JPRAS Open最新文献

{"title":"Dual-purpose extensor pollicis longus transfer for combined type I and IV rheumatoid thumb deformities","authors":"Sébastien Durand,&nbsp;Yves Harder,&nbsp;Jessica Billy,&nbsp;Thomas Orthmann","doi":"10.1016/j.jpra.2025.11.035","DOIUrl":"10.1016/j.jpra.2025.11.035","url":null,"abstract":"<div><div>The Nalebuff classification, widely used by hand surgeons, describes six different canonical patterns. However, combined deformities are rarely reported, despite their significant impact on surgical decision-making. We present a dual-purpose extensor pollicis longus (EPL) transfer designed to address combined type I Boutonnière deformity and type IV metacarpophalangeal (MP) joint ulnar instability in rheumatoid thumb deformities. In two cases, a transosseous tunnel was drilled from dorsal to ulnar at the base of the proximal phalanx of the thumb, allowing passage and dorsal fixation of the EPL tendon. The remaining EPL tendon was then anchored at the ulnar side of the metacarpal head to reconstruct the ulnar collateral ligament. This dual-purpose transfer restores active thumb extension and simultaneously stabilizes the MP joint, thereby eliminating compensatory adduction at the first carpometacarpal joint.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 397-402"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 10-year recurrence-free natural course of high-risk stage II cutaneous melanoma: A case report","authors":"Benedikt Bauer ,&nbsp;Marcel Mayrhofer ,&nbsp;Maximilian Zarfl ,&nbsp;Lars-Peter Kamolz ,&nbsp;Hanna Luze ,&nbsp;Sebastian Philipp Nischwitz","doi":"10.1016/j.jpra.2025.11.029","DOIUrl":"10.1016/j.jpra.2025.11.029","url":null,"abstract":"<div><h3>Background</h3><div>pT4b melanoma of the skin, especially the nodular subtype with present ulceration, typically entails a poor prognosis with high risk for metastatic spread. The accuracy of classic risk prediction models lacks at times. When situated in the face, these malignancies can pose a specific challenge to reconstructive surgeons. Profound fears of cancer treatment further complicate the management of these cases.</div></div><div><h3>Case presentation</h3><div>We present a case of facial reconstruction in a 58-year-old female patient with a high-risk stage II melanoma with recurrence-free survival (RFS) despite an almost 10-year delay of surgical treatment due to existential fears.</div></div><div><h3>Conclusions</h3><div>The presented case provides several key takeaways. First, from a dermatological standpoint, clinicians must expect the unexpected and should look for explanations. Second, from a reconstructive view, complex cases are rarely linear—staged revisions, and setbacks are integral to surgical success. Finally, from a human perspective, sincere empathy, and emotional intelligence are indispensable.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 205-212"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical analysis of the muscle layers of the soft palate in velopharyngeal closure: A cadaveric study","authors":"Keiko Fukino ,&nbsp;Masahiro Tsutsumi ,&nbsp;Yuri Kinoshita ,&nbsp;Yoshiro Matsumoto ,&nbsp;Takashi Ono ,&nbsp;Joe Iwanaga ,&nbsp;Keiichi Akita","doi":"10.1016/j.jpra.2025.12.025","DOIUrl":"10.1016/j.jpra.2025.12.025","url":null,"abstract":"<div><h3>Background</h3><div>In general, the levator veli palatini is essential for velopharyngeal closure as it elevates the velum. However, reconstructing the levator veli palatini alone does not fully restore velopharyngeal closure, suggesting that surrounding muscles—particularly the palatopharyngeus and superior constrictor—are also essential. We aimed to clarify the spatial relationships between the muscle bundles of the soft palate and pharynx macroscopically and histologically, particularly the palatopharyngeus, superior constrictor, and levator veli palatini.</div></div><div><h3>Methods</h3><div>We examined 15 heads from adult Japanese cadavers—12 macroscopically and three histologically.</div></div><div><h3>Results</h3><div>We observed superior constrictor attaching to the most lateral part of the soft palate and three consistently identifiable fiber groups, classified according to their origin on the superior or inferior surface of the soft palate and their relationship to the levator veli palatini. The superolateral part of the palatopharyngeus originated inferior to the levator veli palatini and ran obliquely and transversely on the pharyngeal wall. The superomedial part of the palatopharyngeus originated from the superior surface of levator veli palatini, ran orthogonally to levator veli palatini, and comprised the palatopharyngeal arch. The inferior part of the palatopharyngeus originated from the inferior surface of the palatine aponeurosis and comprised the palatopharyngeal arch. Moreover, the inferior part of the palatopharyngeus was attached to the base of the epiglottis and thyroid cartilage.