Archives of Plastic Surgery-APS最新文献

{"title":"Prospective Observational Study of Supercritical Carbon Dioxide-Processed Acellular Dermal Matrix in Implant-Based Breast Reconstruction.","authors":"Hyung Bae Kim, Ji Hye Oh, Seong Hee Kim, Jin Sup Eom, Hyun Ho Han","doi":"10.1055/a-2863-3696","DOIUrl":"10.1055/a-2863-3696","url":null,"abstract":"<p><strong>Background: </strong>Conventional detergent-based decellularization can disrupt the extracellular matrix (ECM) structure and denature proteins. Supercritical carbon dioxide (scCO ₂ ) processing offers a simplified manufacturing process (<2 hours), minimal protein denaturation, and excellent ECM preservation. This study aimed to evaluate the clinical outcomes of scCO ₂ processing acellular dermal matrix (ADM) compared with conventional detergent-processed ADM.</p><p><strong>Methods: </strong>This prospective observational study enrolled patients undergoing immediate implant-based breast reconstruction with scCO ₂ -processed ADM ( <i>n</i>  = 50) and compared outcomes with a retrospective cohort receiving conventional detergent-processed human ADM ( <i>n</i>  = 50). Patient demographics, comorbidities, and treatment variables were collected. Postoperative complications and BREAST-Q-assessed patient-reported outcomes were analyzed.</p><p><strong>Results: </strong>The groups were comparable in age (45.0 ± 10.4 years vs. 46.8 ± 9.4 years, <i>p</i>  = 0.362), body mass index (median: 21.5 kg/m ² vs. 22.7 kg/m ² , <i>p</i>  = 0.558), comorbidities, and oncologic characteristics. Rates of skin necrosis (2% vs. 0%), nipple-areolar complex necrosis (2% vs. 2%), hematoma (4% vs. 4%), seroma (6% vs. 0%), infection (6% vs. 0%), capsular contracture (8% vs. 12%), implant failure (0% vs. 0%), implant change (2% vs. 2%), and reoperation (2% vs. 2%) did not differ significantly between groups. BREAST-Q questionnaires revealed no significant differences in patient-reported outcomes.</p><p><strong>Conclusion: </strong>scCO ₂ -processed ADM demonstrated safety and patient-reported outcomes equivalent to established detergent-based ADMs. Given its eco-friendly, protein-preserving manufacturing process, scCO ₂ -processed ADM represents a safe and effective alternative for implant-based breast reconstruction. Long-term follow-up studies are warranted.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"211-216"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319937","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":"Surgical Strategies for Unexpected Unilateral Absence of the Latissimus Dorsi Muscle during Breast Reconstruction: A Case Report and Literature Review.","authors":"Matteo Meroni, Tania Panettella, Elena Frey, Elmar Fritsche","doi":"10.1055/a-2820-5151","DOIUrl":"10.1055/a-2820-5151","url":null,"abstract":"<p><p>The latissimus dorsi (LD) muscle is considered one of the most reliable donor sites for autologous breast reconstruction, particularly in patients with prior oncologic treatment or comorbidities precluding microsurgical options. While its consistent anatomy typically permits straightforward surgical planning, rare anatomical anomalies can dramatically alter intraoperative decision-making. We report the case of a 69-year-old woman with a long oncologic history and multiple comorbidities who underwent delayed breast reconstruction using a pedicled LD flap, 1 year after radical mastectomy and axillary lymphadenectomy. Intraoperatively, the LD muscle was found to be completely absent on the left side, with no identifiable muscle belly and tendon. Immediate adaptation was required, and a serratus anterior muscle flap based on a thoracodorsal branch was used instead. Interestingly, retrospective review of a CT scan performed 2 years earlier for a pulmonary complaint revealed clear evidence of unilateral LD muscle absence, an oversight that underscores the importance of targeted imaging review. This case is one of only four reported in the literature, where unilateral absence of the LD muscle in a non-syndromic patient was encountered, and the only one intraoperative discovery during breast reconstruction. This highlights the critical need for anatomical vigilance and intraoperative adaptability in reconstructive surgery. When standard options fail, familiarity with alternative flaps and sequential planning are essential to achieving functional and aesthetic outcomes.