Plastic surgery最新文献

{"title":"Achieving Breast Symmetry After Postmastectomy Radiation Through Contralateral Implant Modification Using Acellular Dermal Matrix Wrapped in a Bouffant Configuration.","authors":"Alyssa Nguyen, Colton H Connor, Claire Fell, Quinton L Carr, Ryan A Cantrell, Alessandra Spagnolia, Christian R Laurent, Bradon J Wilhelmi","doi":"10.1177/22925503261444295","DOIUrl":"https://doi.org/10.1177/22925503261444295","url":null,"abstract":"<p><p>Radiation therapy complicates implant-based breast reconstruction by inducing fibrosis, vascular compromise, and capsular contracture, often resulting in significant breast asymmetry. Reoperation on irradiated implant pockets carries a high risk of wound-healing complications and implant loss, limiting reconstructive options. We present a case demonstrating a contralateral reconstructive strategy to address radiation-induced asymmetry without revising the irradiated breast. A woman with a history of bilateral mastectomy and implant-based reconstruction developed severe asymmetry following postmastectomy radiation to the left breast. Given the patient's preference for the irradiated breast position and the risks of operating on irradiated tissue, revision was performed on the nonirradiated side using a narrow, ultra-high-profile implant wrapped in acellular dermal matrix that was positioned cephalad. This approach restored symmetry when surgical intervention of the irradiated breast was not advised, and nonsurgical treatment of the contracted breast was not preferred. This technique avoids the morbidity associated with operating on irradiated tissue and represents a safe, reproducible treatment option for select patients.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261444295"},"PeriodicalIF":0.6,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779342","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":"Pure Alpha Versus Mixed Adrenergic Vasopressors Perioperative Outcomes in Autologous Free Flap Surgery: A Systematic Review and Meta-Analysis.","authors":"Mohammed Ehmidat, Ibrahim Khalil, Raghad Abuzant, Abdulrahman Ahmed Albalasy, Jamal Ahmad, Engy Amgad Nasr Tolis, Waheed Qaisi, Abdeljalil El Hilali, Amr Elzahy, Soffar Mohammed M","doi":"10.1177/22925503261436402","DOIUrl":"https://doi.org/10.1177/22925503261436402","url":null,"abstract":"<p><p><b>Background:</b> Autologous free-flap reconstruction has transformed reconstructive surgery, restoring form and function in complex head, neck, breast, and limb defects. Maintaining stable perfusion during surgery is essential, yet the choice of vasopressor remains controversial. Surgeons have long feared that α-adrenergic vasoconstriction might jeopardise microcirculation, despite increasing evidence to the contrary. Whether specific vasopressor classes differ in their impact on flap survival has remained uncertain. <b>Methods:</b> We conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO-registered). Eligible randomised controlled trials and observational cohort studies compared perioperative phenylephrine (pure α-agonist) with mixed α/β-agonists (norepinephrine or ephedrine) in adult free-flap surgery. Primary outcomes were flap failure and surgical revision for microvascular compromise; secondary outcomes included thrombosis. Pooled estimates were calculated using random-effects models. <b>Results:</b> Nine studies (two randomised controlled trials [RCTs], seven cohorts) comprising 7181 patients and 8626 flaps were included. Overall flap failure was low (3%), but norepinephrine was associated with higher failure (6%) compared to phenylephrine (2%) and ephedrine (2%). Surgical revision occurred in 12% overall, with norepinephrine again higher (15%) versus phenylephrine (2%). Thrombosis occurred in 7% overall, most frequently with norepinephrine (11%). Sensitivity analyses confirmed the robustness of these findings, though heterogeneity was high and publication bias could not be excluded. <b>Conclusions:</b> In contemporary free-flap surgery, vasopressors are not uniformly harmful - but choice may matter. Phenylephrine and ephedrine were associated with fewer surgical revisions and thrombotic events compared to norepinephrine. While absolute differences in flap failure were small, the higher complication rates with norepinephrine warrant caution, and agent selection should be individualised. Further randomised trials are needed to refine hemodynamic management strategies in microvascular reconstruction.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261436402"},"PeriodicalIF":0.