Annals of Plastic Surgery最新文献

{"title":"Expanding the Indications for the Modified Melbourne Technique: Posterior Vault Reconstruction for Secondary Craniosynostosis With a Persistent Occipital Defect After Encephalocele Repair.","authors":"Haven Ward, Gabriela Cendejas, William Cobb, Joseph Lopez","doi":"10.1097/SAP.0000000000004861","DOIUrl":"10.1097/SAP.0000000000004861","url":null,"abstract":"<p><strong>Introduction: </strong>Occipital encephaloceles are rare neural tube defects characterized by herniation of intracranial contents through a posterior calvarial defect and are frequently associated with complex neurological and structural anomalies. While early surgical repair is essential, children with large occipital encephaloceles remain at risk for delayed sequelae, often necessitating staged craniofacial reconstruction. Among available reconstructive strategies, the Melbourne technique and its modified variants are established methods for posterior vault expansion in severe or late-presenting sagittal synostosis. However, to our knowledge, this technique has not previously been applied in the setting of a large posterior calvarial defect associated with an occipital encephalocele.</p><p><strong>Case presentation: </strong>We report the case of a female infant with a prenatally diagnosed large occipital encephalocele measuring 10×12 cm, associated with Chiari III malformation, posterior fossa hypoplasia, and mild ventriculomegaly. She underwent neonatal encephalocele resection and dural repair, followed by ventriculoperitoneal shunt placement. Over time, she developed secondary sagittal craniosynostosis and a persistent large posterior calvarial defect. At 28 months of age, she underwent posterior cranial vault remodeling using a modified Melbourne technique combined with split-thickness calvarial grafting to reconstruct an 9×8 cm occipital defect. The procedure achieved posterior vault expansion, restoration of cranial integrity, and correction of her scaphocephaly deformity.</p><p><strong>Conclusion: </strong>This case highlights the evolving and multifactorial challenges associated with large occipital encephaloceles, and demonstrates a novel application of the modified Melbourne technique in the setting of secondary sagittal craniosynostosis, a large posterior vault defect, and Chiari III malformation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"540-544"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Vitamin D in Plastic and Reconstructive Surgery: A Systematic Review of Human and Animal Studies.","authors":"Afnan M Nour, Adam Boukind, Lillee Izadi, Kanishk Satish, Sara Iskeirjeh, Saif Badran","doi":"10.1097/SAP.0000000000004838","DOIUrl":"10.1097/SAP.0000000000004838","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D, a fat-soluble hormone, is increasingly recognized for its critical roles in immunomodulation, inflammation control, and tissue regeneration. Its deficiency is a global public health concern, affecting postoperative outcomes across various surgical fields, including plastic and reconstructive surgery.</p><p><strong>Objective: </strong>To systematically review the existing literature on the impact of preoperative and perioperative vitamin D levels on surgical outcomes in plastic and reconstructive surgery, combining findings from both animal and human studies.</p><p><strong>Methods: </strong>A detailed literature search was conducted in Embase, PubMed, Ovid Medline, PubMed Central, Scopus, and Cochrane Central databases. Inclusion criteria encompassed human and animal studies examining the role of vitamin D in wound healing, aesthetic procedures, reconstructive surgeries, nerve regeneration, and orthognathic interventions. Data extraction and quality assessment were performed using standardized tools. A structured sensitivity analysis by study design and quality was also performed.</p><p><strong>Results: </strong>Fifteen studies met the inclusion criteria, including 11 human studies and 4 animal studies. Lower preoperative vitamin D levels were consistently associated with poorer wound healing outcomes, such as hypertrophic scarring, keloid formation, and complication rates in aesthetic and reconstructive surgeries. Animal studies demonstrated that vitamin D supplementation improved flap survival by enhancing angiogenesis and reducing inflammation. Preclinical studies and case reports highlighted vitamin D's neuroregenerative benefits and its role in maintaining bone integrity in orthognathic surgeries. Conclusions regarding wound healing, scarring, and bone healing remained robust across exclusion scenarios. Findings related to nerve regeneration depended predominantly on preclinical evidence.