Annals of Plastic Surgery最新文献

{"title":"Role of Arteriogenesis Mechanism in the Remodeling of Choke Vessels in Delayed Multiterritory Perforator Flaps: A Protein-Based Perspective.","authors":"Lijun Zhang, Ya Hu, Zhonggen Dong, Jianwei Wei, Ping Peng","doi":"10.1097/SAP.0000000000004842","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004842","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to elucidate the role of the arteriogenesis mechanism and its impact on the remodeling of choke vessels within the delayed multiterritory perforator flap (MPF) from the perspective of protein molecular mechanisms.</p><p><strong>Methods: </strong>Integument radiography and HE staining were used to conduct qualitative and quantitative evaluations of the microvascular morphology within the choke zones. A laser Doppler blood flow imager was used to assess blood perfusion. Immunohistochemistry was used to perform qualitative, semiquantitative, and localized analyses of the spatiotemporal dynamic expression of protein molecules involved in collateral artery growth within the choke zone at 1, 3, 5, and 7 days following delayed surgery and flap elevation.</p><p><strong>Results: </strong>Radiographs of the perfused integuments revealed that true anastomoses emerged in choke zones 1 and 2 three days after the delayed surgery. HE staining findings showed that after flap delay surgery, both choke zones 1 and 2 underwent remodeling, characterized by increased arteriolar diameters and decreased microvessel density. The blood perfusion units in choke zones 1 and 2 were significantly higher on 1 day than at 4 hours after the delayed surgery (P<0.05). In choke zones 1 and 2, protein molecules associated with collateral artery remodeling-including TRPV4, VE-cadherin, eNOS, iNOS, ICAM-1, FAK, Ephrin B2, PLGF, CD163, MMP-9, MMP-2, and CX-37-exhibited significant increases after delayed surgery and/or flap elevation, compared with their preoperative expression levels (P<0.05).</p><p><strong>Conclusion: </strong>The spatiotemporal dynamic changes of protein molecules related to the remodeling of collateral arteries are closely related to the remodeling of choke vessels in choke zones 1 and 2 of delayed MPF with ligated perforators in the dynamic region, and the arteriogenesis mechanism may play an important role in the remodeling of these choke vessels.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672964","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 Innovation to Integration: Responsible Integration of Artificial Intelligence in Plastic Surgery.","authors":"Georgios Karamitros, Wesley P Thayer, Gregory A Lamaris, Galen Perdikis, William C Lineaweaver","doi":"10.1097/SAP.0000000000004801","DOIUrl":"10.1097/SAP.0000000000004801","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"115-117"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325662","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 Pentagonal Modification of the Pedicled Latissimus Dorsi Myocutaneous Flap for Chest Wall Sarcoma Reconstruction.","authors":"Prateush Singh, Minhao Hu, Joeseph Overland, Peter Gearing, Avinash Sharma, Hayden Snow, Bryce Jackson, Rizwan Sheikh, Angela Webb, Richard Zinn","doi":"10.1097/SAP.0000000000004766","DOIUrl":"10.1097/SAP.0000000000004766","url":null,"abstract":"<p><p>The myocutaneous latissimus dorsi is a workhorse flap, providing robust, reliable, and composite tissue for extensive chest wall resurfacing. In this paper, we will illustrate the advantages of a pentagonal design with a V-Y modification using a reconstructive case series of 5 vignettes with chest wall defects resulting from sarcoma resection, and summarise the literature on this modification. The advantages of this technique are to: (1) maximize the available skin paddle and avoid unnecessary skin bridges. (2) Maintain V-Y advancement options for the flap, rather than the conventional rotational inset. (3) Minimize the risk of failure of closure of the large donor site. (4) Allow for a broader and wider flap harvest than conventional approaches. (5) Bring nonirradiated tissue into the reconstructed defect. These advantages are important in preserving as much reconstructive local tissue as possible, particularly in cases of extensive resection, as with sarcoma, or in irradiated tissue, in which maximizing vascularity and locoregional flap-based reconstruction is a priority.