR, 0%-29%), and type IV (fluctuating; unpredictable mPFR irrespective of intervention).</p><p><strong>Results: </strong>Type I and II patients may respond well to botulinum toxin injections and/or mirror biofeedback, which can improve mPFR and reduce subjective discomfort. Type III patients or refractory type II cases may benefit from selective neurectomy or myomectomy. In patients with incomplete facial paralysis within 1 year of onset, nerve reconstruction using cross-facial nerve grafting, masseteric nerve transfer, or cross-link surgery to the hypoglossal can be considered, aiming to restore voluntary facial muscle movement while suppressing synkinetic activity. Notably, type IV patients showed minimal response to botulinum toxin, highlighting the importance of careful classification before intervention.</p><p><strong>Conclusions: </strong>By integrating the objective metric of mPFR with individualized treatment strategies, this classification system may offer a practical framework to enhance both functional and aesthetic outcomes in patients with oral-ocular synkinesis. These findings highlight the importance of accurate evaluation and type-specific therapeutic approaches to improve the quality of life in individuals affected by synkinesis following facial nerve palsy.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8134"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075639","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":"A Prospective Split-face Trial Evaluating Skin Recovery and Enhancement with Polynucleotide (Rejuran) Following Fractional Needle Radiofrequency Treatment.","authors":"JongSeo Kim","doi":"10.1097/GOX.0000000000008109","DOIUrl":"10.1097/GOX.0000000000008109","url":null,"abstract":"<p><strong>Background: </strong>Fractional needle radiofrequency (FN-RF: Sylfirm-X) is a widely used energy-based treatment for skin rejuvenation, but it often disrupts the epidermal barrier and delays recovery. Polynucleotide (PN: Rejuran) injection has emerged as a recovery adjunct to promote post-RF healing. This study evaluates whether PN enhances skin barrier recovery when used immediately after FN-RF.</p><p><strong>Methods: </strong>A prospective, split-face clinical trial was conducted in 25 female patients 20-60 years of age. Immediately after treatment, 2 mL of PN was injected into right side, and 2 mL of normal saline was administered to the left side as a control. Skin parameters were objectively measured at baseline and 6 weeks after treatment, including pore size and wrinkle depth in 3-dimensional photography, transepidermal water loss and stratum corneum hydration, cutaneous elasticity, and sonographic dermal thickness. Patient-reported outcomes regarding redness resolution, burning sensation, and perceived improvements in pores, wrinkles, and elasticity were also collected.</p><p><strong>Results: </strong>PN-treated sides showed significantly greater improvement in pore score (Δ +4.79 versus +0.95, <i>P</i> < 0.001) and wrinkle score (Δ +5.04 versus +3.67, <i>P</i> < 0.001). Transepidermal water loss decreased significantly only on the PN side (8.19→3.85, <i>P</i> < 0.001), and stratum corneum hydration increased more markedly (23.42→48.19, <i>P</i> < 0.0001). No significant differences were observed in dermal thickness or elasticity. Patient-reported outcomes indicated faster erythema resolution and higher satisfaction on the PN-injected side.</p><p><strong>Conclusions: </strong>PN injection following FN-RF treatment significantly accelerates skin recovery, improves hydration, and enhances pore refinement compared to radiofrequency alone. PN serves as a clinically effective adjunctive therapy for optimizing postprocedural outcomes in aesthetic dermatology.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8109"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075590","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":"Improving Patient Outcomes by Bridging Bariatric and Body Contouring Surgery with Comprehensive Prehabilitation.","authors":"Chris A Campbell, J Peter Rubin, Arthur Weltman, Jason D Allen, Siddhartha S Angadi","doi":"10.1097/GOX.0000000000008073","DOIUrl":"10.1097/GOX.0000000000008073","url":null,"abstract":"<p><strong>Background: </strong>Rates of obesity and diabetes are increasing in the United States, accompanied by greater use of bariatric surgery and pharmacologic therapies, including glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide-based agents. Although massive weight loss may improve glycemic control and blood pressure, patients seeking body contouring surgery remain medically complex. Reduced fat-free mass associated with weight-loss pharmacotherapy and the high incidence of wound healing complications after excess skin resection present additional perioperative challenges.</p><p><strong>Methods: </strong>We reviewed the growing literature on strategies to optimize outcomes after body contouring surgery, with particular attention to exercise preconditioning, nutritional supplementation, psychological support, and modification of established wound healing risk factors.