Archives of Plastic Surgery-APS最新文献

{"title":"Marionette Line Correction Using Threads.","authors":"Gi-Woong Hong, Jovian Wan, Song-Eun Yoon, Kyu-Ho Yi","doi":"10.1055/a-2923-5767","DOIUrl":"https://doi.org/10.1055/a-2923-5767","url":null,"abstract":"<p><p>Marionette lines and jowl ptosis present unique challenges in Asian populations due to distinct anatomical variations. The modiolus in Asians is positioned approximately 11 mm lateral and 9 mm inferior to the oral commissure, compared to at or above the commissure in Caucasian and African populations, predisposing to downturned oral commissures and age-related ptosis. This innovation describes a dual-technique approach combining multidirectional barbed threads for deep structural lifting with volumizing monofilament threads for superficial rhytide correction. Barbed threads are anchored at Loré's fascia in the sub-superficial musculoaponeurotic system plane, engaging ptotic jowl tissues with vectors perpendicular to the marionette line. This combined strategy addresses both deep ptosis and superficial lines while preserving natural facial dynamics and avoiding critical perioral neurovascular structures. The technique offers a minimally invasive solution tailored to Asian facial anatomy.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"390-394"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116481","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":"Scientific Reasoning in Plastic Surgery.","authors":"Hyunsuk Peter Suh","doi":"10.1055/a-2952-9547","DOIUrl":"https://doi.org/10.1055/a-2952-9547","url":null,"abstract":"","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"388-389"},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116605","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":"Lymphovenous Bypass: Past, Present, and Future.","authors":"Erin Brown, Jin Geun Kwon, Changsik John Pak, Joon Pio Hong","doi":"10.1055/a-2897-0429","DOIUrl":"https://doi.org/10.1055/a-2897-0429","url":null,"abstract":"<p><p>Lymphovenous bypass (LVB) has evolved from an experimental concept to a widely adopted microsurgical intervention for secondary lymphedema. Advances in imaging, surgical technique, and understanding of lymphatic anatomy have expanded its indications, yet its long-term efficacy and ideal application remain incompletely defined. This review examines the historical development, anatomic foundations, and physiologic principles underlying lymphovenous anastomosis. Key topics include the influence of patient-specific lymphatic anatomy and lymphangiogenesis on surgical outcomes, the rheological determinants of lymphatic-venous flow, and evolving techniques such as immediate lymphatic reconstruction (ILR). Both objective and patient-reported outcome (PROM) data are critically appraised, and persisting gaps in knowledge are identified. Emerging evidence demonstrates that lymphangiogenesis and collateral formation after lymphatic injury are highly variable and strongly influence both the development of lymphedema and the success of LVB. Rheological analysis highlights the exponential impact of vessel diameter and flow resistance on anastomotic performance. While LVB yields modest objective limb volume reductions (6-33%), consistent improvements in quality of life and symptom burden are observed. Evidence supporting ILR suggests short-term benefit in reducing lymphedema incidence, though longer-term follow-up indicates attenuation of this effect. LVB represents a mature and evidence-supported component of reconstructive microsurgery, yet substantial heterogeneity persists in patient selection, technical execution, and outcome evaluation. Future progress will depend on integrating precision imaging, standardized outcome measures, and deeper understanding of lymphatic biology to enable personalized, anatomy-driven interventions that restore physiologic lymphatic function.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"439-449"},"PeriodicalIF":1.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116465","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":"Mapping Lymphatic Drainage from the Human Brain to the Head and Neck: Potential Surgical Implications for Dementia.","authors":"Dung H Nguyen, Carmen Higueras, Hiroo Suami, Anna Carrera Burgaya, Joon Pio Hong","doi":"10.1055/a-2897-0477","DOIUrl":"https://doi.org/10.1055/a-2897-0477","url":null,"abstract":"<p><strong>Background: </strong>Lymphatic surgery of the head and neck has been proposed as a potential approach to prevent, delay, or treat Alzheimer's disease (AD). This exploratory anatomical study undertook to map and evaluate potential targets for surgical feasibility studies.