Hatan Mortada, Feras Alshomer, Hyungjoo Noh, Changsik John Park, Joon Pio Hong
{"title":"Peripheral Lymphatic Shunts for Protein-Losing Enteropathy in a Child with THSD1 Mutation: A Case Report.","authors":"Hatan Mortada, Feras Alshomer, Hyungjoo Noh, Changsik John Park, Joon Pio Hong","doi":"10.1055/a-2777-5624","DOIUrl":"10.1055/a-2777-5624","url":null,"abstract":"<p><p>Protein-losing enteropathy (PLE) is a rare disorder characterized by abnormal protein loss through the gastrointestinal tract, often leading to hypoalbuminemia and malnutrition. This case report describes the successful surgical management of chronic lower limb lymphedema and PLE in a 7-year-old male with a thrombospondin type 1 domain-containing 1 (THSD1) mutation, unresponsive to conventional therapies. Despite aggressive nutritional support, including albumin infusions, the patient experienced persistent hypoalbuminemia and ongoing protein loss. Imaging revealed significant lymphatic dysfunction, prompting lymphovenous bypass and lymph node-vein anastomosis (LNVA). Postoperatively, serum albumin levels improved from 1.5 to 3.2 g/dL, limb circumference decreased, and alpha-1 antitrypsin levels normalized. However, a 3-year follow-up revealed a relapse of hypoalbuminemia following an upper respiratory infection, underscoring the need for additional interventions in growing pediatric patients. This case strengthens the potential of lymphatic surgery in addressing PLE-related lymphatic dysfunction when medical treatments fail and emphasizes the need for further research to confirm the efficacy of this approach.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 4","pages":"361-368"},"PeriodicalIF":1.4,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713928","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}
Cesar A Gonzalez-Martinez, Yanko Castro-Govea, Brenda J Tellez-Rodriguez, Karla V Palomo-Barbosa, Mario A Rico-Padilla, Oscar Vidal-Torres, Marco A Treviño-Lozano, Cynthia M Gonzalez-Cantu
{"title":"Safe and Time-Saving Method for Pharyngeal Reconstruction Using an Internal Mammary Artery Perforator Flap.","authors":"Cesar A Gonzalez-Martinez, Yanko Castro-Govea, Brenda J Tellez-Rodriguez, Karla V Palomo-Barbosa, Mario A Rico-Padilla, Oscar Vidal-Torres, Marco A Treviño-Lozano, Cynthia M Gonzalez-Cantu","doi":"10.1055/a-2780-1488","DOIUrl":"10.1055/a-2780-1488","url":null,"abstract":"<p><p>Head and neck squamous cell carcinoma often requires total laryngectomy (TL), creating complex defects, especially in irradiated patients. The internal mammary artery perforator (IMAP) flap is a promising reconstructive option, offering reliable vascularization with minimal donor site morbidity. However, postoperative characteristics such as retention/survival and complications in irradiated patients have not been fully addressed. A retrospective analysis was conducted on seven patients undergoing IMAP flap reconstruction after TL for advanced laryngeal carcinoma. All had prior radiotherapy. The procedures were designed using the Doppler ultrasound technique, and the second intercostal space IMAP was used in most patients, except for one. Flap elevation surgical time, defect coverage, complications, and hospital stay were evaluated. Our patients were 79 ± 4.3 years old. The average surgical time for flap elevation was 61 ± 5.34 minutes. The pharynx defect size was 4.57 ± 0.53 cm <sup>2</sup> , achieving full coverage in all cases. The mean hospital length of stay was 4.0 ± 1.52 days. One patient developed a postoperative hematoma; no flap necrosis or fistulas occurred after 3 months of follow-up. The flap survival rate was 100%. In this work, our IMAP flap design could be considered thin and elongated; however, due to the constant blood flow of the IMAP, we observed reliable results, and no partial or total necrosis was reported. Thus, the IMAP flap is a safe and effective alternative for laryngeal defect reconstruction in irradiated patients, proving excellent viability, favorable aesthetics, reduced morbidity, and minimal complications.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 3","pages":"241-246"},"PeriodicalIF":1.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139355","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":"Women in Microsurgery.","authors":"Gemma Pons","doi":"10.1055/a-2737-7475","DOIUrl":"10.1055/a-2737-7475","url":null,"abstract":"","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 2","pages":"133-134"},"PeriodicalIF":1.