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"223-226"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139336","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 Current Landscape of Robotics in Lymphatic Supermicrosurgery: A Systematic Review.","authors":"Jorge Flores Garcia, Anne Huang, Joon Pio Hong, Min-Jeong Cho","doi":"10.1055/a-2844-9803","DOIUrl":"10.1055/a-2844-9803","url":null,"abstract":"<p><strong>Background: </strong>Lymphedema affects over 250 million people worldwide and is increasingly managed with physiologic procedures such as lymphovenous bypass (LVB) and vascularized lymph node transfer (VLNT). These supermicrosurgical techniques require advanced training, are ergonomically demanding, and can be limited in anatomically constrained regions. Robotic surgical systems offer high-resolution visualization, motion scaling, tremor reduction, and improved ergonomics, making them promising adjuncts for lymphatic supermicrosurgery. However, evidence on safety, feasibility, and outcomes remains limited.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines using PubMed, Cochrane Library, and Embase from inception through December 2024. Eligible studies included human clinical reports of robotic-assisted peripheral lymphatic reconstruction. Extracted data included demographics, operative details, outcomes, and study quality.</p><p><strong>Results: </strong>Seven studies involving 134 patients and 221 anastomoses were included, of which 78% (172) were performed robotically. The Symani system was most frequently used. Robotic procedures comprised 59.9% LVBs and 32% VLNTs or other free flaps. Across studies, mean anastomotic time was longer with robotic assistance (25.7 minutes) compared with manual techniques (11 minutes); however, three studies demonstrated significant time reduction with experience, ultimately approaching manual times. When reported, clinical outcomes, including limb volume reduction and quality-of-life measures, were comparable between robotic and manual groups. Advantages included tremor elimination and improved ergonomics, while challenges included cost, setup time, and lack of haptic feedback.</p><p><strong>Conclusions: </strong>Robotic-assisted lymphatic supermicrosurgery is safe and feasible, with outcomes comparable to conventional surgery. Continued refinement, cost reduction, and standardized outcome reporting will determine its role in expanding therapeutic and preventive lymphatic reconstruction.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"267-274"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319884","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":"Supermicrosurgery in Reconstructive Surgery: A Narrative Review.","authors":"Tae Hyung Kim, Jin Geun Kwon, Changsik John Pak, Hyunsuk Peter Suh, Joon Pio Hong","doi":"10.1055/a-2822-5320","DOIUrl":"10.1055/a-2822-5320","url":null,"abstract":"<p><p>Supermicrosurgery, defined as the anastomosis of vessels smaller than 0.8 mm, represents a significant evolution in the field of reconstructive microsurgery. This review explores its technical foundations, clinical applications, and future directions, with a particular focus on lower extremity reconstruction. By utilizing perforator-to-perforator anastomosis and thin flap techniques, supermicrosurgery allows for reduced donor morbidity, minimized risk to major vessels, and improved aesthetic and functional outcomes. The integration of high-frequency ultrasonography and advanced microsurgical tools has enhanced preoperative planning and intraoperative precision. Despite a steep learning curve, supermicrosurgery is increasingly applied in oncologic, traumatic, ischemic, and diabetic foot reconstructions. Continued innovation in imaging, instrumentation, and robotic assistance suggests a promising future for this subspecialty.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"275-281"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139325","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":"Trigeminal Trophic Syndrome: A Case Report and Literature Review.","authors":"Han-Sang Song, Il-Hwan Kim, Hi-Jin You, Deok-Woo Kim, Tae-Yul Lee","doi":"10.1055/a-2833-4794","DOIUrl":"10.1055/a-2833-4794","url":null,"abstract":"<p><p>Trigeminal trophic syndrome (TTS) is a rare neurocutaneous disorder defined by trigeminal anesthesia, facial paresthesia, and crescentic ulceration of the nasal ala. We describe an 86-year-old woman with long-standing trigeminal neuralgia who developed a suspicious ulcerated lesion on the left nasal ala. Although the initial biopsy showed atypical squamous cells suggestive of squamous cell carcinoma, the combined histopathologic, radiologic, and clinical findings supported a diagnosis of TTS. This case underscores the need to distinguish TTS from malignancy, particularly in elderly patients with neurologic comorbidities. Early recognition may prevent unnecessary invasive procedures and improve outcomes.