</p><p><strong>Methods: </strong>This exploratory anatomical and preliminary laboratory study was supported by fresh cadaver dissection, with indocyanine green (ICG) lymphography to visualize the drainage pathway. Immunohistochemistry was used to confirm the presence of lymphatic tissues and to detect β-amyloid in lymphatic tissues from a cadaver with confirmed dementia. A simulated lymph node-to-vein anastomosis (LNVA) was performed using robotic-assisted supermicrosurgery with the Symani Surgical System (Medical Microinstruments, Inc., Jacksonville, FL, United States).</p><p><strong>Results: </strong>After injection of ICG at the dural meninges, fluorescence progressed toward the skull base to the Level II deep cervical lymph nodes (dCLNs). When injected at the parietal lymphatics, ICG drained past the deep digastric point to the Level II cervical lymph nodes (CLNs). Veins localized adjacent to dCLNs at the deep digastric point and Level II were suggested as candidate surgical targets for LNVA. Histology of lymph nodes from a dementia-confirmed cadaver identified β-amyloid at Level II dCLNs but not at lower levels or in the groin. A robotic-assisted microsurgical LNVA was shown to be feasible.</p><p><strong>Conclusions: </strong>This study found evidence supporting a posterior pathway from human dural meninges to the dCLNs and identified potential surgical candidates for AD intervention. Further research is warranted to build on the feasibility of this approach.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"427-438"},"PeriodicalIF":1.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116489","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":"Extended Superolateral Periosteal Flap for Single-Stage Total Lower Eyelid Reconstruction.","authors":"Pattana Ongkasuwan","doi":"10.1055/a-2908-5494","DOIUrl":"https://doi.org/10.1055/a-2908-5494","url":null,"abstract":"<p><p>Total lower eyelid reconstruction requires restoration of both lamellae and prevention of postoperative malposition. Traditional two-stage approaches often require a prolonged period of monocular vision. This report describes an extended superolateral periosteal flap harvested along the superior orbital rim to within 2-3 mm of the supraorbital notch, achieving a 35-mm length for single-stage total lower eyelid reconstruction. A 71-year-old woman with basosquamous carcinoma involving the entire lower eyelid underwent excision with 5-mm margins, creating a 30 × 35 mm defect. The periosteal flap was secured to the medial canthal tendon, and the conjunctiva was advanced to line the flap. The anterior lamella was reconstructed using a cheek rotation flap. Early follow-up demonstrated satisfactory eyelid position with transient chemosis. At 3 months, a stable margin position was maintained, and no early ectropion, entropion, symblepharon, or lagophthalmos was observed. Compared with free tarsoconjunctival grafts, a vascularized periosteal flap provides intrinsic blood supply and may support tissue survival when recipient bed vascularity is limited. This extended periosteal flap may serve as a single-stage alternative for complete lower eyelid defects while preserving binocular vision during recovery. Longer-term follow-up was limited due to the patient's death from an unrelated medical condition.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"407-411"},"PeriodicalIF":1.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116510","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":"Development of Local Bleomycin-Induced Hindlimb Model Recapitulating Skin Fibrosis and Vasculopathy of Systemic Sclerosis.","authors":"Jun Hyeok Kim, Eunchae Shin, Jaechan Koo, Yeon Hee Ryu, Su Jin Lee, Suk-Ho Moon","doi":"10.1055/a-2908-5229","DOIUrl":"10.1055/a-2908-5229","url":null,"abstract":"<p><strong>Background: </strong>Systemic sclerosis (SSc) features microvascular injury and progressive fibrosis, often culminating in peripheral ischemia, digital ulcers, and tissue loss. Existing animal models typically capture either fibrosis (e.g., bleomycin [BLM] skin models) or ischemia (surgical hindlimb ligation) but rarely both simultaneously in an extremity.</p><p><strong>Methods: </strong>We established a non-surgical, localized model by administering subcutaneous BLM (300 μg per day) to four peri-ankle sites of the right hindlimb in BALB/c and C57BL/6 mice for 14 consecutive days, followed by a 7-day rest. Outcomes included clinical scoring (edema, joint stiffness, skin thickening), laser Doppler perfusion imaging (LDPI; ischemic/contralateral perfusion ratio), histology (hematoxylin and eosin; dermal thickness; inflammation; collagen deposition), quantitative RT-PCR (RT-qPCR) for fibrotic and vascular markers, and immunohistochemical (IHC) staining for collagen type I alpha 1 chain (COL1A1), alpha-smooth muscle actin (α-SMA), cluster of differentiation (CD)31, and CD34 with ImageJ-based quantification.