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13030922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575878","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":"Validity of Ultrasound-Guided Identification of Dilated Lymphatic Vessels to Detect Early Breast Cancer-Related Lymphedema.","authors":"Akitatsu Hayashi, Takeo Fuziwara","doi":"10.1055/a-2780-6493","DOIUrl":"10.1055/a-2780-6493","url":null,"abstract":"<p><strong>Background: </strong>Early detection of breast cancer-related lymphedema (BCRL) is critical for timely intervention and preventing progression, but diagnostic modalities are limited. We assessed the validity of ultrasound-guided identification of dilated lymphatic vessels (UIDL) to detect early BCRL.</p><p><strong>Methods: </strong>A retrospective, observational study with 300 female patients evaluated for suspected BCRL in a lymphedema center between April 2019 and March 2023. All patients underwent gold standard to detect BCRL, indocyanine green (ICG) lymphography, staged by the MD Anderson grading system, and UIDL from the proximal one-third of the upper arm to the distal one-third of the forearm circumferentially. The association between UIDL, with a cutoff of ≥0.5 mm in diameter, and the detection of early BCRL by ICG lymphography was evaluated.</p><p><strong>Results: </strong>In total, 264 (88%) cases were detected as BCRL by ICG lymphography. UIDL's area under the curve was 0.89 (95% CI: 0.84-0.94), with sensitivity of 86.2%, specificity of 91.7%, positive predictive value of 98.4%, and negative predictive value of 53.2%.</p><p><strong>Conclusion: </strong>UIDL showed high sensitivity and specificity in detecting early BCRL. This method may serve as a widely available, non-invasive screening tool during posttreatment surveillance.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 2","pages":"172-177"},"PeriodicalIF":1.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13030929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575901","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":"Effectiveness of Bleeding Control Methods in Rhinoplasty: A Systematic Review and Meta-Analysis.","authors":"Mohammad Reza Zamani, Behzad Imani, Rohollah Abbasi, Ashkan Karimi, Samad Moslehi","doi":"10.1055/a-2706-1208","DOIUrl":"10.1055/a-2706-1208","url":null,"abstract":"<p><p>One of the most common complications of rhinoplasty and septorhinoplasty is intraoperative bleeding, which poses challenges for both surgeons and patients. This systematic review and meta-analysis aimed to evaluate the effectiveness of various bleeding control methods in rhinoplasty and septorhinoplasty surgeries. This study conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed in reputable international databases to identify relevant studies. Ultimately, 16 randomized controlled trials (RCTs) with 933 patients were included in the analysis. The bleeding control methods evaluated included tranexamic acid (TXA), desmopressin, steroids, magnesium sulfate, clonidine, remifentanil, and patient positioning (reverse Trendelenburg position). Data were combined using meta-analysis methods in STATA version 17, and the standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated to assess the effects of the methods. The results showed that TXA (SMD: -1.31; 95% CI: -2.01 to -0.62) and steroids (SMD: -1.07; 95% CI: -1.70 to -0.43) had the most significant impact on reducing bleeding. Patient positioning also showed a considerable effect (SMD: -0.65; 95% CI: -1.01 to -0.30), and desmopressin had a positive impact (SMD: -1.53; 95% CI: -3.12 to 0.06), though this effect was not statistically significant. This study demonstrates that pharmacological and non-pharmacological interventions, such as TXA and patient positioning, can significantly reduce intraoperative bleeding. However, further studies with larger sample sizes and standardized designs are recommended for magnesium sulfate, clonidine, and remifentanil methods. Level of Evidence I.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 1","pages":"3-14"},"PeriodicalIF":1.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108001","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}
Michael I Kim, Janine S Chan, Carly Askinas, Joseph N Carey, David A Daar, Emma C Koesters
{"title":"Plastic Surgery Residency Program Instagram Engagement with Prospective Applicants: A Cohort Analysis in the United States.","authors":"Michael I Kim, Janine S Chan, Carly Askinas, Joseph N Carey, David A Daar, Emma C Koesters","doi":"10.1055/a-2731-4609","DOIUrl":"10.1055/a-2731-4609","url":null,"abstract":"<p><strong>Background: </strong>Social media platforms, particularly Instagram, have revolutionized residency recruitment by offering integrated plastic surgery programs innovative avenues to showcase their culture and engage directly with prospective applicants. The COVID-19 pandemic accelerated this digital shift, making virtual interactions essential for evaluating program fit.