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"253-256"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139344","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":"Congestion … Sinister … Vena Amoris … and the LOVE ♥ of Microsurgery.","authors":"Joon Pio Hong, Marco Innocenti, Geoffrey G Hallock","doi":"10.1055/a-2802-3156","DOIUrl":"10.1055/a-2802-3156","url":null,"abstract":"","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"208-210"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139362","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 Omentum as a Lymphoid Tissue: Its Molecular Aspects and Application in a Murine Model.","authors":"Masahiro Hojo, Dongkyung Seo, Riri Ito, Kosuke Ishikawa, Takahiro Miura, Emi Funayama, Yuhei Yamamoto, Taku Maeda","doi":"10.1055/a-2832-6664","DOIUrl":"10.1055/a-2832-6664","url":null,"abstract":"<p><strong>Background: </strong>The omentum is a vascularized, immune-active tissue with regenerative potential, particularly when activated by intraperitoneal stimuli. Its secreted factors may promote lymphangiogenesis, offering a novel approach to lymphedema treatment.</p><p><strong>Methods: </strong>The omentum was activated in mice using an intraperitoneal polydextran slurry. Gene expression was evaluated over time to assess inflammatory and lymphatic markers. Culture supernatants from the activated omentum were collected, and vascular endothelial growth factor-C ( <i>VEGF-C</i> ) levels were measured. Therapeutic potential was tested in a mouse hindlimb lymphedema model through local application of the supernatant. Histological analysis assessed skin thickness, lymphatic vessel density, and macrophage infiltration.</p><p><strong>Results: </strong>Activation of the omentum induced early upregulation of hypoxia-inducible factor-1 α ( <i>HIF-1α</i> ) and angiopoietin-2 ( <i>Ang2</i> ), followed by increased expression of Forkhead Box C2 ( <i>Foxc2</i> ) and Prospero homeobox-1 ( <i>Prox1</i> ) by day 7, indicating lymphatic maturation. <i>VEGF-C</i> levels in the supernatant were significantly elevated. In the lymphedema model, treated mice exhibited reduced peak edema, faster resolution, and increased skin thickness and lymphatic vessel density compared with controls. Histological analysis revealed enhanced lymphangiogenesis and reduced macrophage infiltration. Downregulation of lymphatic vessel endothelial hyaluronan receptor 1 ( <i>Lyve1</i> ) and Neuropilin-1 ( <i>NRP1</i> ) suggested a predominance of tissue remodeling over structural maintenance.</p><p><strong>Conclusions: </strong>Activated omental tissue secretes potent bioactive factors that promote lymphangiogenesis and tissue regeneration. These findings indicate the potential of activated omentum for functional characterization and possible applications in regenerative medicine. Further investigation in chronic and clinical models is warranted to advance its translational potential.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"299-309"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139316","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":"Non-Scar Fixation Technique for Zygomaticomaxillary Complex Tripod Fracture Using Upper Lid Transconjunctival Incision.","authors":"Han Gyu Cha, Seo Koo Lee, Joon Suk Bae, Seung Min Nam, Eun Soo Park","doi":"10.1055/a-2875-5296","DOIUrl":"10.1055/a-2875-5296","url":null,"abstract":"<p><strong>Background: </strong>Surgical approaches for zygomaticomaxillary complex (ZMC) fractures have evolved toward minimizing cutaneous incisions while maintaining adequate exposure. Conventional approaches for frontozygomatic fixation, such as lateral brow or transconjunctival incisions with lateral extension, may result in visible scarring or periocular complications. Building on previous transconjunctival techniques, we applied an independent upper eyelid transconjunctival incision as a non-cutaneous approach for frontozygomatic fixation in selected ZMC tripod fractures.