Plastic surgery最新文献

{"title":"Management of Merkel Cell Carcinoma of the Digits, Hand, and Wrist.","authors":"Karanvir S Raman, Rahul Thareja, Gabriel Bensimon, Charles Arcand, Abdulaziz AlAzzam, Caroline Esmonde-White, Gabriel N Kuper, Raisa Chowdhury, Maitha AlShamsi, Charlotte Jaloux","doi":"10.1177/22925503261495927","DOIUrl":"10.1177/22925503261495927","url":null,"abstract":"<p><strong>Introduction: </strong>Merkel cell carcinoma (MCC) is a rare and often lethal cancer, with few cases presenting on the hand and digits. Treatments such as ray amputation can drastically impact quality of life and the existing literature is inconclusive. This systematic review evaluates the comprehensive management of surgically treated patients with MCC involving the digits, hand, and wrist.</p><p><strong>Methods: </strong>Following PRISMA guidelines, Medline and EMBASE were searched for studies reporting MCC of the digits, hand, and wrist. Given the heterogeneity of the reported data, no meta-analysis was performed; results are reported descriptively as counts/proportions among cases with available data.</p><p><strong>Results: </strong>Forty-two observational studies were included. Twenty-two reported MCC of the digit (25 lesions), of which 15/25 (60%) underwent wide local excision (WLE) and 10/25 (40%) ray amputation. Among cases with available data, recurrence occurred in 2/7 (29%) after WLE and 2/8 (25%) after ray amputation, with MCC-related mortality in 2/9 (22%) of each. Nineteen studies reported MCC of the hand/wrist (n = 19), of which 17/19 (89%) underwent WLE, with recurrence in 7/14 (50%) and MCC-related mortality in 2/12 (17%). Adjuvant radiotherapy and chemotherapy were used in 10/19 (53%) and 4/19 (21%), and nodal management included sentinel lymph node biopsy in 5/13 (38%) and dissection in 4/13 (31%). An additional aggregate cohort of 25 patients was summarized separately.</p><p><strong>Conclusion: </strong>Evidence for MCC of the digits, hand and wrist is limited to case reports and small series with heterogeneous staging/treatment and incomplete reporting. Further evidence is needed to determine optimal management in this region.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261495927"},"PeriodicalIF":1.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Oversight to Protocol: What Should Human Supervision of Surgical Artificial Intelligence Actually Involve?","authors":"Daiven S Sharma, Erin Proctor","doi":"10.1177/22925503261495935","DOIUrl":"https://doi.org/10.1177/22925503261495935","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261495935"},"PeriodicalIF":1.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Violence Needs Action: A Call to Plastic Surgeons.","authors":"Tanya Cherppukaran, Prism Schneider, Claire Temple-Oberle","doi":"10.1177/22925503261495415","DOIUrl":"10.1177/22925503261495415","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261495415"},"PeriodicalIF":1.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy and Predictive Factors of Sentinel Lymph Node Biopsy in Cutaneous Squamous Cell Carcinoma: A Systematic Review.","authors":"Omar El Sewify, Marion Sylvain, Cory Tremblay, Helene Retrouvey, Ammara Ghumman","doi":"10.1177/22925503261491621","DOIUrl":"https://doi.org/10.1177/22925503261491621","url":null,"abstract":"<p><strong>Introduction: </strong>Sentinel lymph node biopsy (SLNB) is increasingly used to stage cutaneous squamous cell carcinoma (cSCC), particularly in high-risk cases, though its diagnostic accuracy remains debated. This systematic review aims to evaluate SLNB detection rates, diagnostic accuracy, complications and predictors of positivity in patients with non-mucosal cSCC.</p><p><strong>Methods: </strong>Following PRISMA guidelines, Medline, Embase, Scopus and Cochrane Library were searched to January 2025. Studies reporting SLNB outcomes in histologically confirmed cSCC were included. Pediatric and mucosal/anogenital cases were excluded. Data on demographics, tumour characteristics, SLNB outcomes and complications were extracted. Comparisons between SLNB-positive, negative and false-negative groups were performed (<i>p</i> < 0.05).</p><p><strong>Results: </strong>Forty-four studies (3043 patients, 3050 lesions) were included. Among 2956 patients undergoing SLNB, nodes were identified in 96.9%, with positivity in 10.9%. False negatives occurred in 1.7% of the cases (rate 13.2%). SLNB-positive patients had larger tumours (4.24 vs 2.88 cm, <i>p</i> < 0.0001) and deeper invasion (9.81 vs 4.75 mm, <i>p</i> = 0.0007), higher rates of perineural invasion (<i>p</i> = 0.0436), poor differentiation (<i>p</i> = 0.009) and more T2 disease (<i>p</i> = 0.04). No significant differences were found for sex (<i>p</i> = 0.5), immunosuppression (<i>p</i> = 0.068) or tumour location (<i>p</i> = 0.1), though immunosuppression was more prevalent in SLNB-positive cases. Recurrence (24.3% vs 4.2%) and disease-specific mortality (18.2% vs 3.7%) were higher in SLNB-positive patients (<i>p</i> < 0.0002). Complication rates were low (3.2%).