</p><p><strong>Conclusion: </strong>Vitamin D emerges as a potential biomarker and therapeutic agent that could improve surgical outcomes in plastic and reconstructive surgery. Despite promising findings, current evidence faces limitations, including small sample sizes, heterogeneous populations, and inconsistent vitamin D measurement methods. Future large-scale, high-quality studies are necessary to establish definitive guidelines for vitamin D assessment and supplementation in surgical care.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"604-618"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Secondary Burn Reconstruction: A Longitudinal Descriptive Study of a Prospective Registry to Optimize Reconstructive Practice Development in a Regional Burn Center.","authors":"Sara Karti","doi":"10.1097/SAP.0000000000004863","DOIUrl":"10.1097/SAP.0000000000004863","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"619"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Incisional Depression in Double Eyelid Blepharoplasty Using an Elevated Cephalad Orbital Septum Flap Technique.","authors":"Jianhui Zhao, Chen Chen, Zhaoyu Ju, Bei Zhang, Xiao Qin, Wenzhi Hu, Yan Han, Yan Zheng","doi":"10.1097/SAP.0000000000004855","DOIUrl":"10.1097/SAP.0000000000004855","url":null,"abstract":"<p><strong>Background: </strong>Double eyelid blepharoplasty is commonly performed in China. Incisional depression is an established postoperative contour concern, although several contemporary techniques are available to reduce its occurrence. We retrospectively describe outcomes after a full-incision technique using an elevated cephalad orbital septum flap.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of 898 consecutive patients (821 female and 77 male; mean age: 39.3±12.7 y) who underwent primary double eyelid blepharoplasty by one surgeon at one institution between January 2006 and June 2016. The technique used an elevated cephalad orbital septum flap. Six-month outcomes were summarized descriptively using patient-reported measures, a 4-grade incisional-depression assessment scored from standardized, deidentified photographs, and recorded complications.</p><p><strong>Results: </strong>At 6 months, 845 of 898 patients (94.1%) were very satisfied or satisfied with their appearance. The 4-grade incisional-depression assessment was excellent in 805 patients (89.6%), good in 75 (8.4%), fair in 15 (1.7%), and poor in 3 (0.3%); fair or poor grades occurred in 18 patients (2.0%). Thirty-seven patients (4.1%) had a recorded complication. The most frequent were asymmetry (12/898, 1.3%), partial or complete fold disappearance (10/898, 1.1%), and a wide or narrow fold (6/898, 0.7%). Upper-eyelid contour depression or hollowing (2/898, 0.2%) was recorded separately from incisional scar depression.</p><p><strong>Conclusions: </strong>In this retrospective, single-surgeon case series, the elevated cephalad orbital septum flap technique was associated with high patient-reported satisfaction and generally favorable 6-month scar assessments. Comparative studies with prospectively defined outcomes are needed to determine whether the technique reduces incisional depression relative to other approaches.</p><p><strong>Levels of evidence: </strong>Level IV-therapeutic.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"494-500"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helical Cartilage Inversion and V-Y Advancement Flap for Type IIB Constricted Ear Correction.","authors":"Mengyuan Jiang, Jingwei Feng, Jiajun Zhi, Leren He, Yanyong Zhao, Meirong Yang","doi":"10.1097/SAP.0000000000004860","DOIUrl":"10.1097/SAP.0000000000004860","url":null,"abstract":"<p><strong>Objectives: </strong>A type IIB constricted ear is a common congenital auricular deformity. Traditional methods often require multistage surgeries or contralateral tissue transplantation. We hypothesized that helical cartilage inversion grafting combined with a V-Y advancement flap could achieve effective single-stage correction with comparable morphologic improvements to traditional methods, while significantly eliminating donor-site morbidity. This study aims to evaluate the clinical efficacy and safety of this technique.