Seminars in Plastic Surgery最新文献

{"title":"The Role of Microsurgical Free Flap in Complex Nose Defect Reconstruction.","authors":"Cheng-I Yen, Yen-Chang Hsiao","doi":"10.1055/a-2842-2844","DOIUrl":"https://doi.org/10.1055/a-2842-2844","url":null,"abstract":"<p><p>Nasal reconstruction, involving a central facial structure with complex three-dimensional contours and essential respiratory function, continues to evolve. The principal challenge lies in simultaneous restoration of the three essential components-external skin cover, skeletal support, and a vascularized internal lining-often across multiple aesthetic subunits. This review summarizes a decade of clinical experience at Chang Gung Memorial Hospital, focusing on the evolution of reconstructive strategies in 150 patients with total or subtotal composite nasal defects. Particular emphasis is placed on the incorporation of microsurgical free flaps to enhance both aesthetic outcomes and reconstructive efficiency. This chronologically structured review highlights four major advances: (1) refinements of the paramedian forehead flap (PFF), including a T-shaped design for improved biomechanical stabilization in columellar reconstruction; (2) application of vascularized lining using the folded ulnar forearm flap (FUFF) and lower-extremity free flaps, including the anterolateral thigh (ALT) and medial sural artery perforator (MSAP) flaps; (3) integration of digital technologies, including computer-aided design (CAD) and three-dimensional printing, to improve nasal symmetry; and (4) implementation of an expedited protocol involving simultaneous free flap and PFF transfer to facilitate physical and psychosocial recovery. The T-shaped PFF design demonstrated superiority in preventing columellar dehiscence. For internal lining, the FUFF provided thin and pliable coverage with minimal donor-site morbidity; however, lower-extremity flaps (ALT/MSAP) offered enhanced long-term passive structural support, reducing the risk of airway collapse. Digital planning with three-dimensionally printed templates resulted in significantly improved postoperative symmetry in heminasal reconstructions ( <i>p</i>  < 0.05). Simultaneous free flap and PFF transfer proved safe and significantly shortened overall treatment duration. Psychosocial assessments revealed a reduced duration of postoperative distress, underscoring the clinical importance of procedural efficiency. Successful contemporary reconstruction of complex nasal defects requires a specialized, multimodal approach. Optimal long-term aesthetic and functional outcomes are achieved through the synergistic application of refined PFF techniques, appropriate selection of vascularized lining free flaps, and routine use of digital technologies for surgical planning.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 2","pages":"146-150"},"PeriodicalIF":1.2,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Micorosurgical Reconstruction for Peripheral Nerve, Breast, and Lymphedema.","authors":"Tommy Nai-Jen Chang, Jung-Ju Huang","doi":"10.1055/a-2825-0766","DOIUrl":"10.1055/a-2825-0766","url":null,"abstract":"","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"2"},"PeriodicalIF":1.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fu-Chan Wei, MD, FACS, and Chih-Hung Lin, MD.","authors":"Larry H Hollier","doi":"10.1055/a-2848-4359","DOIUrl":"https://doi.org/10.1055/a-2848-4359","url":null,"abstract":"","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 2","pages":"121"},"PeriodicalIF":1.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Free-Style Flaps: A Personal Journey in Clinical Practice, Surgical Pearls and Common Pitfalls.","authors":"Ting-Han Chiu, Hsiang-Shun Shih, Seng-Feng Jeng","doi":"10.1055/a-2842-2857","DOIUrl":"https://doi.org/10.1055/a-2842-2857","url":null,"abstract":"<p><p>The free-style flap, based on the principles of \"angiosomes\" and evolved through the refinement of \"perforator flaps,\" allows for safe harvest once a sizable cutaneous vessel is reliably identified. This approach resolves concerns regarding anatomical inconsistencies in conventional harvests. Successful execution relies on preoperative Doppler mapping or imaging studies, intricate flap design, and meticulous retrograde intramuscular dissection to address technical challenges when unforeseen vascular anatomy is encountered in commonly used flaps or unfamiliar donor sites. Free-style flaps can be employed as either locoregional or free flap transfers, while similar techniques allow for the reuse of previously transferred tissues. Such an approach substantially broadens the options for donor site selection, ensuring precise color and texture matching. However, it requires strict patient selection, flexible intraoperative adjustments, and multiple backup plans to ensure reconstructive success. If strategically employed, free-style flaps serve as a versatile alternative in challenging clinical scenarios.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 2","pages":"139-145"},"PeriodicalIF":1.