Plastic and Reconstructive Surgery Global Open最新文献

{"title":"Detection of Efferent Lymphatic Vessels Using Gamma Probe Guidance for Efferent Lymphatic Vessel Anastomosis.","authors":"Masato Tsuchiya, Toshifumi Yamashiro, Satoru Tamura, Satoshi Kubo, Tetsushi Aizawa, Ryuichi Azuma","doi":"10.1097/GOX.0000000000006812","DOIUrl":"10.1097/GOX.0000000000006812","url":null,"abstract":"<p><p>Efferent lymphatic vessel anastomosis (ELVA) is a microsurgical technique used to anastomose efferent lymphatic vessels from the inguinal lymph nodes (LNs) to the veins in patients with lower extremity lymphedema (LEL). Intraoperative detection of inguinal LNs is important when performing ELVA. Identifying inguinal LNs in patients with mild LEL is easy on palpation, ultrasonography, and indocyanine green (ICG) lymphography because the LNs are large and have good ICG uptake. In contrast, inguinal LNs of patients with advanced LEL are small and have minimal to no ICG uptake owing to lymphatic degeneration; thus, finding LNs in patients with advanced LEL is difficult, and novel techniques are required. This feasibility study evaluated the effectiveness of gamma probes and lymphoscintigraphy in these patients. Nineteen limbs were included in this study. Patients were injected with a Tc^99m isotope 24 hours before ELVA and evaluated based on the Taiwan Lymphoscintigraphy Staging (TLS). Inguinal LNs with radioisotope accumulation were looked for intraoperatively using a gamma probe. Eleven of the 19 limbs were classified as partial obstruction according to the TLS. The detection of LNs using a probe was successful in all limbs classified as partial obstruction, excluding 1 case. However, the gamma probe did not respond to inguinal LNs in limbs classified as total obstruction. In this study, the gamma probe was useful in identifying suitable inguinal LNs for performing ELVA in patients with partial obstruction findings on TLS.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6812"},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226224","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":"Patient Satisfaction Following Top Surgery: A RealSelf Analysis Using Advanced Natural Language Processing.","authors":"Leonardo Alaniz, Avril Stulginski, Jenny Ventura, Arman Ghafari, Hoyune Esther Cho, Medha Vallurupalli, Justin Cordero, Sierra Willens, Jagmeet Arora, Cathy J Tang","doi":"10.1097/GOX.0000000000006826","DOIUrl":"10.1097/GOX.0000000000006826","url":null,"abstract":"<p><strong>Background: </strong>Chest masculinization (top) surgery nearly tripled from 2016 to 2020 and is often the only gender-affirming procedure for transgender men. Outcomes are highly variable and operator-dependent, with limited research evaluating them from the patient's perspective. This study examined the impact of specific surgical metrics and procedure costs on patient-reported outcomes following top surgery.</p><p><strong>Methods: </strong>RealSelf.com was queried for patient reviews. Extracted variables included procedure date, overall satisfaction, procedure cost, and written reviews. An artificial intelligence (AI) natural language processing tool was used for sentiment quantification from 0 to 1. Two authors analyzed sentiment on nipple-areolar complex (NAC) position, NAC quality, scar position, scar quality, and chest contour. Analysis of variance and Mann-Whitney U tested sentiment differences and cost comparisons, whereas the Pearson correlation analyzed cost-sentiment relationships.</p><p><strong>Results: </strong>A total of 350 (96.42%) of 363 reviews were satisfactory, with an indication of \"worth it\" and mean sentiment score of 0.80. Worth it ratings had significantly higher median AI-generated positive sentiment scores than \"not worth it\" ratings (0.91 versus 0.56, <i>P</i> < 0.001). Additionally, patients had a mean satisfaction rate of 92% for the 5 surgical outcomes, with NAC positioning and quality being most influential. Procedure costs were not significantly different, nor did they demonstrate any correlation with satisfaction.</p><p><strong>Conclusions: </strong>Chest masculinization surgeons can optimize patient satisfaction by focusing on key features, particularly related to NAC features and scars. The cost of this procedure did not significantly influence patient satisfaction. Practitioners can benefit from AI language tools to effectively analyze patient feedback and implement rapid improvements in their practice.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6826"},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226230","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":"Breast Reconstruction in De Novo Metastatic Breast Cancer: A Systematic Review.","authors":"Alexzandra Mattia, Mohammad Alomari, Taliah Hyjazie, Nitya Devisetti, Yizhuo Shen, Siba Haykal","doi":"10.1097/GOX.0000000000006810","DOIUrl":"10.1097/GOX.0000000000006810","url":null,"abstract":"<p><strong>Background: </strong>Breast reconstruction in de novo metastatic breast cancer (dnMBC) patients is a viable option. There remains no consensus on recommendations. We summarize postreconstruction clinical outcomes in dnMBC patients to identify surgical candidates.