Seminars in Plastic Surgery最新文献

{"title":"Incorporating Lymphedema Reconstruction into Breast Reconstruction: Concepts, Approach, and Systematic Review.","authors":"Allen Wei-Jiat Wong, Nadia Hui-Shan Sim, Jung-Ju Huang","doi":"10.1055/a-2795-0088","DOIUrl":"10.1055/a-2795-0088","url":null,"abstract":"<p><p>Breast cancer-related lymphedema (BCRL) remains a common and morbid consequence of axillary lymph node dissection (ALND) and radiotherapy (RT). As reconstructive microsurgery has advanced, there is increasing interest in integrating lymphatic surgery into breast cancer pathways-both as primary prevention at the time of ALND and as secondary treatment combined with breast reconstruction. We performed a systematic review to synthesize current concepts, techniques, and evidence supporting integrated breast and lymphatic reconstruction. PubMed and Web of Science were searched from inception to December 27, 2025. Eligible studies included breast cancer patients undergoing lymphatic surgery in preventive and/or therapeutic settings (e.g., vascularized lymph node transfer [VLNT] integrated into breast reconstruction). A total of 89 studies met inclusion criteria, encompassing randomized and prospective comparative studies, retrospective cohorts, health services analyses, technical reports, and case series. Two dominant integration paradigms emerged. Preventive integration most commonly involved immediate lymphatic reconstruction (ILR)/lymphatic microsurgical preventive healing approach (LYMPHA) performed at ALND, with reported feasibility and evolving evidence on risk reduction, learning curve, and technical refinements (mapping strategies, recipient vein selection, coupler-assisted techniques, and vein graft use). Staged pathways-including delayed ALND-can still accommodate ILR when suitable lymphatics and recipient veins remain identifiable. Therapeutic integration primarily comprised VLNT incorporated into autologous breast reconstruction (often DIEP-based) and popularized within the concept of total breast anatomy restoration (TBAR), with generally favorable reports on limb volume, cellulitis burden, and quality of life, albeit largely observational. Emerging omental strategies suggest a potential role for preventive VLNT but remain in early stage. Implementation studies highlight access barriers, and economic analyses suggest ILR may be cost-effective in select high-risk populations. BCRL management is evolving toward integrated, continuum-based intervention through preventive ILR and reconstructive VLNT/TBAR strategies. Standardized outcome definitions, longer follow-up-particularly accounting for RT-and implementation-focused research are required to optimize patient selection and enable scalable, equitable adoption.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"103-112"},"PeriodicalIF":1.4,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786155","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":"Contemporary Surgical Techniques for Facial Paralysis: A Review of the Chang Gung Experience.","authors":"Tiffany W Han, Tommy Nai-Jen Chang, Jerry Tsung-Kai Lin, Luccie Woo, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.1055/a-2782-6209","DOIUrl":"10.1055/a-2782-6209","url":null,"abstract":"<p><p>Facial paralysis can cause profound functional and psychological impact. Management strategies have evolved significantly, with advances in understanding facial nerve anatomy, nerve physiology, and microsurgical techniques. This review provides a comprehensive overview of surgical strategies for both acute and chronic facial paralysis, highlighting contributions from Chang Gung Memorial Hospital that have shaped contemporary practice. Indications, timing, and selection of interventions-including nerve grafting, nerve transfers, and free functioning muscle transplantations-are examined with emphasis on techniques that restore facial symmetry. Recent developments in the management of acute facial paralysis following oncologic resection and in eyelid reanimation are also discussed. By integrating evidence from published research and institutional experience, this review aims to guide the selection of surgical strategies to enhance facial movement and symmetry.