</div></div><div><h3>Conclusions</h3><div>The multidirectional bundles of the palatopharyngeus, superior constrictor, and levator veli palatini within the soft palate are closely related anatomically and play important roles in velopharyngeal closure.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 817-827"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of flap and contralateral donor site tissue perfusion for flap monitoring in microvascular head and neck reconstruction – a retrospective study","authors":"Mark Ooms,&nbsp;Philipp Winnand,&nbsp;Marius Heitzer,&nbsp;Nils Vohl,&nbsp;Anna Bock,&nbsp;Marie Sophie Katz,&nbsp;Frank Hölzle,&nbsp;Ali Modabber","doi":"10.1016/j.jpra.2025.12.020","DOIUrl":"10.1016/j.jpra.2025.12.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative flap monitoring in microvascular head and neck reconstruction based solely on flap tissue perfusion measurements relative to predefined thresholds may be influenced by systemic tissue perfusion alterations. This study compared flap and contralateral donor site tissue perfusion and evaluated the utility of the flap-to-donor site ratio in detecting vascular flap compromise.</div></div><div><h3>Materials &amp; methods</h3><div>Tissue perfusion measured with the O2C analysis system at a tissue depth of 3 mm at 0, 12, 24, 36, and 48 h postoperatively was retrospectively analyzed in 62 patients who underwent head and neck reconstruction with a fasciocutaneous free flap (FFF) (radial free forearm flap) or a perforator free flap (PFF) (anterolateral thigh flap or fibula free flap) between 2020 and 2022. Flap and contralateral donor site tissue perfusion parameters (blood flow, hemoglobin concentration, and hemoglobin oxygen saturation) were compared, and flap-to-donor site ratio cut-off values indicating vascular flap compromise, based on the minimum (blood flow and hemoglobin oxygen saturation) or maximum (hemoglobin concentration) value of all 5 measurement timepoints, were determined.</div></div><div><h3>Results</h3><div>Blood flow, hemoglobin concentration, and hemoglobin oxygen saturation were in general higher at the flap than the donor site (<em>p</em> &lt; 0.05). Cut-off values for the flap-to-donor site ratio indicating vascular flap compromise were as follows for FFFs and PFFs, respectively: &lt;1.063 and &lt;0.224 for blood flow, &gt;1.792 and &gt;1.597 for hemoglobin concentration, and &lt;0.673 and &lt;0.199 for hemoglobin oxygen saturation (sensitivity all 100 % [confidence interval (CI) range 2.5–100.0 %]; specificity all &gt;65 % [CI range 49.0–100.0 %]).</div></div><div><h3>Conclusion</h3><div>The postoperative course of tissue perfusion differs between flap and contralateral donor sites in FFFs and PFFs. The flap-to-donor site ratio could be used to detect vascular flap compromise in microvascular head and neck reconstruction, with further studies needed to confirm the determined cut-off values for the flap-to-donor site ratio indicating vascular flap compromise.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 535-547"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The inframammary fold: Structure, clinical considerations, and reconstructive techniques","authors":"Camellia Richards ,&nbsp;Sonam Patel ,&nbsp;Hannah Markham ,&nbsp;Jajini Varghese ,&nbsp;Ramsey I Cutress","doi":"10.1016/j.jpra.2025.11.022","DOIUrl":"10.1016/j.jpra.2025.11.022","url":null,"abstract":"<div><div>The inframammary fold is a defining structure of breast position and form. Disruption, relocation and reconstruction of the Inframammary fold is therefore significant and may present surgical challenges. Furthermore, the inframammary fold’s anatomy, structure, relationship to other key thoracic landmarks and how these factors impact reconstruction is debated in the literature.</div><div>Several reconstructive techniques have been proposed since the IMF was first described as a distinct structure. These are commonly used in isolation or in combination, however there is a lack of direct comparison between different reconstruction methods. Much of the current literature is based on level IV or level V evidence often with small sample sizes.