Annals of Plastic Surgery最新文献

{"title":"Bioactive Microsurgery and CCL2: A Narrative Review of Immune Modulation Strategies for Peripheral Nerve Repair.","authors":"Claudy Sarpong, Sumaia Khoury, Kyle Bangayan, Vivianna Williams, Daniil Sokolov, Farrah Liu","doi":"10.1097/SAP.0000000000004888","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004888","url":null,"abstract":"<p><p>Peripheral nerve injuries often result in incomplete functional recovery, despite technically successful microsurgical repair. Traditional strategies focus on structural continuity but neglect the immunobiological environment critical for regeneration. CCL2 (monocyte chemoattractant protein-1, MCP-1), a chemokine that coordinates macrophage recruitment and polarization, has emerged as a key regulator of neuroimmune responses involved in nerve healing. This narrative review evaluates the scientific rationale, preclinical evidence, and translational strategies for using CCL2 as a bioactive adjunct in peripheral nerve microsurgery. We synthesize findings from preclinical studies involving CCL2 in nerve injury models, including knockout and overexpression systems, graft integration, stem cell-based therapies, and pain modulation, with emphasis on delivery mechanisms applicable to intraoperative settings such as hydrogels, microsutures, and cellular approaches. Across multiple preclinical injury models, CCL2 has been shown to enhance macrophage-driven repair, promote angiogenesis, facilitate Schwann cell activity, and accelerate axonal regrowth. Loss of CCL2 signaling impairs functional recovery, whereas targeted delivery during the early regenerative window improves outcomes without evidence of prolonged inflammation. These studies further support hydrogels, microsutures, and mesenchymal stromal cell-based therapies as feasible platforms for CCL2 delivery. Together, these data support intraoperative CCL2 modulation as a novel, mechanistically grounded strategy to integrate immune biology with microsurgical technique. This bioactive approach has the potential to improve regeneration and graft integration while minimizing the risk of neuropathic pain through precise temporal and anatomic control of CCL2 delivery.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890758","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":"Invited Commentary on: \"The Rise of Nerve Transfers and the Case for Centralized Brachial Plexus Services\".","authors":"Sunny Vansdadia, Pooja Dhupati, Jonathan Jeger, Shelley S Noland","doi":"10.1097/SAP.0000000000004885","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004885","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890788","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":"Topical Tranexamic Acid Reduces Postoperative Drainage and Hematoma Rates in Soft Tissue Surgery Following a Standardized Surgical Protocol.","authors":"Georg Oppolzer, Lara Steinkellner, Nadalina J Sifkovits, Anabel Hofbauer, Rupert Koller, Albert Fuchs","doi":"10.1097/SAP.0000000000004880","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004880","url":null,"abstract":"<p><strong>Background: </strong>Postoperative bleeding and prolonged drainage remain relevant complications in soft tissue surgery and may result in revision surgery, extended hospital stay, and increased morbidity. Topical tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic effects, has gained increasing attention as a means of reducing these complications while minimizing systemic exposure. However, standardized application protocols and robust outcome data remain limited.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 241 consecutive patients undergoing gender-affirming mastectomy, breast reduction, or abdominoplasty between May 2020 and April 2024. In May 2022, a standardized topical TXA protocol (500 mg per surgical site) was implemented. Primary outcomes were cumulative drain output at 72 hours and postoperative hematoma requiring surgical revision. Secondary outcomes included seroma formation and postoperative complications.</p><p><strong>Results: </strong>Topical TXA was administered in 93 patients (38.6%). Cumulative 72-hour drain output was lower in TXA-treated patients in every procedure, with the greatest relative reduction in abdominoplasty (-62%, P<0.001), followed by gender-affirming mastectomy (-51%, P=0.001) and reduction mammoplasty (-47%, P=0.005). Across all procedures, hematoma requiring surgical revision occurred in 6.5% (6/93) of TXA-treated patients compared with 15.5% (23/148) of controls, showing a relative risk reduction of 58% (P=0.042). No thromboembolic events, seizures, or wound-healing complications were observed.</p><p><strong>Conclusion: </strong>Topical TXA significantly reduces postoperative drainage and hematoma rates in soft tissue surgery without an observed increase in complications. Given its low cost and ease of application, topical TXA represents a valuable adjunct to standardized surgical protocols.