</p><p><strong>Conclusion: </strong>SLNB demonstrates high detection but notable false negative rates in cSCC. Positive SLNB correlates with aggressive tumour features and worse outcomes. SLNB may assist staging in high-risk patients but should be used selectively, with close surveillance in SLNB-negative cases.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261491621"},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in the Management of Facial Palsy: A Narrative Review Across the Care Continuum.","authors":"Adham Elsherbini, Jonah Perlmutter, Ibrahim Durowoju, Adam Mosa","doi":"10.1177/22925503261490552","DOIUrl":"https://doi.org/10.1177/22925503261490552","url":null,"abstract":"<p><strong>Introduction: </strong>Facial paralysis produces substantial functional and psychosocial impairment which facial reanimation surgery seeks to mitigate by restoring facial movement and improving symmetry. However, despite technical advances in nerve- and muscle-based reconstruction, perioperative evaluation and outcome assessment remain largely subjective and variably reproducible. Artificial intelligence (AI) and computer vision have emerged as tools to provide objective, scalable assessment across the facial reanimation care pathway.</p><p><strong>Methods: </strong>MEDLINE, Embase, and the Cochrane Library were searched extensively to identify studies evaluating AI applications relevant to facial reanimation surgery. Included studies were screened by three independent reviewers and mapped to stages of perioperative care using an evidence-mapping framework.</p><p><strong>Results: </strong>Thirteen studies met inclusion criteria and were distributed across multiple stages of care. Evidence was most concentrated in diagnosis and severity assessment and in postoperative follow-up, where AI systems automated facial grading scales, quantified asymmetry, and extracted dynamic motion features from photographs and video. Several machine learning and deep learning models demonstrated high diagnostic accuracy and strong correlations with clinician-assigned scores, often exceeding inter-rater reliability of traditional grading systems. Fewer studies addressed prognostic modeling, preoperative planning, or rehabilitation, though emerging applications included outcome prediction, three-dimensional symmetry analysis, and AI-assisted evaluation of spontaneous emotional expression after reanimation.</p><p><strong>Conclusion: </strong>AI applications in facial paralysis care are most mature in assessment and outcome measurement, where they offer improved objectivity and reproducibility. However, broader clinical integration will require larger, diverse datasets, prospective validation, and alignment with ethical and regulatory standards to demonstrate meaningful patient centered benefit.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261490552"},"PeriodicalIF":1.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transperitoneal Spiralized Rectus Abdominis Muscle Flap for Total Vaginal Reconstruction.","authors":"Semih Baghaki, Doğan Vatansever, Batu Özlüşen, Oytun Türkkan, Muhterem Melis Cantürk, Melike Taşlıpınar","doi":"10.1177/22925503261490563","DOIUrl":"10.1177/22925503261490563","url":null,"abstract":"<p><p>Total vaginal reconstruction remains a significant surgical challenge in patients with altered pelvic anatomy due to oncologic resection, radiation, trauma, or congenital absence. Traditional flap options often present limitations in terms of bulk, reach and donor site morbidity. We present a novel technique utilizing the spiralized rectus abdominis muscle (SRAM) flap for total vaginal reconstruction. A 45-year-old female patient underwent successful vaginal reconstruction using the SRAM flap following oncologic resection. The rectus muscle is spiralized along its longitudinal axis to create an elongated, pliable, well-vascularized neovaginal canal. The procedure was completed without intraoperative or postoperative complications. At 1-year follow-up, the neovagina remained patent and functional, with patient-reported satisfaction and no significant donor site complications. The SRAM flap represents a promising alternative for total vaginal reconstruction, offering enhanced pliability, reliable perfusion, and minimal abdominal wall morbidity. Further studies are needed to validate its long-term outcomes and broader applicability.