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"11-18"},"PeriodicalIF":1.4,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786066","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":"Robot-Assisted Mastectomy and Immediate Microsurgical Breast Reconstruction.","authors":"Luccie M Wo, Wen-Ling Kuo, David Chon-Fok Cheong, Chia-Fang Chen, Jung-Ju Huang","doi":"10.1055/a-2787-1828","DOIUrl":"10.1055/a-2787-1828","url":null,"abstract":"<p><p>Robot-assisted mastectomy has emerged as an evolving technique in breast cancer surgery, with its advantage of improved visualization, precise dissection, and favorable aesthetic outcomes through limited hidden access. With proper patient selection, this approach has facilitated nipple-sparing mastectomy with good aesthetic outcome while maintaining oncologic safety. As an aesthetic outcome is one essential component of developing robot-assisted mastectomy, immediate breast reconstruction has been adapted to integrate with the procedure. While implant-based reconstruction remains the most commonly utilized option, autologous breast reconstruction, although technically more demanding, can also be successfully performed with appropriate modifications and microsurgical expertise, providing durable aesthetic and functional outcomes. This article reviews current reconstructive options with autologous breast reconstruction following robot-assisted mastectomy, discusses technical considerations unique to robotic approaches, and emphasizes the importance of individualized, patient-centered decision-making in reconstructive planning.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"83-88"},"PeriodicalIF":1.4,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786261","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":"Profunda Artery Perforator Flap for Autologous Breast Reconstruction: A Review of the Evidence and the Linkou Chang Gung Memorial Hospital Experience.","authors":"David Chon-Fok Cheong, Chia-Fang Chen, Wen-Ling Kuo, Jung-Ju Huang","doi":"10.1055/a-2781-5836","DOIUrl":"10.1055/a-2781-5836","url":null,"abstract":"<p><p>This study aimed to summarize and highlight institutional experience on the profunda artery perforator (PAP) flap for autologous breast reconstruction. Contemporary series demonstrate high flap success and patient satisfaction with PAP reconstruction. Key technical evolutions include perforator-targeted skin paddle designs, strategies to augment venous outflow when needed, and standardized donor site management. Comparative studies and systematic reviews suggest reconstructive reliability comparable to other autologous options, while donor site wound morbidity remains the main area for optimization. In the low-body mass index (BMI) Asian cohort, PAP reconstruction achieved high success, and closed-incision negative pressure wound therapy (iNPWT) reduced donor site wound complications. The PAP flap is a versatile alternative when the abdomen is unsuitable, particularly for small-to-moderate volume breast reconstruction. Outcomes are optimized by careful patient selection, perforator mapping, thoughtful flap design, proactive venous outflow planning, and meticulous donor site closure. Stacked/Bilateral PAP strategies and staged fat grafting expand indications when a single flap is unlikely to meet volume requirements.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"78-82"},"PeriodicalIF":1.4,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786274","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 DIEP Flap Revisit: A Cornerstone of Modern Autologous Breast Reconstruction Anatomy, Preoperative Planning, Surgical Technique, Outcomes, and Complications.","authors":"Chia-Fang Chen, David Chon-Fok Cheong, Wen-Ling Kuo, Jung-Ju Huang","doi":"10.1055/a-2794-0652","DOIUrl":"10.1055/a-2794-0652","url":null,"abstract":"<p><p>Deep inferior epigastric perforator (DIEP) flap has become a standard of care in autologous breast reconstruction, offering reliable aesthetic outcomes and minimized donor site morbidity. Despite its advantages, substantial variability in perforator anatomy and intramuscular course presents technical challenges, and detailed knowledge, meticulous preoperative planning, and precise microsurgical techniques are the key to success. Advances in preoperative imaging, particularly computed tomography angiography (CTA), have enhanced perforator selection and flap design, improving operative efficiency and safety. DIEP flap reconstruction is applicable across a wide range of clinical scenarios, including immediate and delayed reconstruction, patients requiring or receiving irradiation, and those with low body mass index (BMI) or prior abdominal surgeries. Emerging innovations, including robotic-assisted flap harvest, image-guided navigation, and sensory neurotization, aim to further reduce donor site morbidity and improve functional and aesthetic outcomes. This review summarizes the anatomical foundations, surgical strategies, perioperative care, postoperative outcomes, and evolving techniques in effective DIEP flap breast reconstruction.