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778207","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":"On the Limits of Physician Political Advocacy.","authors":"Michael Kreidstein","doi":"10.1177/22925503261442144","DOIUrl":"https://doi.org/10.1177/22925503261442144","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261442144"},"PeriodicalIF":0.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778238","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":"Early Experience With Utilizing Biodegradable Temporizing Matrix (BTM) for Complex Pediatric Wound Reconstruction.","authors":"S K Cho, Y Dhanapala, R L Hartley, A R Harrop, Fog Fraulin, T R Cawthorn","doi":"10.1177/22925503261440508","DOIUrl":"10.1177/22925503261440508","url":null,"abstract":"<p><p><b>Background:</b> Biodegradable Temporizing Matrix (BTM) is a synthetic dermal regeneration template composed of a polyurethane bilayer matrix. Although the use of BTM is well established in adult burn populations, its application for complex pediatric wounds is only beginning to emerge. This case series describes our institution's early experience with BTM for managing a variety of complex pediatric wounds. <b>Method:</b> A retrospective chart review was conducted at the Alberta Children's Hospital examining children with complex wounds treated with BTM. Data collected included etiology of the wound, rationale for BTM selection, size of wound, time to wound closure or coverage with split-thickness skin graft (STSG), complications and cosmetic/functional outcomes. <b>Results:</b> Eleven children (age range: 2 weeks to 15 years) had wounds treated with BTM between December 2023 and December 2024. The etiology of the wounds varied (eg, trauma, infection, pressure, and postsurgical). Several patients had wound with complicating factors including sepsis, immunosuppression, or exposed critical structures (eg, dura and joint capsule). There was 1 treatment failure in a patient with cognitive delay who removed the BTM 1 week after application. Following BTM application, 6 patients subsequently underwent application of STSG while the other 5 patients healed spontaneously by secondary intention. Wound colonization was the most common complication (5 patients); these were all successfully managed with oral antibiotics. <b>Conclusion:</b> BTM is a useful reconstructive option for managing challenging wounds in children and can be utilized in variety of ways. Specific indications for BTM and its relative position on the reconstructive ladder are still evolving. We outline 5 key learning points that may be considered when using BTM in a pediatric population.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261440508"},"PeriodicalIF":1.2,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779348","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":"Advancements in Smart Wound Dressings: Leveraging Sensor Technology for Real-Time Wound Monitoring and Management.","authors":"Claudy Sarpong, Joseph M Larson, Isabella Oh, Nitya Devisetti, Subhas Gupta","doi":"10.1177/22925503261440483","DOIUrl":"10.1177/22925503261440483","url":null,"abstract":"<p><strong>Introduction: </strong>This review aims to evaluate smart wound dressings (SWDs) that integrate sensor technology for real-time monitoring of acute and chronic wounds, with emphasis on clinical relevance, validation status, and translational limitations.</p><p><strong>Methods: </strong>A structured literature search was performed to identify preclinical, translational, and human studies evaluating sensor-enabled wound dressings, including technologies measuring temperature, pH, moisture, and infection-associated parameters. Relevant studies were selected based on applicability to sensor-integrated wound monitoring. Key features extracted included sensing modality, validation model, regulatory context, and reported clinical applicability.</p><p><strong>Results: </strong>Sensor-enabled wound dressings demonstrate promising noninvasive approaches to wound monitoring; however, the level of clinical validation varies widely. While some systems have advanced to limited human use supported by observational data, many remain at the preclinical or early feasibility stage. Direct comparisons with established diagnostic standards and robust patient-centered outcome data are largely lacking.</p><p><strong>Conclusions: </strong>SWDs represent a rapidly evolving field with significant potential to improve wound monitoring. Current clinical adoption is constrained by limited comparative validation and regulatory pathways that do not require demonstrated efficacy. Future studies benchmarking these technologies against accepted diagnostic standards will be essential to defining their clinical role.