Plastic surgery最新文献

{"title":"Head and Neck Cutaneous Melanoma: Is Reduced Radial Margin of Excision Safe?","authors":"Uriel Clemente-Gutierrez, Anouska Agarwal, Kristin Buchko, Mahmoud Seif-Elnasr, Suhail Sayed, Kumar A Pathak","doi":"10.1177/22925503261429463","DOIUrl":"10.1177/22925503261429463","url":null,"abstract":"<p><p><b>Introduction:</b> It is often challenging to achieve recommended excision margins in head and neck cutaneous melanoma (HNCM). This study assessed the impact of reduced radial excision margins on disease-specific survival (DSS), disease-free survival (DFS), and local recurrence-free survival (LRFS) in these patients. Given ongoing uncertainty regarding optimal margin width for melanomas ≥1 mm, a secondary contemporary margin-based analysis was performed. <b>Methods:</b> This population-based study included patients diagnosed with HNCM in Manitoba, Canada, between 1970 and 2020. Radial excision margins were classified as \"recommended\" or \"reduced\" according to National Comprehensive Cancer Network guidelines. A secondary analysis compared outcomes between narrower (∼1 cm) and wider (∼2 cm) excision margins in patients with Breslow thickness ≥1.0 mm. Survival outcomes were evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards models. <b>Results</b>: A total of 716 patients met inclusion criteria; 177 had recommended margins and 539 had reduced margins. Patients in the reduced-margin group had thicker tumors (2.36 vs 1.72 mm, <i>p</i> = .007) and fewer Stage I melanomas (58.6% vs 78%, <i>p</i> < .001). Local recurrence occurred in 4.3% of reduced-margin and 6.2% of recommended-margin patients. Kaplan-Meier analysis showed no differences in DSS, DFS, or LRFS. On multivariable analysis, margin status was not an independent predictor of survival, whereas advanced stage and scalp location were associated with worse outcomes. In the secondary margin-based analysis, margin width was not independently associated with DSS, DFS, or LRFS. <b>Conclusion:</b> Reduced radial excision margins were not associated with inferior oncologic outcomes in HNCM. These findings support the oncologic safety of selective margin reduction in appropriately selected patients.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261429463"},"PeriodicalIF":0.6,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503988","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":"Spontaneity Versus Symmetry in Facial Reanimation: A PRISMA-Guided Narrative Review.","authors":"Hargaven Singh Gill, Glenda Sze Ling Chong, Gurveer Kaven Singh Gill","doi":"10.1177/22925503261429923","DOIUrl":"10.1177/22925503261429923","url":null,"abstract":"<p><p><b>Introduction:</b> Facial reanimation aims to restore dynamic smiling and facial symmetry after paralysis. Ipsilateral masseteric nerve transfer, contralateral facial nerve via cross-facial nerve graft (CFNG), and dual innervation approaches each demonstrate distinct profiles in spontaneous activation and movement symmetry during free functional muscle transfers or direct facial nerve reinnervation. <b>Methods:</b> A systematic review of PubMed, Embase, and the Cochrane Library was conducted (January 2000-March 2025) in accordance with PRISMA 2020 guidelines. Studies comparing masseteric nerve innervation, CFNG, and dual innervation in free muscle transfer or direct fifth-to-seventh nerve coaptation were included. Case reports, series with fewer than 10 patients, non-English studies, and those lacking quantitative smile outcomes were excluded. <b>Results:</b> Twenty-eight studies encompassing 7574 patients met inclusion criteria. Fourteen studies evaluated single innervation techniques, and 14 assessed dual innervation. Masseteric nerve innervation produced greater commissure excursion and improved symmetry, particularly early postoperatively, but demonstrated low spontaneous smile rates, typically under 30%. CFNG achieved higher spontaneity-up to 75% in select studies-but was associated with delayed activation and reduced excursion. Dual innervation achieved spontaneous smile rates up to 98% while maintaining strong, symmetric movement. Pediatric patients showed superior excursion and spontaneity, reflecting greater neural plasticity. Patient-reported outcomes favored masseteric innervation early and CFNG or dual innervation for long-term emotional benefit. <b>Conclusions:</b> CFNG optimizes spontaneity but may compromise strength and speed. Masseteric innervation offers rapid, symmetric smiles with limited emotional spontaneity. Dual innervation provides the most balanced outcomes, particularly in pediatric patients.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261429923"},"PeriodicalIF":0.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499664","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":"Comparison of Porcine Tendon to Novel 3D-Printed Silicone Model for Learning Flexor Tendon Repair Techniques.","authors":"Véronique M Doucet, Abby L Rentz, Christian J Petropolis","doi":"10.1177/22925503261424896","DOIUrl":"https://doi.org/10.1177/22925503261424896","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical simulation has become an important component of surgical residency. Several animal and synthetic flexor tendon repair simulators have been described, with variable degrees of fidelity. The purpose of this study was to determine the effectiveness of a silicone flexor tendon repair model in comparison to a porcine tendon repair model. <b>Methods:</b> A silicone flexor tendon model was created using polypropylene fibres bound in cured silicone to simulate epitenon with the use of a 3D printed mold. Deep flexor tendons were harvested from porcine forelimbs for comparison. Participants tested the models by completing core and epitendinous tendon repairs. Models were evaluated with 5-point Likert Scale questions and a comment section. <b>Results:</b> Nine plastic surgery residents and three plastic surgeons participated in the study. Simulation realism was 3.9/5 for the silicone model and 4.6/5 for the porcine model (p = 0.001). Educational utility was 4.6/5 for the silicone model and 4.6/5 for the porcine model (p = 0.546). Overall, the silicone model scored 4.3/5 and the porcine model 4.6/5 (p = 0.078). <b>Conclusion:</b> We created a moderate-fidelity tendon repair model that is convenient to use, easily reproducible, and of equal educational utility to a porcine model based on our study results. This model has significant potential for simulation learning in postgraduate surgical education. Further validation is required to confirm its efficacy in postgraduate surgical education and skill transfer to the operating room.