</p><p><strong>Methods: </strong>This retrospective analysis included 20 patients (23 ears) with type IIB constricted ear. Through a retroauricular approach, the excessively folded helical cartilage was transected to create a free cartilage graft, then inverted and reconnected. A retroauricular V-Y advancement flap provided soft tissue coverage. Surgical outcomes were assessed using auricular measurements, the Aesthetic Outcomes Scale (AOS), and the Visual Analog Scale (VAS).</p><p><strong>Results: </strong>The mean patient age was 5.2±1.8 years with a 12-month follow-up. Postoperative ear vertical height increased from 40.3±3.5 to 50.5±3.8 mm (25.3% increase, P <0.001). AOS scores improved from 1.8±0.6 to 3.2±0.7 ( P <0.001). VAS satisfaction scores increased from 2.1±1.2 to 8.3±1.4 ( P <0.001). A total of 90% of patients achieved satisfaction scores ≥7, with 13.0% complication rate.</p><p><strong>Conclusion: </strong>Helical cartilage inversion grafting combined with V-Y advancement flap is a safe and effective single-stage correction method for type IIB constricted ear, characterized by minimal trauma, adequate soft tissue coverage, and low complication rates, providing a valuable clinical treatment option.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"526-531"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Versatility of a Pedicled Rectus Femoris and Anterior Lateral Thigh Chimeric Flap in Staged Complex Abdominal Wall Reconstruction: A Case Report in a Transplant Recipient.","authors":"Agustin Herber, Taylor Kreul, Robert Unger, Jimmy Chim","doi":"10.1097/SAP.0000000000004887","DOIUrl":"10.1097/SAP.0000000000004887","url":null,"abstract":"<p><p>Complex abdominal wall reconstruction (CAWR) can pose significant challenges for surgeons and their patients. An extra layer of complexity is added when considering reconstruction in patients with impaired immune function, such as after a solid organ transplant, due to increased risk for poor wound healing, infection, and subsequent incisional hernia formation. Options for CAWR include primary closure by local tissue advancement, component separation, skin grafts, alloplastic material/mesh, pedicled or free flaps, or abdominal wall allotransplantation. When considering flap use in CAWR, the choice of coverage depends on the location and size of the abdominal wall defect. At a certain point, end-stage abdominal wall deficits, where reconstruction with local tissue is not possible, need to be considered. In these instances, we propose using pedicled regional flaps or even free tissue transfer. Here, we describe a case of a 35-year-old immunosuppressed male with a large spigelian hernia with loss of domain that developed after a repeat cadaveric renal transplant for which he underwent a staged CAWR with temporary abdominal closure, subsequent ventral hernia repair with biological mesh in an underlay fashion, and utilization of tunneled anterior lateral thigh and rectus femoris pedicled flaps.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"598-603"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Local Oversight to National Frameworks: Twenty Years of Face Transplant Governance: Erratum.","authors":"Aliyar Zahedi Vafa, Mica C G Williams, Omar Allam, Maryam Berih, Paula Flores-Pérez, Nathalie Roche, Patrick Lassus, Bohdan Pomahac, Olivier F Noel","doi":"10.1097/SAP.0000000000004890","DOIUrl":"10.1097/SAP.0000000000004890","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"621"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal Wall Pseudohernia Secondary to Subcostal Nerve Entrapment After Lateral Spinal Surgery: A Case Report.","authors":"Nicole Rossi, Sanjeev Puri","doi":"10.1097/SAP.0000000000004886","DOIUrl":"10.1097/SAP.0000000000004886","url":null,"abstract":"<p><p>Abdominal wall pseudohernia is an uncommon condition characterized by laxity of the abdominal wall without a fascial defect, typically resulting from denervation of the abdominal wall musculature. Subcostal nerve injury is a rare but important cause, particularly following lateral spinal approaches. We present the case of a 75-year-old man with multiple prior spinal surgeries who developed a persistent left lateral abdominal wall pseudohernia. The condition persisted for 1 year despite conservative management; therefore, surgical exploration was undertaken. Intraoperative findings demonstrated dense perineural fibrosis with complete encasement of the subcostal nerve. Functional assessment using nerve stimulation revealed diminished motor response. Neurolysis was performed with restoration of contraction of the abdominal wall musculature following decompression. The patient experienced complete resolution of abdominal wall laxity within 1 month postoperatively.