</p><p><strong>Results: </strong>Current evidence suggests that supplementing conventional risk-factor modification with exercise preconditioning, nutritional support, and psychological interventions improve the cardiorespiratory fitness of weight loss patients. Comprehensive prehabilitation initiated before bariatric surgery and continued throughout weight loss and subsequent plastic surgical treatment may also improve weight-loss durability, body composition, and candidacy for body contouring.</p><p><strong>Conclusions: </strong>Prehabilitation may provide a comprehensive, longitudinal approach to optimizing patients undergoing bariatric and body contouring surgery. Integrating exercise, nutritional supplementation, psychological support, and traditional risk-factor modification has the potential to improve surgical candidacy, perioperative health, and postoperative outcomes. Further research is needed to define standardized protocols and determine their effectiveness in this population.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8073"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040198","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":"Prehabilitation in Head and Neck Surgery and Reconstruction.","authors":"Anne C Kim, Paul Indyk, Justin M Broyles","doi":"10.1097/GOX.0000000000008069","DOIUrl":"10.1097/GOX.0000000000008069","url":null,"abstract":"<p><strong>Background: </strong>Head and neck surgery and reconstruction for malignancy often results in significant functional, nutritional, and psychological morbidity that can delay recovery and impair quality of life. Prehabilitation offers a multimodal, proactive approach to optimize patients before surgery by targeting modifiable risk factors and baseline impairments.</p><p><strong>Methods: </strong>In this narrative review, we synthesized current evidence and clinical guidelines across 6 domains of prehabilitation, medical risk assessment, nutritional optimization, swallowing therapy, pain management, physical conditioning, and psychological support, to provide a practical framework for perioperative teams.</p><p><strong>Results: </strong>Early identification and treatment of tobacco, alcohol, and cannabis use, along with correction of preoperative anemia, can reduce perioperative morbidity and the need for transfusion. Nutritional prehabilitation initiated at or near the time of diagnosis, and ideally continued throughout neoadjuvant therapy, uses validated screening tools; individualized dietetic counseling; and, when indicated, immunonutrition and enteral support to mitigate malnutrition and improve wound healing. Baseline swallowing assessment with bedside screening and instrumental studies, followed by targeted exercise programs, helps preserve function and support adequate oral intake. Preoperative multimodal analgesia, structured aerobic and resistance exercise (including respiratory training), and psychological interventions, such as psychoeducation and cognitive behavioral therapy, collectively enhance adherence to rehabilitation, support emotional coping, and improve functional recovery.</p><p><strong>Conclusions: </strong>Multimodal, multidisciplinary prehabilitation should be considered an essential component of surgical preparation for patients undergoing head and neck surgery and reconstruction, with patient-centered care plans tailored to individual risk profiles to improve postoperative outcomes and overall quality of life.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8069"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040278","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":"Prehabilitation for Patients Undergoing Breast Reduction Surgery: A Scoping Review.","authors":"Layne N Raborn Macdonald, Anne Claire Kim, Jeffrey E Janis","doi":"10.1097/GOX.0000000000008074","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008074","url":null,"abstract":"<p><strong>Background: </strong>Reduction mammoplasty (RM) is one of the most common plastic surgery procedures, with close to 76,000 performed annually. Between 14% and 53% of patients may experience a complication after RM. Medically optimizing patients preoperatively is essential to mitigate these risks and provide the best surgical outcome. This scoping review aims to identify the efficacy of prehabilitation for cosmetic RM and identify mutable patient characteristics that could reasonably be targeted with prehabilitation to improve surgical outcomes.</p><p><strong>Methods: </strong>A comprehensive PubMed review was performed in April 2025 to identify cosmetic RM-related articles that discussed risks associated with mutable patient characteristics and outcomes following prehabilitation. Data collected included article type, topic, participant information, and study outcome.</p><p><strong>Results: </strong>A total of 123 articles met inclusion criteria. Most articles addressed the effects of body mass index (n = 61, 50%), age (n = 55, 45%), or mental health (n = 19, 15%). High-risk mutable characteristics identified included obesity, malnourishment, frailty, diabetes, smoking, poverty, cardiovascular and hematologic issues, vitamin D deficiency, history of bariatric surgery, and chronic steroid use. Only 1 article directly reported the effects of prehabilitation regimens on RM outcomes, showing that a weight loss intervention reduced complications.