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Microsurgery in Living Donor Liver Transplantation.","authors":"Tsan-Shiun Lin, Yuan-Cheng Chiang, Chao-Long Chen","doi":"10.1055/a-2842-2010","DOIUrl":"https://doi.org/10.1055/a-2842-2010","url":null,"abstract":"<p><p>Liver transplantation (LT) is an accepted curative therapy to save select patients with end-stage liver failure, congenital liver diseases affecting the liver or bile duct, and hepatocellular carcinoma. Living donor liver transplantation is an indispensable and alternative choice to manage the scarcity of deceased liver grafts and to provide a quick way to access a healthy graft. Successful hepatic artery reconstruction for liver transplantation is crucial for outcomes. Difficult hepatic artery reconstructions (HAR) are not uncommon in LT, especially in living donor liver transplantation (LDLT). They are defined as graft or recipient hepatic arteries smaller than 2 mm in diameter, size discrepancy greater than 2 to 1, and also include cases with multiple hepatic arteries, suboptimal quality, or those that require immediate redo HAR during transplantation. Technique refinements include selection of the appropriate recipient HA, precise HA dissection, early recognition of vessel injury under the microscope, meticulous use of clips for branch ligations whenever needed, deliberate oblique cut of the artery, and the use of a modified funneling technique, or shifting to an alternative artery to replace a pathologic HA. Reconstruction of an additional HA for dual arterial supply can also contribute to the improved result and minimize complications. Complex biliary anatomies are also commonly encountered in living donor liver transplantation. Reconstruction using microsurgical techniques and specific surgical strategies can lead to a significant reduction of biliary complications, as seen in our experience from an average of 10.35% between 2006 and 2021, to 6.5% in the year 2022. These techniques and approaches include using the ipsilateral bile duct as the first choice for duct anastomosis, an additional figure-of-8 suture over the anastomosis site, centralization of duct anastomosis when size discrepancy is greater than 2 to 1, and thoughtful selective biliary stent insertion in select cases. In conclusion, the application of microsurgical techniques and refined surgical strategies has tremendously improved the results of hepatic artery and biliary reconstructions in living donor liver transplantation, leading to lower complication rates and better outcomes.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 2","pages":"124-132"},"PeriodicalIF":1.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Compression Neuropathy: What's New?","authors":"Chrisovalantis Lakhiani, Tommy Nai-Jen Chang, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.1055/a-2828-4914","DOIUrl":"10.1055/a-2828-4914","url":null,"abstract":"<p><p>Compression neuropathies comprise a diverse spectrum of peripheral nerve disorders resulting from chronic mechanical insult within anatomically constrained fibro-osseous or myofascial tunnels. Although common entities such as carpal and cubital tunnel syndromes are well established, several less frequently addressed compression syndromes remain diagnostically and therapeutically controversial. This chapter reviews contemporary advances in the pathophysiology, diagnostic evaluation, and surgical management of select complex compression neuropathies, with specific focus on thoracic outlet syndrome (TOS), groin and pelvic neuropathies, and common peroneal nerve entrapment. TOS continues to generate debate regarding diagnostic criteria and operative indications; however, in carefully selected patients, supraclavicular decompression with first rib and scalene resection yields high rates of durable symptom relief. Neuropathic groin and pelvic pain syndromes-including ilioinguinal, genitofemoral, and pudendal neuropathies-require rigorous clinical assessment, exclusion of proximal pathology, and confirmatory diagnostic nerve blocks prior to intervention. Contemporary reconstructive strategies, including targeted muscle reinnervation and regenerative peripheral nerve interfaces, have expanded surgical options for refractory neuromas. Common peroneal nerve compression, including subclinical presentations preceding overt foot drop, underscores the importance of early recognition and timely decompression to mitigate irreversible axonal degeneration. Detailed patient selection, early and anatomically comprehensive decompression, and adherence to principles of peripheral nerve biology are essential to optimize functional outcomes in modern peripheral nerve surgery.