</p><p><strong>Methods: </strong>We identified 88 Accreditation Council for Graduate Medical Education-accredited integrated plastic surgery programs for the academic year 2023 to 2024. Instagram posts from January 1, 2020, to October 26, 2024, were reviewed, focusing on \"engagement posts\" (e.g., meet-and-greets, question-and-answer [Q&A] sessions, open houses, workshops, conference meet-ups). Programs were stratified into cohorts based on Doximity rankings (Top 20, 21-40, 41-60, and 61-88), geographic region, and program size.</p><p><strong>Results: </strong>All programs maintained active Instagram profiles, collectively sharing 13,719 posts and averaging 32.4 posts per program annually. Among these, 369 (2.7%) were engagement posts, with meet-and-greets accounting for 71.3% of such content. Notably, Top 20 programs posted significantly more frequently (52.6 posts/year) than lower-ranked cohorts (21-40: 35.0, 41-60: 26.8, 61-88: 20.1; <i>p</i> < 0.001) and had a higher engagement post rate (3.9% vs. 2.0-2.7%; <i>p</i> = 0.033).</p><p><strong>Conclusion: </strong>Higher-ranked and larger programs exhibit a more robust Instagram presence with greater emphasis on engagement opportunities, despite these posts comprising only a small fraction of overall content. These findings highlight the potential for optimized social media strategies to enhance digital outreach and improve residency recruitment in an evolving virtual landscape.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 1","pages":"117-122"},"PeriodicalIF":1.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107965","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}
Samarth Gupta, Rajan Arora, Kripa Mishra, Anchit Kumar, Nikhil Prasad
{"title":"Personal Strategies for DIEP Flap Breast Reconstruction in Patients with Prior Abdominal Surgery and Hernia Repairs.","authors":"Samarth Gupta, Rajan Arora, Kripa Mishra, Anchit Kumar, Nikhil Prasad","doi":"10.1055/a-2710-4367","DOIUrl":"10.1055/a-2710-4367","url":null,"abstract":"<p><p>Delayed breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in patients with a history of abdominal wall hernias and/or cesarean sections presents unique challenges. This study examines 10 such cases, emphasizing key technical considerations. Our findings highlight the importance of lateral row perforators, as medial paraumbilical perforators are often compromised in patients with prior umbilical hernia repairs. Additionally, deep inferior epigastric arteries (DIEAs) may be damaged in previous lower abdominal surgeries, necessitating intraoperative confirmation of vessel patency. While preoperative CT angiography aids in planning, it may misrepresent perforator size or location due to adherence to fascia. In our approach, a gastrointestinal surgeon performed concurrent hernia repair while the plastic surgery team secured the DIEP flap perforators and pedicle. Preservation of umbilical vascularity was ensured by avoiding complete skeletonization. In the case shown, only a single lateral row perforator was usable, despite preoperative imaging suggesting additional perforators. All patients had successful flap integration, with no cases of flap failure, necrosis, postoperative hernias, wound dehiscence, seroma, hematoma, or infection. A delayed flap inset was performed using the Rosebud technique, ensuring optimal aesthetic outcomes and high patient satisfaction. This study highlights the critical role of a multidisciplinary approach, precise perforator identification, and careful interpretation of preoperative imaging in achieving optimal outcomes in complex DIEP flap breast reconstruction.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 1","pages":"129-132"},"PeriodicalIF":1.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107975","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":"Next-Generation Flap Monitoring: Systematic Review and Meta-Analysis of Hyperspectral Imaging.","authors":"Parintosa Atmodiwirjo, Cristabella Rininta","doi":"10.1055/a-2660-4344","DOIUrl":"10.1055/a-2660-4344","url":null,"abstract":"<p><p>Early detection of perfusion deficits is crucial for optimal flap outcomes. Hyperspectral imaging (HSI) offers a non-invasive method to assess tissue perfusion, potentially detecting complications earlier than Doppler ultrasound or near-infrared spectroscopy. This systematic review and meta-analysis evaluate the efficacy and diagnostic accuracy of HSI in monitoring flap viability, particularly in detecting ischemia and necrosis. A systematic search of PubMed, ScienceDirect, and Cochrane Library was conducted following PRISMA 2020 guidelines. Studies on HSI's role in flap viability were critically appraised using the Critical Appraisal Skills Programme checklist. A random-effects model was applied for the meta-analysis. Nine studies were included, six focusing on flap complications. HSI demonstrated a median sensitivity of 93% (63-100%) and a median specificity of 96% (81-100%) for detecting compromised flaps, outperforming clinical assessments in some cases. Significant