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890796","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":"Cumulative Smoking Exposure and Major Recipient-Site Complications After Standardized Free-Flap Reconstruction for Head and Neck Cancer.","authors":"Yoshiro Abe, Makoto Mizuguchi, Kenta Ikushima, Takuto Inoue, Mariko Nishioka, Ichiro Hashimoto","doi":"10.1097/SAP.0000000000004879","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004879","url":null,"abstract":"<p><p>Free tissue transfer is the standard reconstructive approach for complex head and neck defects; however, major recipient-site complications remain clinically significant. Reported risk factors for these complications have been inconsistent, partly because of heterogeneity in defect characteristics, reconstructive techniques, and perioperative management across institutions. This study aimed to identify independent predictors of major recipient-site complications and total flap or jejunal necrosis in patients with continuous intraoral-cervical composite defects managed in a standardized single-center setting. We retrospectively analyzed 183 consecutive patients who had undergone free tissue transfer within a standardized reconstructive program. The same 2 senior plastic surgeons primarily planned the reconstructions and performed the key steps, including flap design, vascular anastomosis, and flap inset. Techniques were standardized within each reconstructive category, with 3-dimensional planning when indicated and protocolized postoperative flap monitoring. Recipient-site complications were graded using the Clavien-Dindo (C-D) classification, and cumulative smoking exposure was quantified using the Brinkman index (BI; cigarettes/day×years). Severe (C-D ≥III) complications occurred in 20.8% of patients, and total necrosis occurred in 3.3%. Seventeen patients (9.3%) had grade IIIb complications, 13 of whom underwent reoperation requiring wound closure, revision reconstruction, or thoracic duct ligation. BI and bilateral neck dissection were independent predictors of severe complications, whereas BI was the only factor significantly associated with total necrosis. Each 100-unit increase in BI increased the odds of severe complications and necrosis, and receiver operating characteristic analysis yielded an area under the curve of 0.858 (95% CI: 0.735-0.981) for total necrosis. The length of hospital stay was significantly prolonged in patients with C-D ≥III complications and in those with total necrosis. In all necrosis cases, circulatory compromise was recognized after postoperative day 3 despite protocolized monitoring. Even under standardized reconstructive and monitoring conditions, clinically significant complications remained relatively common, suggesting that cumulative smoking exposure may reflect patient-related vascular vulnerability in a setting designed to minimize technical variation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890747","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 Rise of Nerve Transfers and the Case for Centralized Brachial Plexus Services.","authors":"Ashley I Simpson","doi":"10.1097/SAP.0000000000004884","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004884","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890818","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":"Access to Reconstructive Surgery After Female Genital Mutilation/Cutting in the United States: A Patient-Reported Outcomes Study.","authors":"Malia Voytik, Salman Khan, Margaret M Hornick, Sarah Barnett, Elizabeth Card, Arturo J Rios-Diaz, Ayaka N Deguchi, Robyn B Broach, Ivona Percec","doi":"10.1097/SAP.0000000000004874","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004874","url":null,"abstract":"<p><p>Female genital mutilation/cutting (FGM/C) remains prevalent worldwide and has lasting physical and psychological consequences. In the United States, an estimated 513,000 women and girls have undergone or are at risk of FGM/C, yet clitorolabial reconstruction is rarely offered and performed by few specialists. This study aimed to identify barriers to accessing reconstructive surgery. Patients who underwent FGM/C reconstruction by a single plastic surgeon at a quaternary academic center between 2017 and 2024 were surveyed. The survey assessed access to care, perceived barriers, social support, and satisfaction with surgical outcomes. Of 38 eligible patients, 21 completed the survey (55.3% response rate). Median age was 37 years (IQR: 32.1-46.5). The majority identified as Black/African American (81.0%) or Middle Eastern/North African (14.3%) and as cisgender female (85.7%). Type 2 FGM/C was most common (85.7%). Over half (57.1%) had considered reconstruction for more than 3 years before pursuing care. Most (81.0%) independently located their surgeon online, and 85.7% had never consulted another provider regarding FGM/C. Patients in this cohort frequently considered reconstruction for several years before accessing surgical care. Although 92.5% had insurance, 57.1% reported financial hardship. Additional barriers included travel burden and limited emotional support. Despite these challenges, most respondents reported satisfaction with their surgical outcomes. Persistent financial, geographic, and social barriers highlight the need for increased provider awareness, improved referral pathways, and expanded reconstructive services to ensure timely and comprehensive care for individuals affected by FGM/C.