</p><p><strong>Methods: </strong>A systematic review was conducted across PubMed/MEDLINE, Scopus, and Web of Science from January 1, 1990, to November 1, 2024. The study methods were in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on patient demographics, disease characteristics, oncological treatment, surgical details, and clinical outcomes were collected.</p><p><strong>Results: </strong>A total of 7 studies (2635 breast cancer survivors) were identified. The average (SD) age was 47.5 (2.35) years, and most participants were White (n = 2080, 79.3%). Across studies, 39.0% (n = 761) of patients underwent implant-based reconstruction, 38.8% (n = 757) autologous reconstruction, 5.99% (n = 117) combined reconstruction, and 16.4% (n = 320) were not specified. Most cancers were invasive ductal carcinoma (81.3%) with estrogen-positive (73.1%) or progesterone-positive (48.4%) receptors and human epidermal growth factor receptor 2-positive (33.7%) status. Primary tumors most often metastasized to bone (44.4%) or lymph nodes (38.5%). Overall survival and breast cancer-specific survival rates were prolonged among reconstructed patients without increased predilection for complications or delay in tumor treatment.</p><p><strong>Conclusions: </strong>Reconstruction in dnMBC patients is an appropriate option, especially among younger patients with oligometastatic disease. Future studies are encouraged to investigate the impact on well-being and prolonged survival rates, which primarily seem to be limited to those with low disease burden and hormone receptor-positive tumor subtypes.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6810"},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226221","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":"Computer-based Simulation of Facial Flap and Cleft Lip Reconstruction Using Multiresolution Physics.","authors":"Qisi Wang, Court B Cutting, Eftychios Sifakis","doi":"10.1097/GOX.0000000000006820","DOIUrl":"10.1097/GOX.0000000000006820","url":null,"abstract":"<p><p>Computer-based simulation of complex local flap reconstructions of the face requires very high-density finite elements to render accurately due to the intricate incision designs frequently used. This is particularly true in detailed cleft lip/nose repairs. If the entire anatomic model is embedded in a high-resolution solid lattice, the element count becomes so high that simulator performance is very slow, even on a high-performance workstation. This article introduces a simulator in which the model is initially presented at a low, but acceptable physical resolution. As the surgeon operates on the model, only the areas impacted are recut at very high resolution. This surgical subvolume is then merged back into the rest of the model. The dramatic reduction in finite element count results in a surgical simulation program that is quite fast, even on a modest personal computer. This article presents examples of this simulator used in a variety of facial flap and cleft lip reconstructions. Future uses in plastic surgery for patient-specific simulation, education, and illustration are discussed. The simulator is available as free, open-source software.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6820"},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226223","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":"Enhancing Localization in Multiple Spontaneous Cerebrospinal Fluid Leakage Reconstruction With Fluorescence Endoscopy: A Case Study.","authors":"Zheng Chen, Jinsen Zhang, Peter Jih Cheng Wong, Minjie Fu, Yuan Feng, Hao Xu, Guo Yu, Wei Hua","doi":"10.1097/GOX.0000000000006834","DOIUrl":"10.1097/GOX.0000000000006834","url":null,"abstract":"<p><p>Spontaneous cerebrospinal fluid (CSF) leakage, with unknown etiology, is challenging to diagnose and repair, particularly in localizing the leak. We present a 40-year-old woman with multiple spontaneous CSF rhinorrheas. Conventional methods failed to pinpoint the defects, but using indocyanine green (ICG) with endoscopy, we precisely identified the leaks and successfully completed the reconstructive repair.