differences were observed between viable and necrotic tissues in four key HSI parameters: Oxygen saturation, tissue hemoglobin index (THI), tissue water index, and near-infrared perfusion index (NIR-PI). THI and NIR-PI effectively differentiated venous congestion from arterial occlusion. However, heterogeneity across the studies indicated a need for standardized protocols. Notably, HSI detected perfusion deficits up to 4.8 hours before clinical signs. HSI shows promise for postoperative flap monitoring, enabling earlier detection of ischemia and necrosis. Future research should focus on standardized imaging protocols, real-time analysis, and larger multicenter trials to confirm HSI's clinical utility and cost-effectiveness.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 1","pages":"91-101"},"PeriodicalIF":1.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107979","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":"<i>Corynebacterium</i> Infection Following Implant-based Breast Reconstruction: Lessons from the Five Consecutive Patients.","authors":"Jiye Kim, Minwoo Park, Seung Yong Song","doi":"10.1055/a-2734-7103","DOIUrl":"10.1055/a-2734-7103","url":null,"abstract":"<p><strong>Background: </strong>Infection is a challenging complication in prosthetic breast reconstruction. Recently, we encountered cases of <i>Corynebacterium striatum</i> infection following prosthetic breast reconstruction in breast cancer patients. We would like to share our experience of preventing reconstruction failure from this uncommon infection.</p><p><strong>Methods: </strong>This is a retrospective study on consecutive cases of <i>Corynebacterium</i> infection that occurred within 2 months in five patients who underwent implant-based breast reconstruction. One patient had a history of preoperative radiation therapy, one required reoperation due to postoperative bleeding, and two experienced hemovac obstruction events. Patients were immediately hospitalized and treated with hemovac insertion, IV antibiotics, and, if necessary, reoperation for salvage.</p><p><strong>Results: </strong><i>Corynebacterium striatum</i> was identified in the hemovac cultures or intraoperative specimens of all patients. Based on the antibiotic susceptibility of the identified strain, infection with a single bacterial strain was suspected. All patients underwent hemovac re-insertion, and one patient was successfully salvaged with IV antibiotic treatment alone. However, the remaining four patients required implant change during the salvage process. The bacteria became negative within a period ranging from 1 to 7 weeks after identification, and salvage was successfully achieved without reconstruction failure in all patients by postoperative days 20 to 58.</p><p><strong>Conclusion: </strong><i>Corynebacterium</i> is an uncommon pathogen in implant-based breast reconstruction, and reports of its treatment are very rare. This study presents our experience with successful treatment and outlines the clinical symptoms and treatment methods. We hope that this report can serve as a reference for reconstructive surgeons who may encounter similar situations.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 1","pages":"28-37"},"PeriodicalIF":1.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107998","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":"Severe Phytophotodermatitis Caused by Mulberry Tree: A Case Report and Literature Review.","authors":"Young Geun Kim, Keun-Cheol Lee","doi":"10.1055/a-2699-8042","DOIUrl":"10.1055/a-2699-8042","url":null,"abstract":"<p><p>Phytophotodermatitis (PPD) is an uncommon dermatologic condition that occurs after exposure to furocoumarins found in certain plant saps, which become activated upon ultraviolet A radiation exposure. This condition is frequently misdiagnosed as cellulitis, allergic dermatitis, or other common skin disorders. Here, we present a case of severe PPD in a 52-year-old male who initially developed a rash and blistering on his forearm following outdoor activity. He was initially misdiagnosed with cellulitis; however, his symptoms persisted despite antibiotic treatment, prompting further evaluation. A detailed patient history revealed recent contact with a mulberry tree, and together with characteristic biopsy findings, confirmed the diagnosis of PPD. The patient showed significant improvement following the administration of oral corticosteroids and topical steroid treatment. This case underscores the importance of recognizing PPD in clinical practice to prevent misdiagnosis and ensure effective management.</p>","PeriodicalId":47543,"journal":{"name":"Archives of Plastic Surgery-APS","volume":"53 1","pages":"123-128"},"PeriodicalIF":1.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107540","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}