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886257","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":"Reconstruction of the Pelvic Floor With a Gluteus Maximus-Including Posterior Thigh Flap After Total Pelvic Exenteration.","authors":"Yoshihiko Tamanoi, Kakuru Otsubo, Tomoyuki Koike, Kenichi Kokubo, Ayato Hayashi","doi":"10.1097/SAP.0000000000004882","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004882","url":null,"abstract":"<p><strong>Background: </strong>Total pelvic exenteration (TPE) creates a massive pelvic dead space associated with a high risk of severe postoperative complications. We evaluated the clinical outcomes of pelvic floor and perineal reconstruction using a modified posterior thigh flap including the gluteus maximus muscle in patients undergoing TPE for anal canal cancer.</p><p><strong>Patients and methods: </strong>We retrospectively reviewed 4 male patients who underwent this reconstruction at our institution between April 2020 and March 2025. Clinical outcomes, including operative details, postoperative complications, and ambulatory function (assessed through manual muscle testing), were analyzed.</p><p><strong>Results: </strong>All flaps survived completely, effectively obliterating the pelvic dead space. No major complications, such as pelvic sepsis, fistula formation, or ambulatory dysfunction, were observed at 6 months postoperatively. Hip extension strength on the reconstructed side was preserved at manual muscle testing grade 5 in all patients. Minor donor-site complications consisted of one hematoma requiring surgical hemostasis and 2 minor wound dehiscences that healed with conservative management.</p><p><strong>Conclusions: </strong>The posterior thigh flap, including the gluteus maximus, provides ample vascularized tissue to fill the pelvic cavity, spares the abdominal wall, and allows for early mobilization. In addition, releasing the muscle insertion provides greater flap mobility. This technique is a reliable reconstructive option that may minimize postoperative morbidity following TPE.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886274","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":"Proximal-First Pedicle Approach for Prone Latissimus Dorsi Flap Harvest: Technical Refinement for Posterior Reconstruction.","authors":"Yooseok Ha, Jeong Tae Kim, Seung Eun Hong, Youn Hwan Kim","doi":"10.1097/SAP.0000000000004883","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004883","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction of posterior body defects often requires intraoperative repositioning, which increases operative time and disrupts surgical workflow. Although the latissimus dorsi (LD) flap is a reliable option for posterior reconstruction, prone-position LD harvest has been infrequently described outside of breast reconstruction. This study introduces a proximal-first pedicle approach for LD flap harvest in the prone position and evaluates its clinical applicability for posterior body reconstruction.</p><p><strong>Patients and methods: </strong>A retrospective review was conducted of 28 patients who underwent prone-position LD flap harvest between March 2012 and February 2025 for reconstruction of sacrococcygeal, ischial, gluteal, popliteal, or transtibial defects. The operative technique focused on early identification of the thoracodorsal pedicle through the teres major-latissimus dorsi intermuscular window, allowing pedicle-first dissection before flap design. Both musculocutaneous (mcLD) and muscle-sparing (msLD) variants were analyzed. Patient demographics, flap characteristics, operative time, complications, and clinical outcomes were evaluated. Donor-site upper-extremity function was assessed using the QuickDASH questionnaire.</p><p><strong>Results: </strong>Twenty-eight patients (19 males and 9 females; mean age, 55.8 y) underwent prone LD flap reconstruction. Twenty-five flaps were harvested as mcLD flaps and 3 as msLD flaps. The mean flap size was 234.4 cm², and the mean total operative time was 168.2 minutes (range: 105 to 270 min). One case of partial flap necrosis occurred, while all other flaps survived without major complications. Primary donor site closure was achieved in 53.6% of cases. The mean follow-up duration was 48.5 months. The mean QuickDASH score was 2.32±0.78 (n=21).</p><p><strong>Conclusion: </strong>Although a prone LD flap harvest has been described previously, a standardized pedicle-first strategy has not been established. The proximal-first pedicle approach introduced in this study provides consistent early exposure of the thoracodorsal system and facilitates flap harvest without intraoperative repositioning.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879046","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":"https://doi.org/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":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","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":"https://doi.org/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":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","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}