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"213-217"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147872497","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":"Rethinking Recovery: Beyond the 18-month Milestone in Nerve Transfer Surgery.","authors":"Hongdao Dong, Gursagar Jhanji, Orest Fylyma, Aneesh Karir, Tod A Clark, Jennifer L Giuffre","doi":"10.1097/SAP.0000000000004774","DOIUrl":"10.1097/SAP.0000000000004774","url":null,"abstract":"<p><strong>Purpose: </strong>Conventional dogma is that recovery following nerve transfer surgery plateaus ∼18 months post operation. This widely accepted notion has shaped patient counselling, patient expectations, and clinical follow-up protocols. This study aims to re-examine the long-term recovery beyond 18 months and present novel findings that challenge the conventional recovery timeline.</p><p><strong>Materials and methods: </strong>A retrospective review of adult patients who underwent nerve transfer surgery more than 5 years ago was conducted. Once identified, these patients were contacted to perform a telephone survey, a qualitative interview, and a clinical re-examination of the reinnervated muscles. Patient-reported outcomes were gathered using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and objective muscle strength was evaluated using the British Medical Research Council (BMRC) scale.</p><p><strong>Results: </strong>Thirty-one patients were identified for having undergone 37 nerve transfers longer than 5 years ago. The documented 18-month postoperation BMRC grade, 5 years ago, was an average of 3.3/5. Clinical re-examinations of 22 of these patients, a minimum of 5 years post nerve transfer, showed significant improvements in muscle strength, with the average BMRC grade to 4.4/5. Most patients (90.3%) experience continued functional recovery beyond 18 months. The average DASH score, more than 5 years following their nerve transfer, was 24.7, indicating an overall positive functional outcome. Notably, 87.1% of patients resumed work or preinjury activities.</p><p><strong>Conclusion: </strong>This study suggests that nerve recovery extends beyond the traditionally accepted 18-month timeframe, thereby highlighting the need to amend patient counselling and expectations and revise the follow-up and rehabilitation protocols to optimize long-term success following nerve transfer surgery.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"201-205"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925869","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":"Unilateral Versus Bilateral Fronto-Orbital Advancement in Non-Syndromic Unicoronal Craniosynostosis: A Systematic Review and Pooled Data Analysis.","authors":"Serhat Şibar, Halil Şafak Uygur, Pelin Kuzucu","doi":"10.1097/SAP.0000000000004805","DOIUrl":"10.1097/SAP.0000000000004805","url":null,"abstract":"<p><strong>Background: </strong>Nonsyndromic unicoronal craniosynostosis (NS-UCS) is characterized by asymmetric craniofacial deformity and remains one of the most challenging entities in craniofacial surgery. Fronto-orbital advancement (FOAR) may be performed either unilaterally or bilaterally, yet the optimal approach remains controversial. The present study aims to compare surgical outcomes, complication profiles, and long-term stability between unilateral and bilateral FOAR to clarify selection criteria for surgical technique.</p><p><strong>Methods: </strong>A systematic review was conducted using the PubMed, Web of Science, and Cochrane databases, following PRISMA guidelines. Studies involving nonsyndromic anterior plagiocephaly treated by unilateral or bilateral FOAR with ≥12 months of follow-up were included. Twenty studies encompassing 511 patients met the inclusion criteria. Data were pooled, and statistical analyses were performed using (IBM SPSS Statistics version 29.0; IBM Corp., Armonk, NY) and Python-based analytical tools.</p><p><strong>Results: </strong>Of the included patients, 315 (61.6%) underwent bilateral FOAR and 196 (38.4%) underwent unilateral FOAR. Contour deformity was significantly more frequent after unilateral FOAR (75.0% vs. 27.5%, P <0.05). Due to heterogeneous reporting across studies, postoperative strabismus outcomes could not be reliably compared using pooled analysis. Bilateral procedures required longer operative times (213 vs. 162 min, P <0.05), though no significant differences were found in overall complication rate, hospital stay, or relapse incidence between the 2 groups.</p><p><strong>Conclusion: </strong>Both unilateral and bilateral FOARs provide effective correction of craniofacial asymmetry in NS-UCS, but they differ in their complication profiles. Unilateral FOAR offers reduced surgical exposure and shorter operative duration but has a higher rate of contour irregularities. Bilateral FOAR achieves more comprehensive orbital and forehead correction, albeit with longer operative times and broader surgical exposure. These results suggest that the choice of technique should be guided by deformity severity, contralateral asymmetry, and surgeon experience. The analysis identifies critical data gaps in reporting relapse and revision rates, underscoring the need for prospective studies with standardized outcome measures to refine surgical algorithms for anterior plagiocephaly.