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6834"},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226226","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":"Ethical Considerations for Generative Artificial Intelligence in Plastic Surgery.","authors":"Ravi Dhawan, Kendall Douglas Brooks, Orr Shauly, Denys Shay, Albert Losken","doi":"10.1097/GOX.0000000000006825","DOIUrl":"10.1097/GOX.0000000000006825","url":null,"abstract":"<p><p>The integration of artificial intelligence (AI) into surgical care is rapidly transforming healthcare by enhancing efficiency, clinical decision-making, and patient outcomes. Generative AI (genAI), a subfield using large language models such as ChatGPT, Bard, and Midjourney, holds significant promise in automating tasks such as surgical planning and discharge summaries. However, it raises concerns about misinformation, data breaches, biases, and misuse. No genAI technology has yet received Food and Drug Administration approval for surgical use, emphasizing the need for thorough regulatory evaluation. This article proposed 5 ethical principles, adapted from World Health Organization recommendations, to guide the adoption and governance of genAI in plastic surgery. These principles include ensuring data transparency, maintaining patient autonomy, prioritizing safety and accountability, promoting equity, and investing in sustainability. Each principle is illustrated with a hypothetical case to highlight potential ethical breaches and the importance of rigorous testing, clear communication, and continuous monitoring. By adhering to these guidelines, stakeholders can ensure that genAI serves to enhance patient care and uphold the highest standards of ethical practice in surgical settings.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6825"},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226227","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":"Management of Severe Gunshot Injuries of the Lower Third of the Face: A Case Series and Review.","authors":"Elia Kassouf, Samer Abou Zeid, Aref Nassar, Marc Aoude, Charbel El Feghaly, Fadi Sleilati","doi":"10.1097/GOX.0000000000006800","DOIUrl":"10.1097/GOX.0000000000006800","url":null,"abstract":"<p><strong>Background: </strong>Major ballistic trauma to the lower face is especially challenging due to its crucial functional and aesthetic roles, involving key soft tissue and bone structures. Proper and timely management of such injuries is crucial, as it can significantly improve both long-term functional recovery and cosmetic outcomes, enhancing the patient's quality of life. This study reviewed optimal management strategies by presenting a case series of 7 patients.</p><p><strong>Methods: </strong>We retrospectively reviewed cases involving major gunshot injuries to the lower third of the face, treated at our department over a 10-year period. Patient outcomes were assessed considering both functional and aesthetic results.</p><p><strong>Results: </strong>Seven patients with bone comminution and varying soft tissue loss were included. Early reconstruction was performed in 5 cases, with 2 receiving free fibula flaps and the rest undergoing osteosynthesis. No primary bone grafting was done. Soft tissue reconstruction required free flaps in 2 cases. After a mean follow-up of 5.6 years, 4 patients healed uneventfully. Complications included 1 fibula flap loss, osteitis with fistula, pseudarthrosis, salivary incontinence, and fibrous adhesions. Two patients required multiple bone grafts, and dental rehabilitation was completed in 4 of 5 indicated cases. Cosmetic results were unsatisfactory in 2 total lower lip reconstructions.</p><p><strong>Conclusions: </strong>We favor conservative debridement and early reconstruction. Extensive bone and tissue loss requires the early use of free flaps. Primary bone grafting was not possible. Secondary operations were needed for optimal functional and cosmetic results.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6800"},"PeriodicalIF":1.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226229","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":"Cleft Lip and Palate Digital Impression Workflow.","authors":"Prasad Nalabothu, Benito K Benitez, José Wittor de Macedo Santos, Andreas A Mueller","doi":"10.1097/GOX.0000000000006741","DOIUrl":"10.1097/GOX.0000000000006741","url":null,"abstract":"<p><p>The traditional method of capturing cleft lip and palate morphology using dental impressions and plaster casts has long been considered the gold standard. However, especially for infants, digital impressions have proven to be accurate and safe. We present a protocol successfully adopted by 2 cleft centers that utilize intraoral scanners for cleft care in an outpatient setting, as well as in the operating theater. We demonstrate the positioning of the patient, scanner, monitor, and clinician, along with technical steps to capture a digital impression of the lip, nose, and cleft palate within approximately 1 minute. We also show how digital impressions can improve documentation, allow digital pretreatment, and be used for outcome comparison. The illustrated description is accompanied by a step-by-step video. Digital impressions provide enhanced 3-dimensional reconstructions of the complete cleft anatomy, which are beneficial for presurgical orthopedic planning, anatomical studies, and long-term treatment documentation. This approach minimizes risks such as airway obstruction and storage challenges encountered with physical models. Its adoption in cleft centers represents a significant advancement in cleft care, facilitating more accurate records and improving patient safety. Digital impressions can set a new standard in cleft care, improving record-taking for clinical needs and outcome analysis, and replacing traditional methods.