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"71-77"},"PeriodicalIF":1.4,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786332","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":"Evolution of Robotic-Assisted Sympathetic Trunk Reconstruction: Technical Innovation and Clinical Experience.","authors":"Lisa Wen-Yu Chen, Cheyenne Wei-Hsuan Sung, Yin-Kai Chao, Chuan Cheng, See-Tong Pang, Tommy Nai-Jen Chang","doi":"10.1055/a-2781-6808","DOIUrl":"10.1055/a-2781-6808","url":null,"abstract":"<p><p>Endoscopic thoracic sympathectomy, while effective for palmar hyperhidrosis, results in devastating compensatory sweating and autonomic dysfunction affecting >80% of patients. We present our institutional evolution of robotic-assisted sympathetic trunk reconstruction (STR) for post-sympathectomy complications. Our prospective series of 23 patients underwent robotic STR with free nerve grafting (mean follow-up: 2 years). Six-month outcomes demonstrated significant improvement: Chest severity 9.4 ± 0.9 to 6.0 ± 2.4 ( <i>p</i>  < 0.001), back severity 9.3 ± 0.8 to 6.1 ± 2.6 ( <i>p</i>  < 0.001), with sustained gains at 2 years. To minimize donor site morbidity, we progressively transitioned to free intercostal nerve autografts, followed by vascularized intercostal nerve (vICN) grafting beginning January 2025. Vascularized grafts maintained immediate perfusion, enabling continuous Schwann cell proliferation and accelerated recovery. A propensity score-matched analysis of vICN versus free intercostal grafts achieved 100% technical success with no vascular complications. Six-month vICN recipients demonstrated continuous improvement without temporary worsening observed in controls. Recently, single-port robotic systems substantially reduced postoperative chest wall morbidity. These innovations demonstrate that precisely executed microsurgical technique, enabled by robotic precision and interdisciplinary expertise, offers viable treatment for carefully selected patients with intolerable post-sympathectomy complications.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"50-54"},"PeriodicalIF":1.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786234","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":"Microsurgical Chest Wall Reconstruction with Abdominal Flaps for Large Full-Thickness Oncologic Defects.","authors":"Shiuan Shyu, David Chon-Fok Cheong, Chia-Fang Chen, Yin-Kai Chao, Jung-Ju Huang","doi":"10.1055/a-2781-3414","DOIUrl":"10.1055/a-2781-3414","url":null,"abstract":"<p><p>Extensive full-thickness chest wall defects following oncologic tumor resection present complex reconstructive challenges, particularly in large, vessel-depleted defects. A retrospective review of patients with full-layer oncologic chest wall resection and microsurgical reconstruction with abdominal-based flaps was conducted. Demographics, comorbidities, defect characteristics, surgical techniques, complications, and outcomes were presented. Eight patients with locally advanced breast cancer, lung cancer, and recurrent desmoid fibromatosis underwent resection and reconstruction: four for curative and four for palliative intent. Defect sizes ranged from 16 cm × 14 cm to 24 cm × 16 cm (area: 224-384 cm ² ). Reconstruction included a combination of pedicled transverse rectus abdominis myocutaneous (TRAM) and free deep inferior epigastric artery perforator (DIEP) flaps, bilateral free DIEP flaps, and bilateral free muscle-sparing TRAM flaps, with flap sizes ranging from 28 cm × 13 cm to 36 cm × 14 cm. All flaps were transferred successfully with few complications. Microsurgical chest wall reconstruction with abdominal flaps offers substantial volume, robust vascularity, and flexible design, making them a durable alternative for complex chest wall defects.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"89-96"},"PeriodicalIF":1.4,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786268","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":"Engineering the Lymphatic Vasculature: Current Concepts and Challenges from Preclinical Strategies to Clinical Practice.","authors":"Hui-Yi Hsiao, Jung-Ju Huang","doi":"10.1055/a-2781-6794","DOIUrl":"10.1055/a-2781-6794","url":null,"abstract":"<p><p>Lymphedema is a chronic, debilitating condition characterized by impaired lymphatic drainage, tissue swelling, and fibrosis. Conventional treatments mainly focus on finding symptomatic solutions, rarely using tissue-engineered approaches of regenerative therapies. Tissue engineering approaches have emerged as promising strategies to restore lymphatic function by integrating molecular cues, cellular components, and biomaterial scaffolds. This review summarizes recent advances and challenges in lymphatic regeneration, focusing on (1) molecular regulation, including growth factors and chemical modulators; (2) cellular components with primary lymphatic endothelial cells (LECs), stem cells, fibroblasts, and macrophages; (3) biomaterials and engineering strategies, highlighting hydrogels, 3D scaffolds, and controlled delivery systems; and (4) preclinical and translational studies in different animal models. Finally, current and emerging strategies in clinical and plastic reconstructive surgery are discussed. Challenges such as cell survival, molecular specificity, and functional integration are highlighted, along with future directions for combinatorial approaches. This review provides a current framework for advancing tissue-engineered solutions and challenges for lymphedema and promoting translational success.