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"166-175"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238391","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":"Microsurgery Applications in Nonplastic Surgery Specialties.","authors":"Barite Gutama, Ronald M Cornely, Emma J B Nordahl, Ayush Saha, Huseyin Karagoz, Galen Perdikis, Wesley Thayer, William Lineaweaver, Panambur L Bhandari, Feng Zhang","doi":"10.1097/SAP.0000000000004806","DOIUrl":"10.1097/SAP.0000000000004806","url":null,"abstract":"<p><p>Microsurgery, once the domain of plastic and reconstructive surgery, has seen widespread adoption across a broad range of nonplastic surgical specialties. Utilizing magnification and refined instrumentation, microsurgery enables precise manipulation of structures at the submillimeter level, improving outcomes in complex surgical procedures. This review highlights the expanding role of microsurgery in various nonplastic surgery specialties. We summarize key innovations, clinical outcomes, and emerging applications, while also addressing future directions in considerations to redefine microsurgery and the role of robotic microsurgery. The findings underscore the growing importance of microsurgical techniques in advancing modern surgical care across disciplines.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"190-196"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350398","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 Lateral Cutaneous Nerve of the Calf: An Underrecognized Source of Entrapment Neuropathy and Neuroma Pain.","authors":"Andreas Gohritz, A Lee Dellon, Dirk J Schaefer, Eric Williams","doi":"10.1097/SAP.0000000000004760","DOIUrl":"10.1097/SAP.0000000000004760","url":null,"abstract":"<p><p>The lateral cutaneous nerve of the calf (LCNC), a purely sensory branch of the common peroneal nerve, is frequently overlooked or misidentified in anatomic and clinical literature. Due to its small caliber, variable origin, and overlapping sensory distribution, the LCNC is often mistaken for the lateral sural nerve or disregarded as clinically insignificant. For patients with either misdiagnosed or undiagnosed pain in the lateral knee or calf, microsurgical decompression or nerve relocation of the LCNC can result in symptom improvement or complete resolution. The purpose of this paper is to underscore the importance of considering the LCNC in patients with posterolateral calf pain of unclear etiology.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"97 2","pages":"197-200"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418154","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":"Development and Deployment of an Explainable Machine Learning Model for Preoperative Prediction of Thigh Liposuction Volume in Female Patients.","authors":"Jiyang Li, Kaifang Hua, Yunpeng Gu, Xinyu Zhang, Guie Ma, Yue Qi, Bo Yin, Bo Chen, Qianwen Lv, Facheng Li, Xuefeng Han","doi":"10.1097/SAP.0000000000004758","DOIUrl":"10.1097/SAP.0000000000004758","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative estimation of liposuction volume is essential for achieving optimal aesthetic outcomes and minimizing surgical complications. However, conventional assessment methods are primarily subjective and rely heavily on the surgeon's experience, which may lead to inconsistent results.</p><p><strong>Objective: </strong>This study aimed to develop and externally validate a machine learning model to predict thigh liposuction volume in female patients using routine preoperative clinical and anthropometric data.</p><p><strong>Methods: </strong>A retrospective cohort of 518 female patients was analyzed, including 423 cases for model development and 95 for external validation. Eight key predictors were selected using the Boruta algorithm. A linear regression model with Elastic Net regularization was trained and compared with 5 other machine learning models. Model performance was evaluated by mean absolute error (MAE), root mean squared error (RMSE), mean absolute percentage error (MAPE), and Pearson correlation. Shapley Additive Explanations (SHAP) analysis was used for interpretability, and a web-based prediction tool was developed for clinical deployment.