</p><p><strong>Conclusions: </strong>Although RM prehabilitation with a focus on weight loss demonstrated quantifiable improvement in surgical outcomes, prehabilitation programs for other mutable characteristics have not been directly studied. However, risk-increasing characteristics should be optimized before surgery. Further evidence is needed to provide quantifiable data on the effectiveness of prehabilitation.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8074"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040331","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":"Prehabilitation for Aesthetic Surgery: An Evidence-based Guide.","authors":"Andrew J Malek, Alex J Dong, Justin M Broyles","doi":"10.1097/GOX.0000000000008070","DOIUrl":"10.1097/GOX.0000000000008070","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing number of aesthetic plastic surgery procedures performed annually and increasing emphasis placed on surgical prehabilitation to improve postoperative outcomes, there is not yet a standardized guide for patients undergoing these aesthetic procedures. The aim of this review is to identify the major components of prehabilitation for aesthetic surgery to decrease the risk of perioperative complications and facilitate a smooth recovery process.</p><p><strong>Methods: </strong>A narrative literature review was conducted for common aesthetic surgery topics, including medical management, nutrition and diet, substance use cessation, weight management, and psychological factors surrounding aesthetic surgery. Additional information was included for specific procedures with existing robust evidence, including rhytidectomy and rhinoplasty.</p><p><strong>Results: </strong>There are strong existing ties between established risk factors such as malnutrition, diabetes, and tobacco use with adverse surgical outcomes, though these topics lack aesthetic surgery-specific recommendations. Hypertension and obstructive sleep apnea should be addressed and managed for patients seeking rhytidectomy or rhinoplasty, respectively. Psychological concerns are pervasive among aesthetic surgery patients and should be kept in consideration beginning at the initial consultation. Emerging players, such as glucagon-like peptide-1 agonists, have shifted the aesthetic landscape, and patients should be counseled on their use with the latest evidence-based recommendations.</p><p><strong>Conclusions: </strong>Prehabilitation in aesthetic surgery should address known risk factors early on in surgical planning to prevent poor outcomes and should be tailored to each patient. There are certain measures, outlined here, that patients undergoing aesthetic surgery can take to prepare themselves for improved surgical outcomes and recovery.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8070"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040178","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":"Prehabilitation for Pressure Ulcer Surgery: A Practical and Evidence-based Guide.","authors":"Sacha C Hauc, Jeffrey E Janis","doi":"10.1097/GOX.0000000000008075","DOIUrl":"10.1097/GOX.0000000000008075","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to synthesize current evidence and provide a clinically actionable framework for perioperative prehabilitation in patients undergoing pressure ulcer (PU) reconstruction.</p><p><strong>Methods: </strong>We conducted a narrative synthesis of the best available evidence, including clinical guidelines, randomized controlled trials, observational studies, and expert consensus statements relevant to perioperative optimization for PU surgery. Literature was reviewed across key domains known to influence surgical outcomes. Evidence was translated into patient-centered, clinically actionable recommendations.</p><p><strong>Results: </strong>Preoperative optimization across nutritional, mechanical, and functional domains was associated with improved wound healing and reduced postoperative complications in PU reconstruction. Nutritional supplementation with an 8-week course of vitamins A, B₉, C, and E, along with zinc, selenium, and copper, was associated with improved outcomes. Comprehensive nutritional assessment was essential; although albumin and prealbumin may suggest malnutrition, tools such as the NUTRIC (Nutrition Risk in the Critically Ill) score, dietary intake evaluation, and body composition analysis provided more accurate risk stratification. Pressure off-loading surfaces reduced shear forces and improved tissue perfusion. Smoking cessation for a minimum of 30 days improved vascular and immune recovery. Tailored preoperative exercise programs, delivered through physical therapy, enhanced functional reserve. Among ambulatory patients, metabolic equivalent levels less than 4 identified higher perioperative risk, with prehabilitation notably improving functional capacity.</p><p><strong>Conclusions: </strong>Multidisciplinary, evidence-based prehabilitation targeting modifiable risk factors improves physiological readiness and surgical outcomes in PU reconstruction. Standardized implementation of nutritional optimization, off-loading strategies, smoking cessation, and functional conditioning may reduce complications and recurrence while enhancing postoperative recovery.