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"113-120"},"PeriodicalIF":1.4,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786071","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":"From Limb to Brain: Lymphedema as a Systemic Disease with Metabolic, Immunological, and Neurodegenerative Consequences and the Disease-Modifying Potential of Lymphaticovenous Anastomosis-An Integrative Analysis.","authors":"Johnson Chia-Shen Yang","doi":"10.1055/a-2780-1561","DOIUrl":"10.1055/a-2780-1561","url":null,"abstract":"<p><p>Lymphedema has traditionally been viewed as a localized disorder characterized by regional fluid accumulation and tissue swelling. However, emerging evidence challenges this paradigm, revealing that lower limb lymphedema induces significant systemic pathophysiological changes. This review synthesizes recent findings demonstrating that lymphedema triggers widespread oxidative stress, chronic inflammation, dysregulated gene expression in circulating monocytes, and contralateral limb muscle edema-even in the absence of clinical lymphedema in the unaffected limb. Furthermore, we examine the potential association between lymphedema and increased Alzheimer's disease (AD) risk through shared mechanisms involving oxidative stress and neuroinflammation. Lymphaticovenous anastomosis (LVA), a minimally invasive supermicrosurgical technique, has emerged as an effective intervention that not only reduces limb volume but also reverses many of these systemic alterations. Studies utilizing advanced imaging techniques, including magnetic resonance volumetry and diffusion tensor imaging, combined with comprehensive biomarker analyses, have documented post-LVA improvements in antioxidant capacity, reduction in oxidative stress markers, normalization of inflammatory cytokines, recovery of dysregulated gene expression patterns, and decreased muscle edema bilaterally. Additionally, preliminary data suggest LVA may reduce AD biomarkers, including tau protein and amyloid-beta levels, while increasing neuroprotective factors such as brain-derived neurotrophic factor. These findings fundamentally redefine lymphedema as a systemic condition with far-reaching metabolic and potentially neurodegenerative consequences, positioning LVA as a therapeutic intervention with benefits extending beyond local symptom control to systemic disease modification.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"40 1","pages":"97-102"},"PeriodicalIF":1.4,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786211","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":"Intestinal Free Flaps and \"J\"-Designed Anterolateral Thigh Free Flap for Pharyngoesophageal and Voice Tube Reconstruction in Patients with Laryngopharyngectomy Defects.","authors":"Chung-Kan Tsao, Rushil R Dang, Hung-Chi Chen","doi":"10.1055/s-0045-1812866","DOIUrl":"10.1055/s-0045-1812866","url":null,"abstract":"<p><p>Total laryngopharyngectomy for advanced hypopharyngeal and laryngeal cancers results in complex defects that compromise both swallowing and phonation. Restoration of these functions is critical for quality of life, yet reconstructive options present unique challenges. This study evaluates the outcomes of free ileocolon flaps and J-designed anterolateral thigh (J-ALT) flaps for simultaneous reconstruction of the pharyngoesophagus and voice conduit in patients undergoing total laryngopharyngectomy. Between 1988 and 2025, 231 patients underwent ileocolon flap reconstruction, and from 2014 to 2025, 124 patients underwent J-ALT flap reconstruction. Technical refinements, including plication of the ileocecal valve and precise flap inset, were implemented to optimize swallowing and phonation. In the ileocolon cohort, overall flap survival was 97%, with low rates of fistula and anastomotic complications; 78% of patients achieved good swallowing function, and 64% demonstrated satisfactory speech outcomes. The J-ALT flap demonstrated comparable swallowing outcomes, with 97% of patients resuming oral intake and 50% achieving fluent speech through the neophonation tube. Both techniques avoided the complications associated with tracheoesophageal prostheses, including obstruction, infection, and mechanical failure. These findings highlight that meticulous surgical planning and a multidisciplinary approach can achieve reliable long-term restoration of alimentary and vocal function. Both ileocolon and J-ALT flaps represent viable reconstructive options for patients with a favorable life expectancy.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 4","pages":"216-224"},"PeriodicalIF":1.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12714446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806124","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}