</p><p><strong>Results: </strong>BLM induced persistent hindlimb edema and contracture with significantly reduced perfusion measured by LDPI compared with the contralateral limb, persisting after the rest period. Histology revealed marked dermal thickening with dense collagen and leukocyte infiltration. RT-qPCR demonstrated dose-dependent upregulation of α-SMA and transforming growth factor β (TGF-β) mRNA, and IHC confirmed increased COL1A1- and α-SMA-positive areas alongside reduced CD31/CD34 capillary density in BLM-treated limbs. The protocol was technically simple and showed reproducible results.</p><p><strong>Conclusions: </strong>Local peri-ankle BLM produces a chronic fibrotic phenotype accompanied by microvascular alteration in an accessible limb, complementing classic SSc models and surgical hindlimb ischemia. This platform enables functional perfusion readouts alongside fibrosis endpoints and is well-suited for preclinical screening of proangiogenic or antifibrotic strategies of interest to reconstructive surgery.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 4","pages":"378-385"},"PeriodicalIF":1.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799678","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":"Epidemiological and Clinical Characteristics of Facial Bone Fractures across Age Groups: A Single-Center Retrospective Analysis of 4,975 Patients at a Regional Trauma Center in Gangwon Province, South Korea.","authors":"Woosang Jeon, Minwoo Park, Sug Won Kim, Jiye Kim","doi":"10.1055/a-2870-8157","DOIUrl":"10.1055/a-2870-8157","url":null,"abstract":"<p><strong>Background: </strong>Patient age influences diagnosis, operative planning, and recovery in facial fracture care. We aimed to delineate age-dependent patterns in fracture sites, injury mechanisms, and management across pediatric, working-age, and elderly cohorts at a regional trauma center.</p><p><strong>Methods: </strong>We retrospectively analyzed 4,975 patients with computed tomography (CT)-confirmed facial fractures (2016-2021), stratified into <20, 20-64, and ≥65 years. Fracture sites, mechanisms, and management (conservative, closed reduction, open reduction and internal fixation [ORIF]) were recorded. Group differences were tested using chi-square/analysis of variance (ANOVA) with Holm adjustment. Multivariable logistic regression identified independent predictors of operative management.</p><p><strong>Results: </strong>The cohort was predominantly male (∼3:1). Nasal fractures were most common (42.3%) but declined with age (60.1%, 41.7%, 31.5%, respectively). Zygomaticomaxillary complex (ZMC) and orbital fractures increased with age (ZMC: 10.3%, 20.7%, 30.8%, respectively; orbital: 14.2%, 25.6%, 28.1%, respectively). Mandibular fractures were more frequent in younger patients (11.6% vs. 5.7% in patients aged ≥65 years). In the elderly, falls (slip/roll/fall-down combined 52.6%) predominated, whereas assault and sports were proportionally higher in younger groups. Mechanism was strongly associated with fracture site ( <i>p</i>  < 0.001). Operative treatment was less frequent in the elderly, in whom conservative care predominated. In multivariable analysis, increasing age independently predicted lower odds of surgery ( <i>p</i>  < 0.001), whereas multiple fractures were the strongest predictor of operative intervention (adjusted odds ratio = 2.50, <i>p</i>  < 0.001).</p><p><strong>Conclusions: </strong>Facial fracture patterns, mechanisms, and treatment differ by age. Findings support age-tailored prevention-fall prevention for older adults and high-energy injury mitigation for younger cohorts-and individualized strategies balancing functional priorities against systemic risk in the elderly.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 4","pages":"331-341"},"PeriodicalIF":1.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799647","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":"The Top 100 Most Cited Articles in Reconstructive Microsurgery: Identifying Evidence Gaps and Research Trends for Future Investigation: A Bibliometric and Visualization Analysis.","authors":"Hatan Mortada, Mustafa Qais Al-Khafaji, Zainalabden E Jefri, Kian Daneshi, Abdulelah Alwadai, Chihiro Matsui, Feras Alshomer","doi":"10.1055/a-2885-8984","DOIUrl":"https://doi.org/10.1055/a-2885-8984","url":null,"abstract":"<p><strong>Background: </strong>Reconstructive microsurgery restores form and function after trauma, oncological resection, or congenital deformities. This study provides a bibliometric analysis of the most cited articles, identifies evidence gaps, and proposes future research priorities.