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261424896"},"PeriodicalIF":0.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691740","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":"State of the Art of Artificial Intelligence in Plastic Surgery.","authors":"Nitzan Kenig, Marianna Ostrerova, Elena Benedito Crespo, Javier Montón Echeverría","doi":"10.1177/22925503261429913","DOIUrl":"10.1177/22925503261429913","url":null,"abstract":"<p><p><b>Introduction:</b> Artificial intelligence (AI) raises a fundamental question for modern plastic surgery: will it enable personalized, patient-centered, efficient care, or lead to a dystopian, automated care that diminishes human autonomy, which is dominated by generic \"AI slop\" that eventually deteriorates the doctor-patient relationship? <b>Methods:</b> This study examines current applications of large language models, generative AI, and neural networks in plastic surgery, assessing AI's roles in surgical planning, automation of repetitive tasks, outcome evaluation, education, and patient communication, alongside associated ethical, legal, and practical risks and considerations. <b>Results:</b> AI has demonstrated utility in evaluating postoperative outcomes, predicting potential surgical complications, assisting with patient inquiries, providing preoperative guidance, and delivering patient education. However, significant challenges accompany these advances, including risks of algorithmic paternalism, cognitive debt, biased decision-making, misinformation, and the use of synthetic images that may create unrealistic patient expectations. Additional concerns include data privacy, accountability, environmental impact, equitable access to AI technologies, and potentially negative patient perceptions or interactions. <b>Conclusions:</b> AI can meaningfully enhance plastic surgery if integrated responsibly, with appropriate human oversight, transparency, and preservation of clinical judgment. The future of the field depends on balancing technological innovation with ethical responsibility while maintaining authenticity, empathy, and patient-centered care. Surgeons must develop AI literacy, monitor public perceptions of AI, establish ethical guidelines, and actively guide responsible adoption to harness AI's benefits while safeguarding human values, creativity, and trust. Future strengths for high-end or boutique practices may lie in emphasizing enhanced human presence, personality, and authenticity rather than excessive reliance on AI.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261429913"},"PeriodicalIF":0.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487073","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":"Commentary: Recommendations for a Canadian Breast Implant Registry.","authors":"Mitchell H Brown","doi":"10.1177/22925503261430355","DOIUrl":"https://doi.org/10.1177/22925503261430355","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261430355"},"PeriodicalIF":0.6,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463632","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":"Frostbite in Children: A Case Series and Development of a New Iloprost-Driven Protocol: Les engelures chez les enfants : une série de cas et l'élaboration d'un nouveau protocole faisant appel à l'iloprost.","authors":"Kessia S Varkey, Simon J Parsons, Thomas R Cawthorn, Rebecca L Hartley, Yoga Dhanapala, A Robertson Harrop, Frankie O G Fraulin","doi":"10.1177/22925503261424890","DOIUrl":"https://doi.org/10.1177/22925503261424890","url":null,"abstract":"<p><p><b>Introduction:</b> Frostbite in children is uncommon; however, when severe, it can be associated with amputation of digits. Frostbite protocols have been established for adults but not for children. This project outlines our experience with the use of a newly developed iloprost-driven protocol for managing frostbite in children. <b>Methods:</b> Motivated by a severe case of frostbite in a teenager, resulting in amputations of multiple digits, the adult Yukon Frostbite Protocol was modified for use in children. Key elements of the new Frostbite Management in Children Protocol include rewarming, iloprost infusion, alteplase administration, and hyperbaric oxygen therapy, if required. Frostbite severity is categorized according to the Cauchy grading system which in turn dictates specific treatment. A review of 3 subsequent cases treated using the protocol was performed. Outcomes recorded included digital amputation rate, motor/sensory recovery, and adverse effects of treatment. <b>Results:</b> In December 2022 to March 2024, 3 patients met the criteria for treatment with iloprost under the new protocol: a 9-year-old female with grade 3 frostbite; a 15-year-old male with grade 2 frostbite; and a 16-year-old male with grade 2 frostbite. There were no amputations. All 3 patients recovered motor and sensory function, though one patient experienced significant hypersensitivity. There were no adverse effects from the treatment protocol, and it was well accepted by nursing and medical staff. <b>Conclusion:</b> An iloprost-based protocol has been developed for children with frostbite. The protocol was accepted by hospital staff and well tolerated by the patients.