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 5","pages":"e6741"},"PeriodicalIF":1.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180687","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":"Pediatric and Juvenile Lunatomalacia: To Treat Surgically or Not? A Systematic Review and Personal Experience.","authors":"Till Wagner, Sophie Riesmeijer, Dietmar Ulrich","doi":"10.1097/GOX.0000000000006756","DOIUrl":"10.1097/GOX.0000000000006756","url":null,"abstract":"<p><strong>Background: </strong>Pediatric or juvenile lunatomalacia is still a less understood disease of childhood or young adolescence with spontaneous lunate osseous alterations and sometimes incomplete reconstitution of the lunate shape and bony structure. The treatment regimen to be used is still unclear. Given the young age of the patients, the question arises whether surgery is beneficial.</p><p><strong>Methods: </strong>We performed a systematic literature review and analysis. We included studies from the last 5 decades addressing this issue and included additional publications identified through manual screening of references. Data were collected from public bibliographic databases.</p><p><strong>Results: </strong>We included a total of 37 studies in this article. No studies of higher levels of evidence were available. Almost all were case reports or case series, but the quality was overall rated good in most cases. Adding our case to the available studies with a focus on the treatment results, the survey and statistical analysis revealed that a conservative approach most likely results in the best outcomes until the age of 15 years.</p><p><strong>Conclusions: </strong>Our systematic review of this topic demonstrated a lack of high-quality studies. Only reports and smaller case series were found to provide answers. The total number of patients with this entity is also low, but this work is the most comprehensive review of reported cases in the literature. Considering all these reports and our case, we recommend a conservative approach until the age of 15 years.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 5","pages":"e6756"},"PeriodicalIF":1.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183269","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":"Presence of Tissue Expanders Does Not Affect Radiotherapy Dose Distribution to Heart and Lungs.","authors":"Jeewon Chon, Peter Laub, Mike Wesolowski, Safi Bajwa, Taylor Drew, Naomi Desai, Nazanin Azarvash, Jennifer S Wick, Timothy King","doi":"10.1097/GOX.0000000000006819","DOIUrl":"10.1097/GOX.0000000000006819","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer treatment often involves mastectomy and postmastectomy radiotherapy (PMRT). PMRT rates are increasing and can improve outcomes in node-positive cases. Although the risks of PMRT to reconstructed breasts are known, the influence of tissue expanders (TEs) on radiation to nearby organs such as the heart and lungs remains unclear.</p><p><strong>Methods: </strong>Patients who underwent total mastectomy and completed a full course of PMRT with 3-dimensional computer tomography planning between January 2014 and August 2022 at Loyola University Medical Center were included. Patient dose statistics for ipsilateral lung, heart, and clinical target volume, as well as demographics, clinical characteristics, PRMT boost, and bolus were collected. Dose statistics for ipsilateral lung and heart were compared between mastectomy versus mastectomy + TE, and dose statistics were compared between dichotomized TE intraoperative fill volumes. Correlations between dose statistics and BMI were analyzed.</p><p><strong>Results: </strong>A total of 124 patients were included in the study. There were no significant differences in lung or heart radiotherapy across all dose metrics between patients who underwent mastectomy versus mastectomy + TE, or between patients with TE fill volume 60 mL or less versus 60 mL or more. Correlations between BMI and heart maximum dose (<i>P</i> = 0.03) were significantly different and showed a positive, monoclonal correlation (correlation: 0.20, 95% confidence interval: 0.02-0.37).</p><p><strong>Conclusions: </strong>The presence of TE and intraoperative expander fill volume did not affect dose distribution or complications to the organs at risk. Increased BMI correlated with an increased maximum dose to the heart.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 5","pages":"e6819"},"PeriodicalIF":1.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173166","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}