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"39-49"},"PeriodicalIF":1.4,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Nerve Reconstruction in Lower Extremities: Institutional Experience of Chang Gung Memorial Hospital.","authors":"Yusuf Alper Aytac, Shiuan Shyu, Johnny Chuieng-Yi Lu, Lisa Wen-Yu Chen, David Chwei-Chin Chuang, Tommy Nai-Jen Chang","doi":"10.1055/a-2815-5518","DOIUrl":"10.1055/a-2815-5518","url":null,"abstract":"<p><p>Lower-extremity nerve reconstruction, most commonly involving the lumbosacral plexus (LSP), sciatic nerve (including common peroneal and posterior tibial nerves), and the femoral nerve, remains one of the most demanding challenges in peripheral nerve surgery, with outcomes primarily determined by injury mechanism, anatomical level, and timing of reconstruction. Over the past 35 years (1987-2022), the Peripheral Nerve Team at the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan treated 3 patients with LSP injuries, 6 patients with femoral nerve injuries, and 35 patients with sciatic nerve injuries using different surgical techniques, including neurolysis, direct nerve repair, cable grafting, nerve transfer, vascularized nerve grafting, and adjunctive procedures such as functioning free muscle transplantation (FFMT) and tendon transfer. The corresponding surgeons included D.C-C.C., T.N-J.C., and J.C-Y.L. as the senior authors in this paper. Meaningful recovery clustered with early timing and tension-free nerve coaptation; in selected long-segment or scarred beds, well-constructed multistranded or vascularized grafts achieved useful function, yet the superiority of vascularized constructs was not uniform across cases. Delayed exploration and isolated neurolysis generally yielded limited improvement. Although functional recovery declined with increasing graft length, satisfactory results were observed in selected extensive reconstructions using multiple grafts appropriately and, when indicated, FFMT. These observations highlight the complexity of lower-extremity nerve reconstruction and the need for careful surgical planning and long-term follow-up to optimize outcomes after nerve reconstruction in the lower extremities.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"30-38"},"PeriodicalIF":1.4,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper Extremities Peripheral Nerve Injuries and Reconstruction.","authors":"Rebecca Qian Ru Lim, Llewellyn Thomas, Lisa Wen-Yu Chen, Johhny Chuieng-Yi Lu, David Chwei-Chin Chuang, Tommy Nai-Jen Chang","doi":"10.1055/a-2815-4594","DOIUrl":"10.1055/a-2815-4594","url":null,"abstract":"<p><p>It is important to recognize neurological symptoms postemergency or elective surgery of the upper limb, as it could herald injury to the peripheral nerves. Prompt diagnosis, workup, and management of these conditions may affect eventual clinical outcomes. We present a series of cases in different orthopaedic-related scenarios to discuss the variety of causes and treatment options available for this group of patients. This study reflects level of evidence V.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"19-29"},"PeriodicalIF":1.4,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tommy Nai-Jen Chang, MD, and Jung-Ju Huang, MD, FACS.","authors":"Larry H Hollier","doi":"10.1055/a-2815-5593","DOIUrl":"10.1055/a-2815-5593","url":null,"abstract":"","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"1"},"PeriodicalIF":1.4,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Neurotization: Techniques, Outcomes, and Future Directions.","authors":"Laura Chia-Fang Chen, Hsuan-Ta Teng, Jung-Ju Huang, Johnny Chuieng-Yi Lu, David Chon-Fok Cheong, Shu-Wei Kao, Wen-Ling Kuo, Shiuan Shyu, Cheyenne Wei-Hsuan Sung, Lisa Wen-Yu Chen, Tommy Nai-Jen Chang","doi":"10.1055/a-2790-9948","DOIUrl":"10.1055/a-2790-9948","url":null,"abstract":"<p><p>The growing population of breast cancer survivors has increased the demand for breast reconstruction that restores not only shape but also sensory function. Neurotization techniques aiming to reestablish breast and nipple sensation have demonstrated promising outcomes, yet optimal approaches remain undefined. A scoping review of PubMed and EMBASE was conducted, focusing on studies of breast neurotization across autologous and implant-based reconstructions. Quantitative tools enable objective assessment of breast sensation across reconstruction types. Neurotization of autologous flaps improves recovery of protective and erogenous sensation and enhances physical well-being without adding significant surgical risk. Neurotization on implant-based breast reconstruction with nerve graft also showed promising sensory outcomes. Autografts support consistent nerve regeneration but are technically demanding; allografts simplify surgery and reduce morbidity but remain costly and underexplored. While preclinical data favor superficial neurotization, both superficial and deep approaches yield good clinical outcomes. Neurotization significantly improves postoperative sensation and patient-reported outcomes. Standardized prospective studies are needed to optimize technique selection and validate long-term benefits.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"55-70"},"PeriodicalIF":1.4,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}