</p><p><strong>Methods: </strong>The top 100 most cited articles were retrieved from Scopus on January 1, 2025, and analyzed for publication trends, authorship, themes, and impact metrics using VOSviewer and R Bibliometrix.</p><p><strong>Results: </strong>From 57,925 articles, the top 100 were selected (mean citations: 251.99 ± 207.78), predominantly in Q1 journals. Head and neck reconstruction dominated (49.5%). Hidalgo D.A. was the most frequent author, and the United States contributed nearly half of all articles. Most provided Level III-IV evidence (38.14% each); none met Level I criteria. Annual citation rates increased from 6.87 (1970s) to 16.32 (2010s). Four evolutionary phases were identified: Technical feasibility, clinical refinement, evidence-based optimization, and emerging interdisciplinary standardization.</p><p><strong>Conclusions: </strong>Three critical findings emerged: (1) No Level I studies and only 7.22% Level II evidence; (2) geographic concentration, with nearly half of contributions from the United States; and (3) a thematic shift from anatomical descriptions toward outcomes research. These findings provide a roadmap for advancing the field.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"456-473"},"PeriodicalIF":1.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116523","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":"Nasal Reconstruction Using Free TAPAS Flap for Internal Lining Restoration after Hemi-Rhinectomy: A Case Report.","authors":"Leonardo Brambilla, Giorgio Giacomini, Arianna Gatto, Erica Michela Cavalli, Andrea Marchesi","doi":"10.1055/a-2870-8089","DOIUrl":"https://doi.org/10.1055/a-2870-8089","url":null,"abstract":"<p><p>Nasal reconstruction represents a challenge for the three-dimensional structure with a three-layer structure. Internal lining remains the most demanding tissue to be reconstructed. We utilized the free temporal artery posterior auricular skin (TAPAS) flap for reconstructing the internal nasal lining of the vault and septum of a single coana following hemi-rhinectomy. A case study of a 79-year-old male patient with a malignant melanoma illustrates the effectiveness of this approach. A free TAPAS flap was harvested to restore the lining, together with a homolateral forehead flap for the external skin resurfacing. Cartilage was raised from the septum and auricular concha to recreate the nose framework. Although it is relevant, lining reconstruction remains underestimated, especially when approaching hemi-nasal defects. Our technique allows for one-stage reconstruction through the usage of the TAPAS flap, a thin and pliable tissue with a negligible aesthetic impact. The features of the TAPAS flap match the necessities of lining reconstruction of complex nasal defects.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"421-426"},"PeriodicalIF":1.4,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116595","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":"Monkeypox-Associated Genital Necrosis in an Immunocompromised Patient: Case Report and Literature Review of Genital Mpox Reconstruction.","authors":"Nae-Ho Lee, Beom Jin Lim, Jin Yong Shin, Yoon Kyu Chung, Si-Gyun Roh","doi":"10.1055/a-2856-5092","DOIUrl":"https://doi.org/10.1055/a-2856-5092","url":null,"abstract":"<p><p>Monkeypox (Mpox) is a viral infection that has shown increased global incidence, particularly affecting immunocompromised populations. We present a case of a 45-year-old human immunodeficiency virus (HIV)-positive man with progressive penile ulceration and necrosis. Mpox was confirmed via polymerase chain reaction testing of skin and oropharyngeal lesions. Despite antiviral therapy and antibiotics, the patient developed full-thickness necrosis of the penile shaft, scrotum, and suprapubic region. Surgical incision, drainage, and debridement were performed, followed by reconstruction using a pedicled anterolateral thigh flap. Secondary intention healing was selected for the penile shaft to preserve tissue elasticity and erectile function. The patient achieved complete wound healing within 3 months without complications. This case highlights a severe and rare manifestation of mpox in the setting of advanced HIV infection, emphasizing the importance of early diagnosis, multidisciplinary management, and tailored surgical planning to optimize both functional and aesthetic outcomes in immunocompromised patients.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 5","pages":"395-401"},"PeriodicalIF":1.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116571","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}