</p><p><strong>Results: </strong>The final model demonstrated strong predictive performance (external MAE=349.96 mL; r =0.93, P <0.001) and maintained accuracy across Body Mass Index (BMI) categories. SHAP analysis identified body fat rate, skinfold thickness, and thigh circumference as top predictors.</p><p><strong>Conclusions: </strong>This explainable and externally validated model enables individualized, data-driven prediction of liposuction volume, supporting safer and more precise surgical planning in clinical practice.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"118-127"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760386","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":"Incisional Ventral Hernia Repair in the Liver Transplant Population-Is Biological Mesh Worth the Risk?: A Single Surgeon Experience.","authors":"Cody C Fowler, Brielle E Raine, Callista Zaronias, Derek E Bell","doi":"10.1097/SAP.0000000000004751","DOIUrl":"10.1097/SAP.0000000000004751","url":null,"abstract":"<p><strong>Purpose: </strong>Ventral hernia repair (VHR) with mesh is the gold standard; however, the risks associated with mesh may have significant consequences for immunocompromised patients. This study seeks to evaluate outcomes of VHR in transplant recipients with and without biological mesh.</p><p><strong>Methods: </strong>A retrospective review of all VHRs for liver transplant recipients from 2016 to 2024 was conducted. Baseline characteristics, operative details, and postoperative outcomes were compared between patients undergoing VHR with and without biological mesh.</p><p><strong>Results: </strong>Thirty-six patients were included; 20 (55.6%) underwent repair without mesh and 16 (44.4%) with biological mesh. Hernia size was larger in the mesh cohort (11.3±5.5 vs. 7.8±4.2 cm, P =0.034). The majority underwent anterior component separation, 19.4% unilateral and 38.9% bilateral. Meshes used were Ovitex (50%), Strattice (37.5%), and FlexHD (12.5%). Placement was primarily retrorectus (50%) or intraperitoneal (37.5%). Length of stay was shorter without mesh (3.5 vs. 5 d, P =0.008). Follow-up trended toward longer in the mesh cohort. Complication rates were comparable with a trend toward fewer postoperative infections without mesh (5.0% vs. 25.0%, P =0.085). All mesh infections required reoperation, and 1 patient died from complications. Recurrence rates were comparable (no mesh 10.0% vs. mesh 12.5%, P =0.813).</p><p><strong>Conclusion: </strong>VHR can be safely performed without mesh in select liver transplant patients, reducing the likelihood of potentially life-threatening postoperative infections without a significant increase in recurrence rates.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"242-245"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643574","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":"Free-Style Zygomatico-Orbital Artery Propeller Perforator Flap.","authors":"Hai-Hua Huang, Ze-Yong Wu, Jin-Biao Zheng, Yu-Cang Shi, Qian-Qian Zhang, Xiu-Feng Chen, Sui-Jiang Wang","doi":"10.1097/SAP.0000000000004740","DOIUrl":"10.1097/SAP.0000000000004740","url":null,"abstract":"<p><strong>Background: </strong>Despite the limitations of existing perforator flap designs, detailed descriptions of the zygomatic-orbital artery (ZOA) and its perforators remain scarce. Consequently, their clinical applications have not been adequately explored.</p><p><strong>Methods: </strong>In our previous report, which provided an anatomic basis for understanding the ZOA and its anastomoses with surrounding arteries, we developed a distal ZOA perforator propeller flap. In this study, we expanded our focus to include all perforators, with applications extending beyond eyelid reconstruction. The propeller flap technique was used in 16 patients. The flap size ranged from 2.0×1.1 cm to 7.5×2.5 cm.</p><p><strong>Results: </strong>Complications included necrosis at the distal flap margin in one patient and minor congestion at the flap tip in another, both of which healed without surgical intervention. All the other flaps survived, and no signs of disease recurrence were noted during the follow-up period (mean: 17.4 mo). All patients reported satisfactory cosmetic and functional outcomes.</p><p><strong>Conclusion: </strong>This study revealed the feasibility of reconstructing lateral orbit and eyelid defects with a local freestyle ZOA perforator propeller flap. The flap's reliability, versatility, and superior aesthetic outcomes make it an attractive option for surgeons, while also protecting the ZOA and temporal branches of the facial nerve.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"160-165"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670067","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}