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261440483"},"PeriodicalIF":1.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723566","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":"Canadian Facial Reanimation Services: An Exploratory National Survey.","authors":"Catherine F Roy, Heather Baltzer, Tessa A Hadlock, Marco M Mascarella","doi":"10.1177/22925503261440510","DOIUrl":"10.1177/22925503261440510","url":null,"abstract":"<p><p><b>Background :</b> Canada has a strong historical legacy in facial reanimation, yet few comprehensive programs exist nationally. Facial reanimation requires specialized expertise, multidisciplinary care, and resource-intensive interventions, which naturally centralize services in high-volume centers. Conversely, timely assessment and longitudinal follow-up are essential, creating challenges in a geographically vast country with provincially siloed healthcare systems. This study aimed to characterize the availability, structure, and perceived barriers to facial reanimation care across Canadian academic centers. <b>Methods :</b> A 15-item cross-sectional survey was distributed to department heads or delegates from Canadian university-affiliated plastic surgery (N = 15) and otolaryngology departments (N = 12). The survey assessed available services, multidisciplinary resources, outcome tracking, and perceived barriers. Responses were collected anonymously using REDCap and analyzed descriptively. <b>Results :</b> Fifteen of 27 departments responded (55.6%), representing six provinces. Core interventions including static suspension, periocular procedures, and nerve transfers were widely available. Cross-facial nerve grafting (80%), regional muscle transfer (67%), and free muscle transfer (73%) were less consistently offered. Only 53% of departments performed surgical procedures for non-flaccid facial paralysis. Outcome evaluation relied primarily on clinician-graded scales and subjective patient reports, with limited use of validated patient-reported outcome measures and standardized photo/video documentation. Half of centers reported a formal multidisciplinary team, with variable access to neuromuscular retraining therapists and psychologists. Common barriers included limited awareness among referring physicians, restricted operating room time, and insufficient allied health resources. <b>Conclusion:</b> Canadian centers provide broad access to foundational facial reanimation interventions, but gaps remain in advanced procedures, multidisciplinary support, and standardized outcomes tracking. Respondents unanimously supported expanding facial reanimation services.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261440510"},"PeriodicalIF":1.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723652","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":"Would AI Take a Research Year? Pilot Study Evaluating the Reliability of ChatGPT in Advising Plastic Surgery Applicants on Research Years.","authors":"Naomi N Ghahrai, Skye T Coffey, Virginia Bailey, Praneet Paidisetty, Robert G DeVito, Christopher A Campbell","doi":"10.1177/22925503261440496","DOIUrl":"https://doi.org/10.1177/22925503261440496","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) such as OpenAI's GPT-4o are increasingly used to summarize information and report trends in available data for medical education. For integrated plastic surgery, the utility of LLMs to recommend taking a research year has not been established. We aim to establish the reliability of ChatGPT reproducibility of research year recommendations for medical students applying to integrated plastic surgery.</p><p><strong>Methods: </strong>De-identified, self-reported integrated plastics applicant profiles in publicly available Google Sheets from 2022-2025 were assembled. Inputs provided to GPT-4o (three runs per profile) included Step 2 CK (Clinical Knowledge) score, AOA designation, and research productivity. Research-year status and match outcome were withheld. The model returned a binary recommendation to pursue a research year. Reproducibility was summarized as cross-run concordance. We compared model recommendations with applicants' actual research-year decisions.</p><p><strong>Results: </strong>Of 98 entries, 55 complete profiles were retained. Mean Step 2 CK was 258.3 (SD = 10.4). Applicants reported a mean 20.1 (SD = 19.9) research presentations, 3.84 (SD = 3.6) first-author publications, and 9.18 (SD = 6.4) total publications. Twenty-one eligible applicants (51.2%) reported AOA. Overall, 98.2% (54/55<b>)</b> matched. Across the three computed runs, there was a 98% concordance in recommendations. The LLM recommended a research year for 32.7% (18/55) of entries, whereas 45.5% (25/55) actually undertook one (p = 0.208). Agreement between model recommendations and applicant decisions was 41.8% (p = 0.28).