</div><div>The inframammary fold’s anatomy is discussed in this review on a macro- and microscopic level. Indications and procedures for inframammary fold reconstruction are discussed. The distinct challenges presented by different reconstructive techniques, gender-affirming surgery, inframammary fold insufficiencies and pathologies are considered.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 457-472"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S.W.A.T. flap in plastic surgery: The latissimus dorsi. In-depth overview of a classic weapon and systematic review of its reported uses.","authors":"Belén Andresen-Lorca ,&nbsp;Alessandro Thione ,&nbsp;María García-García ,&nbsp;Iván Heredia-Alcalde ,&nbsp;Alberto Pérez-García ,&nbsp;Alfonso Amador Valverde-Navarro ,&nbsp;María D Pérez-del-Caz","doi":"10.1016/j.jpra.2025.08.037","DOIUrl":"10.1016/j.jpra.2025.08.037","url":null,"abstract":"<div><div>The latissimus dorsi (LD) flap deserves recognition as the “S.W.A.T. flap” in reconstructive surgery, as a reflex of its unparalleled versatility and adaptability in addressing complex, high-risk reconstructive challenges. Much like the special intervention units we propose it to be named after, the LD flap offers a wide range of strategies that allow us to tailor it to fit virtually any defect in the human body, making it a cornerstone of reconstructive surgery.</div><div>This flexibility is supported by various features. The multiple dissection techniques and patient positioning options available enhance its utility in multi-disciplinary settings. Also, it can be harvested with different tissue compositions, such as muscle, skin, bone, and adipose tissue, providing surgeons with numerous configurations suited for diverse anatomical and functional needs. Moreover, the consistency of the thoracodorsal pedicle, allows for multiple vascular configurations and the creation of composite or chimeric flaps, making it highly adaptable to complex defect reconstructions. Furthermore, the LD flap is easily elevated with minimal donor-site morbidity, making it an attractive option for both functional and aesthetic restoration.</div><div>To demonstrate the broad applications of the LD flap, a systematic review following PRISMA guidelines was conducted. The review aimed to identify and synthesize reported cases of the flap’s use across a variety of clinical scenarios, yielding articles detailing its use in diverse anatomical regions.</div><div>This article highlights the LD flap’s essential role in modern reconstructive surgery, advocating for its recognition as the “S.W.A.T. flap” due to its exceptional versatility, reliability, and broad applicability.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 269-280"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of local application of nonivamide/nicoboxil (FinalgonⓇ) on random-pattern skin flap survival after nipple-sparing mastectomy and breast reconstruction with tissue expander","authors":"Anja Imsirovic,&nbsp;Anton Schwabegger,&nbsp;Agnese Nitto,&nbsp;Marie Emilia Casari,&nbsp;Dolores Wolfram-Raunicher,&nbsp;Monika Lanthaler","doi":"10.1016/j.jpra.2025.11.024","DOIUrl":"10.1016/j.jpra.2025.11.024","url":null,"abstract":"","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 249-252"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compensatory hypertrophy of the superior gluteus maximus following botulinum toxin-induced weakening of the inferior fibers","authors":"Kyu-Ho Yi ,&nbsp;Jin-Hyun Kim ,&nbsp;Isabella Rosellini ,&nbsp;Jong Keun Song ,&nbsp;Wong Ka Fai ,&nbsp;Byung Ki Cho ,&nbsp;Konstantin Frank ,&nbsp;Ji-Soo Kim ,&nbsp;Carlos Bautzer ,&nbsp;Benjamin Ascher","doi":"10.1016/j.jpra.2025.12.016","DOIUrl":"10.1016/j.jpra.2025.12.016","url":null,"abstract":"<div><div>Selective chemodenervation of the inferior gluteus maximus (GMax) may induce compensatory hypertrophy of its superior fibers. Two healthy female subjects underwent ultrasound-guided botulinumtoxinA (JETEMA THE TOXIN, JETEMA Co., Ltd., Korea) injections (100 IU) into the inferior GMax. Six-week follow-up revealed increased fullness and definition in the superior region without adverse effects. The observation supports the concept that targeted muscle weakening can promote adaptive hypertrophy in adjacent fibers. This minimally invasive approach may have potential applications in aesthetic body contouring and functional rehabilitation.