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"566-567"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of State Legislation on Regional Availability of Gender-Affirming Surgeons in the United States.","authors":"David A Febre-Alemañy, Jacqueline Ihnat, Paula S Flores-Pérez, Melanie Vassallo, Sacha C Hauc, Omar Allam, Karen Bach, Michael Alperovich","doi":"10.1097/SAP.0000000000004834","DOIUrl":"10.1097/SAP.0000000000004834","url":null,"abstract":"<p><strong>Purpose: </strong>Provider scarcity is one of the principal barriers to gender-affirming care (GAC) in the United States, with poorly characterized geographic variation. State-level legislation governing access to gender-affirming surgery (GAS) provides a framework for examining how the regulatory environment correlates with surgeon availability. This study examined the geographic distribution of GAS surgeons across the United States and its association with state legislative classification.</p><p><strong>Methods: </strong>Six provider databases were queried to identify surgeons offering gender-affirming procedures and their practice locations. Isochrone application programming interface (API) software mapped all counties within a 2-hour drive of each surgeon. Surgeon-to-transgender population ratios were calculated.</p><p><strong>Results: </strong>Surgeons per 10,000 transgender individuals ranged from 0 to 26.4 (national average 8.2). Chest surgery had the broadest access, with 65.4% of counties (83.9% of the population) within a 2-hour drive of at least one surgeon. Access declined substantially for more specialized procedures: 30.9% of counties (65.1% of the population) for facial feminization; 16.1% of counties (50.0% of the population) for chondrolaryngoplasty; and 15.0% of counties for vaginoplasty. Restrictive states averaged 5.91 surgeons per 10,000 transgender individuals, compared with 9.80 in neutral states and 10.83 in protective states; shield states averaged 7.65.</p><p><strong>Conclusions: </strong>Access to GAS varies markedly by procedure type and state legislative category. Chest surgery has the widest geographic availability, while access to genital reconstruction and voice surgery remains critically limited. Surgeon density is significantly lower in restrictive states than in neutral or protective states, a pattern consistent across parametric and nonparametric analyses.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"583-588"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Final Tongue Size in the Treatment of Macroglossia Associated With Beckwith-Wiedemann Syndrome: Review of 29 Cases.","authors":"Renato da Silva Freitas, Lucas Guimarães Alves, Maitê Mateus, Isabella Correa de Oliveira, Marc Domit Werner Linnenkamp, Isis Juliane Guarezi Nasser, Eduardo Angeli-Freitas","doi":"10.1097/SAP.0000000000004862","DOIUrl":"10.1097/SAP.0000000000004862","url":null,"abstract":"<p><p>Beckwith-Wiedemann syndrome (BWS) is a rare congenital disorder whose main clinical feature is macroglossia. This frequent manifestation may impair respiratory, feeding, speech, and orofacial developmental functions. When significant functional and/or aesthetic repercussions are evident, surgical excision is the primary management approach, with several techniques described. In this study, we analyzed medical records from 29 patients diagnosed with BWS and macroglossia, and evaluated 26 cases of partial glossectomy performed between 2015 and 2025. Indications, surgical technique, postoperative course, and short-term and medium-term outcomes are discussed, emphasizing the importance of early and standardized intervention. A new clinical grading for macroglossia was developed in BWS. All procedures were performed by a single surgeon in a craniofacial surgery reference center in Southern Brazil, with patients aged between 5 months and 8.9 years. Epidemiologically, 65.4% of the patients were female and the average age of surgery was 18.5 months, the median was 10 months. Macroglossia was classified as mild in 11.5%, moderate in 46.2% and severe in 42.3% of cases. The average tongue reduction was 31.6% in length and 21% in width. Retrospective analysis of medical records demonstrated appropriate functional improvement, a low complication rate, and satisfactory aesthetic and respiratory outcomes in most cases. The findings reinforce the safety and effectiveness of partial glossectomy in managing macroglossia associated with BWS.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"521-525"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}