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8075"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040255","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":"Vascularized Perifascial Areolar Tissue-augmented Superficial Circumflex Iliac Artery Perforator Flap as an Adhesion-tolerant Functional Gliding Interface.","authors":"Shinsuke Takagi, Toshinori Hokazono, Keiichi Tamagawa, Yasutaka Kojima, Ryu Igaki, Takaki Miyashita, Shogo Hamada, Tsutomu Horinouchi, Akitoki Osawa, Koichi Kadomatsu","doi":"10.1097/GOX.0000000000008111","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008111","url":null,"abstract":"<p><strong>Background: </strong>Postoperative adhesions can impair reconstructions involving mobile structures. Perifascial areolar tissue (PAT) has been used for wound healing and nonvascularized interposition, but its role as a vascularized gliding interface remains underexplored.</p><p><strong>Methods: </strong>This retrospective clinical case series reviewed 6 patients who underwent vascularized PAT-augmented superficial circumflex iliac artery perforator (SCIP) flap reconstruction between 2018 and 2023. PAT was harvested in continuity with the SCIP flap pedicle and used prophylactically to create a gliding interface in 3 cases and therapeutically as an anti-tethering interface in 3 cases. Outcomes included structure-specific clinical findings and adhesion-related symptom severity on an 11-point numeric rating scale (NRS), when applicable.</p><p><strong>Results: </strong>The cohort included 4 male patients and 2 female patients, with a median age of 50 years (range, 34-68 y) and median follow-up of 24 months (range, 10-60 mo). Reconstructed structures included extensor tendons, the median nerve, the facial nerve, the larynx, and the lateral femoral cutaneous nerve; 1 patient had prior radiotherapy. All flaps survived, with no flap-related complications or adhesion-related secondary procedures. Therapeutic cases improved from a median preoperative NRS value of 9 to values of 1, 0, and 1, respectively, at final follow-up. Prophylactic cases had a final NRS value of 0 and no clinically evident restricted gliding or tethering.</p><p><strong>Conclusions: </strong>Vascularized PAT-augmented SCIP flaps may provide an anti-adhesion/gliding interface for selected reconstructions involving mobile structures. Larger comparative studies are required.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8111"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040283","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":"Functional Outcomes in Ambulatory Sacral Defect Reconstruction: Focused Appraisal and Muscle-splitting Gluteus Maximus V-Y Advancement.","authors":"Federico Sacasa, Gustavo Herdocia Baus","doi":"10.1097/GOX.0000000000008119","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008119","url":null,"abstract":"<p><strong>Background: </strong>Sacral ulcer reconstruction is usually described in chronically immobilized or neurologically impaired patients. In ambulatory patients, reconstruction must provide durable coverage while preserving function and future reconstructive options. Ambulatory-specific functional outcomes remain poorly synthesized.</p><p><strong>Methods: </strong>We report the case of a previously ambulatory 69-year-old woman with a stage IV sacral pressure ulcer after transient immobilization due to an acute metabolic derangement. Reconstruction was performed using a unilateral muscle-splitting gluteus maximus myocutaneous V-Y advancement flap. A focused appraisal of published reports in ambulatory patients was performed to contextualize functional outcomes across reconstructive modalities.</p><p><strong>Results: </strong>After serial debridement, infection control, and metabolic optimization, a clean 14 × 8 cm defect was reconstructed. The flap enabled midline closure through convergent advancement vectors while preserving the femoral insertion, avoiding pedicle dissection, and maintaining a multipedicled vascular architecture for dead-space obliteration and central padding. At 12 months, durable closure without recurrence was achieved. Functional recovery improved from a Barthel index of 65 to 95, with return to independent ambulation. Available ambulatory-specific reports generally describe preserved ambulation across reconstructive modalities despite heterogeneity in technique, cohort composition, and follow-up.</p><p><strong>Conclusions: </strong>Functional preservation after sacral reconstruction in ambulatory patients can be achieved across reconstructive modalities and may depend more on patient selection, physiological optimization, and biomechanical considerations than on flap type alone. Unilateral muscle-splitting gluteus maximus V-Y advancement offers a reliable option for selected stage IV sacral defects requiring durable coverage, functional preservation, and maintenance of future reconstructive options.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 9","pages":"e8119"},"PeriodicalIF":1.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040156","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}