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 1069-1072"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stepwise Assessment and Full Evaluation in DIEP flap after abdominal liposuction","authors":"Federico Taraschi ,&nbsp;Liliana Barone Adesi ,&nbsp;Alessandro Cina ,&nbsp;Giuseppe Visconti ,&nbsp;Marzia Salgarello","doi":"10.1016/j.jpra.2026.01.003","DOIUrl":"10.1016/j.jpra.2026.01.003","url":null,"abstract":"<div><div>The use of DIEP flaps in patients with a history of abdominal liposuction remains controversial due to concerns about potential damage to perforator vessels, which are crucial for the flap’s perfusion. Some studies suggest liposuction does not significantly harm perforator vessels, allowing for successful breast reconstruction, while others indicate potential risks, underscoring the need for thorough preoperative assessment and planning, including consideration of the superficial venous system, which may be compromised due to subcutaneous scarring from liposuction or from direct damage by the cannula. This study aims to develop a decision-making algorithm for autologous breast reconstruction using DIEP flaps in patients with a history of abdominal liposuction. It is a retrospective, monocentric observational clinical study conducted at the Plastic Surgery Unit of Policlinico Gemelli in Rome from 2011 to 2024. The study includes female patients over 18 years with clinical indications for DIEP flap reconstruction and a history of abdominal liposuction. Data collected from patient records encompass demographic information, surgical details, preoperative imaging results, and postoperative outcomes. Preoperative evaluations involve abdominal angio-CT and color Doppler ultrasound to assess the integrity of perforator vessels and the superficial venous system. Intraoperative assessments include clinical evaluation and indocyanine green fluorescence angiography. Despite the challenges posed by previous abdominal liposuction, the study finds that DIEP flap reconstructions can be successful with thorough preoperative planning and intraoperative assessments. The SAFE-DIEP protocol, which incorporates comprehensive evaluation of both arterial and venous systems, proves effective in mitigating complications. Notably, no flap failures or significant complications are observed.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 1044-1052"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal-based vs. alternative flaps: Surgical outcomes and quality of life following different techniques of autologous breast reconstruction","authors":"Lisanne Grünherz ,&nbsp;Stella Vocke ,&nbsp;Laura C. Siegwart ,&nbsp;Victoria Wlach ,&nbsp;Anna Burger ,&nbsp;Pietro Giovanoli ,&nbsp;Nicole Lindenblatt ,&nbsp;Duveken B.Y. Fontein","doi":"10.1016/j.jpra.2025.12.011","DOIUrl":"10.1016/j.jpra.2025.12.011","url":null,"abstract":"<div><div>Abdominal-based flaps are considered the gold standard for autologous breast reconstruction (ABR). With the increasing number of women undergoing mastectomy, however, alternative free flaps from other regions have emerged as valuable alternatives when patients do not qualify for an abdominal-based flap. This single-center cohort study evaluates objective and subjective outcomes in patients who underwent abdominal-based versus alternative flaps for breast reconstruction.</div><div>Patients who underwent ABR between 2010 and 2022 were included. Baseline patient characteristics and data on oncological and surgical treatment were collected. Since 2018, all patients received the validated BREAST-Q questionnaire evaluating satisfaction and quality of life preoperatively and at regular intervals following surgery. Multinomial logistic regression evaluated the probability of flap complications based on the type of flap. We also evaluated quality of life between abdominal-based and alternative flaps.</div><div>Of the 183 patients were included in this study (146 abdominal-based and 37 alternative flaps). We could not ascertain a relationship between type of flap and flap complications. More donor-site complications and more secondary aesthetic corrective surgery were noted in patients who underwent abdominal-based flaps. Our results did not show any differences between patients who underwent abdominal-based compared to alternative flap types for various satisfaction domains of the BREAST-Q.</div><div>Abdominal-based and alternative free flap types are both viable treatment options in ABR and several variables need to be considered when selecting the appropriate flap for the right patient. Careful flap selection and the shared decision-making process between patient and surgeon reflect high patient-satisfaction and an optimal aesthetic result.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 644-653"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}