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261490563"},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Venous Congestion in DIEP Flap Reconstruction: A Pooled Analysis Demonstrating the Limited Predictive Value of Patient-Level Risk Factors.","authors":"Danielle A Cohen, Frances Perry, Rebecca Spouge, Penelope M A Brasher, Michael Martin, Esta Bovill, Sheina A Macadam","doi":"10.1177/22925503261486455","DOIUrl":"10.1177/22925503261486455","url":null,"abstract":"<p><strong>Introduction: </strong>Intraoperative venous congestion complicates 2% to 20% of deep inferior epigastric perforator flap breast reconstructions (DIEP) and is attributed to persistent superficial venous dominance. Despite numerous proposed predictors, no consensus exists. This study aims to identify clinical and anatomic risk factors.</p><p><strong>Methods: </strong>A retrospective cohort of DIEP patients at five university affiliated centers (2008-2021) was analyzed. Intraoperative venous congestion was defined by documentation of clinically evident congestion occurring prior to anastomosis and prompting a secondary venous outflow procedure. Preoperative CT angiograms were reviewed for anatomic variables. A rapid review identified risk factors, and cohort data were combined with extracted data to perform pooled analyses.</p><p><strong>Results: </strong>Our cohort included 301 patients (411 flaps) with 36 events of intraoperative venous congestion (8.8%). Pooled data included 7189 flaps across 12 studies. Among clinical factors, diabetes (OR 1.78, 95% CI 0.89-3.59) and prior abdominal surgery (OR 1.32, 95% CI 0.67-2.63) demonstrated trends toward increased risk, while smoking, hypertension, and preoperative radiation showed no meaningful association. Anatomic factors including number of perforators and superficial inferior epigastric vein diameter were not predictive. Thinner flaps showed a trend toward congestion (mean difference -2.40 mm, 95% CI -5.24-0.54). Abnormal venous connections, reported in individual studies, showed strong associations with congestion.</p><p><strong>Conclusion: </strong>Diabetes, prior abdominal surgery, and thinner flaps demonstrated trends toward association with intraoperative venous congestion, though none reached statistical significance. Abnormal venous connections, identified in the literature, showed the strongest associations and represent the highest-priority target for future investigation. Identification of these factors preoperatively may support surgical planning, but intraoperative assessment remains essential.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261486455"},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: \"Closed-Incision Negative Pressure Therapy Compared to Conventional Dressing Following Autologous Abdominal Tissue Breast Reconstruction: The MACVAC Pilot Randomized Control Trial\".","authors":"Alan D Rogers","doi":"10.1177/22925503261490578","DOIUrl":"10.1177/22925503261490578","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261490578"},"PeriodicalIF":1.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Stewardship of Health Data in Public Discourse.","authors":"Aishwarya Arun Nair, Kimberlyn McGrail, Kathleen Armstrong","doi":"10.1177/22925503261486386","DOIUrl":"10.1177/22925503261486386","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261486386"},"PeriodicalIF":1.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical Resection of a Giant Facial Plexiform Neurofibroma in a Resource-Limited Setting.","authors":"Tertius Venter, Alan D Rogers, Konrad Mende, Thandiwe Munaiwa, Andrew Hodges","doi":"10.1177/22925503261485189","DOIUrl":"10.1177/22925503261485189","url":null,"abstract":"<p><p>Giant facial plexiform neurofibromas (PNFs) in neurofibromatosis type 1 are surgically challenging, particularly in low- and middle-income countries where patients may present late and repeated staged procedures may be impractical. We report a 20-year-old woman from rural Zimbabwe with a massive recurrent left facial PNF after three prior debulking procedures. She underwent single-stage radical excision of involved skin, mucosa, parotid tissue, and facial nerve branches, followed by immediate anterolateral thigh free flap reconstruction and static facial suspension. Two units of packed red blood cells were transfused, the flap survived, and she was discharged on postoperative day 6. At 22 months, a small localized mucosal recurrence had been excised without further recurrence. This case, considered alongside a 34-patient operative experience, supports definitive macroscopic clearance with immediate reconstruction as a pragmatic strategy when repeated debulking is unlikely to provide durable benefit.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261485189"},"PeriodicalIF":1.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}