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261424890"},"PeriodicalIF":0.6,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444617","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":"Integrating Point-of-Care Ultrasound (PoCUS) in Plastic Surgery at an Academic-Community Hospital: Enhancing Patient Care and Resource Allocation.","authors":"Maleka Ramji, Veronica Pentland, Ryan E Austin, Sophocles H Voineskos","doi":"10.1177/22925503261419802","DOIUrl":"10.1177/22925503261419802","url":null,"abstract":"<p><p><b>Introduction:</b> Point-of-care ultrasound (PoCUS) utilization in plastic surgery is increasing, as it improves diagnostic and procedural precision through real-time anatomic assessment. PoCUS also optimizes system resource utilization by avoiding unnecessary diagnostic imaging (DI). This study evaluated surgeon-performed PoCUS within a plastic surgery department at an academic-community hospital, with a focus on diagnostic utility and its impact on DI referrals. <b>Method:</b> This retrospective cohort study included all patients who underwent PoCUS as part of their plastic surgery care at our hospital. All PoCUS exams were performed by staff plastic surgeons using a single handheld, high-frequency portable ultrasound device. Demographic data were collected by retrospective review of clinical records. <b>Results:</b> PoCUS was utilized in 70 patients between November 1, 2023, and October 31, 2024. PoCUS assessment was not only performed in the ambulatory clinic (65%) and minor surgery (26%) settings, but was also utilized in the operating room and on the ward. The Average patient age was 50 years (range: 9-88), and the most common anatomic regions scanned included the upper extremity (54.2%), back (13.9%), head and neck (11.1%), breast (9.7%), and lower extremity (8.3%). PoCUS was used to guide procedures in 44.4% of cases. In our study, PoCUS was an adequate substitute for DI referral in 96.8% of cases. <b>Conclusions:</b> PoCUS is valuable across a broad range of plastic surgery settings and can improve care quality by providing ultrasound guidance during procedures. PoCUS can also reduce unnecessary DI and associated follow-up appointments, thereby improving hospital resource utilization.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261419802"},"PeriodicalIF":0.6,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12960261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378294","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":"Predictive Career Factors for Medical Students Interested in Plastic Surgery.","authors":"Todd Dow, Kenzie MacNeil, Katie Ross, Tammy Selman, Michael Bezuhly","doi":"10.1177/22925503261424888","DOIUrl":"https://doi.org/10.1177/22925503261424888","url":null,"abstract":"<p><p><b>Purpose:</b> Most medical students accurately identify the specialty to which they will ultimately match before entering clerkship. Understanding the factors that attract students to plastic surgery could help attract the strongest candidates and clarify misconceptions about the field. This study aims to identify these factors and the career values driving interest in plastic surgery. <b>Methods:</b> First- and second-year medical students at a single Canadian institution were surveyed on their career interests, goals, and factors influencing their ideal career. Data from a prospectively maintained database were analyzed from 2018 to 2025. Students who ranked plastic surgery among their top 3 choices and those who expressed interest in the specialty were compared to those who did not. Multivariate logistic regression models were used to identify factors associated with interest in plastic surgery. <b>Results:</b> A total of 608 individual medical students responded to the survey between 2018 and 2025. Most respondents were female (65.0%). Multivariate analysis revealed that students valuing \"high income potential\" (<i>P</i> = .032), \"status among colleagues\" (<i>P</i> = .026), \"results of interventions available immediately\" (<i>P</i> = .002), and \"research opportunities\" (<i>P</i> = .005) were more predictably likely to rank plastic surgery as a top 3 career choice. Similar trends existing for students interested in plastic surgery (Likert 4 or 5). <b>Conclusions:</b> Misconceptions about plastic surgery persist among medical students. Those attracted by high income, immediate results, research opportunities, and fewer long-term follow-ups were more likely to express interest in the field. Findings from this study highlight perceptions and values that may influence medical students' early interest in plastic surgery. Addressing these perceptions within medical education may support more informed and accurate understanding of the specialty.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261424888"},"PeriodicalIF":0.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12956607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365673","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":"Commentary: Oncoplastic Breast Reconstruction Complications and Patient-Reported Outcomes.","authors":"Charles Arcand, Tyler Safran, Joshua Vorstenbosch","doi":"10.1177/22925503261425233","DOIUrl":"https://doi.org/10.1177/22925503261425233","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261425233"},"PeriodicalIF":0.6,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326804","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: The Use of Negative Pressure Wound Therapy for Breast Surgeries: A Systematic Review and Meta-Analysis.","authors":"Alan D Rogers","doi":"10.1177/22925503261425245","DOIUrl":"10.1177/22925503261425245","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261425245"},"PeriodicalIF":0.6,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326817","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}