</p><p><strong>Methods: </strong>This retrospective comparative study included 27 patients with unilateral ZMC tripod fractures, of whom 12 underwent non-scar fixation using an upper eyelid transconjunctival approach, and 15 underwent fixation through preexisting periorbital traumatic lacerations. The surgical strategy consisted of initial reduction and fixation via an intraoral approach, followed by selective additional fixation of the frontozygomatic region when residual step deformity or instability was present. Preoperative and 6-month postoperative computed tomography and three-dimensional photogrammetry were used to evaluate bony and soft tissue intermalar height differences.</p><p><strong>Results: </strong>Preoperative intermalar height differences were comparable between groups. At 6 months postoperatively, both groups showed marked improvement, with bony differences of -0.2 ± 1.2 mm and -0.4 ± 0.4 mm, and soft tissue differences of 0.0 ± 0.6 mm and -0.2 ± 0.7 mm in the non-scar and control groups, respectively, with no clinically meaningful between-group differences. No clinically significant approach-related ophthalmic complications were observed.</p><p><strong>Conclusions: </strong>The upper eyelid transconjunctival approach is a reliable non-cutaneous option for frontozygomatic fixation in selected ZMC tripod fractures, providing adequate exposure and stable fixation without visible scarring.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"234-240"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319869","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":"Anatomical Relationship of Lateral Low-to-Low Nasal Osteotomy and Inferior Nasal Turbinate. Is Webster's Triangle Still Important?","authors":"Atchara Setthajindalert, Padcha Tunlayadechanont, Thiti Tantitham","doi":"10.1055/a-2836-2147","DOIUrl":"10.1055/a-2836-2147","url":null,"abstract":"<p><strong>Background: </strong>Lateral low-to-low osteotomies in rhinoplasty raise safety concerns regarding Webster's triangle and airway patency. This study aimed to measure the distance between the osteotomy line and the anterior inferior nasal turbinate and evaluate its relationship with other nasal characteristics.</p><p><strong>Methods: </strong>We retrospectively analyzed CT scans from 81 East Asian patients (January-December 2020). This study used a virtual simulation to measure the distance between a projected lateral low-to-low osteotomy line and the anterior inferior nasal turbinate on CT scans, along with nasal bone length/thickness, pyriform aperture width, and rhinion-nasomaxillary suture distance. Linear regression and Spearman correlation assessed parameter associations.</p><p><strong>Results: </strong>The 81 patients (mean age 46.7 years) showed an average distance of 7.1 ± 3.2 mm (right) and 6.5 ± 3.0 mm (left) between the osteotomy line and the inferior nasal turbinate. A significant negative correlation ( <i>r</i>  = -0.35, <i>p</i>  < 0.001) was found between rhinion-nasomaxillary suture distance and this osteotomy-turbinate distance. No correlation was seen with nasal bone length or pyriform aperture width. Measurements demonstrated good intrarater reliability (intraclass correlation coefficient [ICC] = 0.98).</p><p><strong>Conclusions: </strong>The lateral low-to-low osteotomy line does not intersect the anterior nasal turbinate, indicating it can be safely performed without concern for Webster's triangle. However, caution is advised for patients with higher nasal dorsum projection (shorter rhinion-nasomaxillary suture distance). This study offers valuable insights into East Asian nasal characteristics for rhinoplasty.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"227-233"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319943","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":"Intrathoracic Migration of a Breast Prosthesis after Minimally-Invasive Atrial Myxoma Resection: A Case Report and Literature Review.","authors":"Amy Dawson, Emily Mackay, Gordon Buduhan","doi":"10.1055/a-2819-1883","DOIUrl":"10.1055/a-2819-1883","url":null,"abstract":"<p><p>Intrathoracic migration of breast prostheses has been described after both open and minimally invasive cardiothoracic and breast surgery, with several proposed mechanisms of migration. In this report, we describe an unusual presentation of intrathoracic migration of a breast prosthesis following remote minimally invasive cardiac surgery for atrial myxoma resection. Due to the rare but documented risk of intrathoracic breast prosthesis migration following minimally invasive cardiothoracic surgery, consideration should be given to strategies for mitigating this risk at the time of surgery.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"217-222"},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139396","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}