</p><p><strong>Conclusion: </strong>ChatGPT demonstrated internal consistency, but its recommendations could not predict which students would take a research year en route to a successful residency match.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261440496"},"PeriodicalIF":0.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723558","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":"Anatomical Landmarks of Umbilical Aesthetics.","authors":"Edoardo Raposio, Elisa Bertulla","doi":"10.1177/22925503261438772","DOIUrl":"10.1177/22925503261438772","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261438772"},"PeriodicalIF":1.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675934","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":"WALANT Thumb CMC Joint Denervation Under Field Sterility: A Case Report and Description of Technique.","authors":"Alexander Platt, Merry Faye Graff, Brett Ponich, Aaron Knox","doi":"10.1177/22925503261436369","DOIUrl":"10.1177/22925503261436369","url":null,"abstract":"<p><p>Thumb carpometacarpal (CMC) osteoarthritis is a common condition that can affect a patient's ability to function normally in daily life. Surgical CMC denervation of the thumb has emerged as a less invasive option for patients who want to recover and return to activity sooner. Here, we report the use of the Wide-Awake Local Anesthesia No Tourniquet technique for first CMC denervation under field sterility.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261436369"},"PeriodicalIF":1.2,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675908","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 Hypothermia in Plastic Surgery: Procedure-Specific Patterns and the Call for Preventive Strategies.","authors":"Keenan S Fine, Sara Booth, Heather Larson, Karin L Zuegge, Katherine Gast","doi":"10.1177/22925503261436334","DOIUrl":"10.1177/22925503261436334","url":null,"abstract":"<p><p><b>Introduction:</b> Intraoperative hypothermia is a common yet underrecognized concern in plastic surgery, contributing to increased risks of surgical site infections, coagulopathy, and delayed recovery. This study characterizes intraoperative temperature dynamics and identifies procedure-specific risks to guide warming strategies. <b>Methods:</b> We performed a retrospective review of 1923 elective plastic and reconstructive surgeries under general anesthesia at a single academic institution. Preincision and postoperative core temperatures were recorded using nasopharyngeal or esophageal monitoring. Intraoperative temperature change was defined as the difference between these measurements. Multivariable linear and logistic regression models assessed associations between procedure type and both temperature change and postoperative hypothermia (<36.0 °C), adjusting for surgery duration, inpatient status, and preincision temperature. <b>Results:</b> The mean intraoperative temperature change across all procedures was +0.16 °C. However, substantial variation existed by procedure. Free flap breast reconstruction, facial procedures, oncoplastic breast reduction, and panniculectomy were associated with temperature increases, while hand surgery showed significant decreases (<i>P</i> = .002). Preincision hypothermia was present in 36.6% of cases and postoperative hypothermia in 32.3%. On multivariable analysis, body contouring (OR = 1.84, <i>P</i> = .005) and hand procedures (OR = 3.91, <i>P</i> = .004) were significantly associated with increased odds of postoperative hypothermia, while aesthetic breast revision trended toward significance (OR = 1.84, <i>P</i> = .055). Neither surgery duration nor inpatient status predicted postoperative hypothermia. <b>Conclusions:</b> Hypothermia remains highly prevalent in plastic surgery procedures performed under general anesthesia, particularly among patients undergoing hand and body contouring procedures. High rates of preincision hypothermia further underscore the need for improved perioperative warming protocols. Multimodal warming strategies should be implemented consistently to maintain normothermia and reduce the risk of hypothermia-related complications.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261436334"},"PeriodicalIF":1.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623621","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}