Annals of Plastic Surgery最新文献

{"title":"Open Surgical Approach and Preoperative/Postoperative Patient Analyzes in Deep Posterior Nasal Septum Deviations With Spur Formation Associated With Nose-Related Facial Pain and Headache.","authors":"Dinçer Altınel","doi":"10.1097/SAP.0000000000004358","DOIUrl":"10.1097/SAP.0000000000004358","url":null,"abstract":"<p><strong>Abstract: </strong>Patients with septal deviation may present with several different complaints. While they may present with nose-specific complaints such as breathlessness, they may also present with complaints such as headache and facial pain. We selected the patients in our study from the cases whose clinical complaints were breathing problems and facial pain/headaches.In this study, we evaluated 65 septorhinoplasty patients between 2010-2022 with breathing problems due to deep posterior spur formations and facial pain/headaches. We used the visual analog scale to evaluate the severity of facial pain and headaches. Computerized tomography images were obtained to evaluate airway. On computerized tomography imaging data, the proximity of the spur formation to the nasal side wall structures in axial and coronal planes and the distances in the passage width after removal in the postoperative period were measured.As a result of the data we obtained, it was observed that spur formation, an osteophytic structure located in the posterior septum, caused serious breathing complaints accompanied by headache. We adopted the view that open septal intervention is more successful in reaching this deformity, which is mostly located in the posterior part of the septum, due to the difficulty in surgical accessibility and our goal of obtaining effective surgical results.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"17-23"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109526","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 Diversity in Residency Program Selection: Insights From Applicants to Integrated Plastic Surgery Programs.","authors":"Mia D Do, Jeremiah M Taylor, Thais Calderon, Abra H Shen, Jeffrey B Friedrich","doi":"10.1097/SAP.0000000000004363","DOIUrl":"10.1097/SAP.0000000000004363","url":null,"abstract":"<p><strong>Background: </strong>Prior research has identified criteria valued by residency applicants when assembling their rank lists. However, with the composition of medical trainees continuously diversifying, there has been greater emphasis on creating a physician cohort reflective of the general US census. This study aimed to evaluate if faculty/resident diversity has a similar influence as established program features on residency program selection for current applicants applying to plastic surgery residency.</p><p><strong>Methods: </strong>A survey was administered to candidates of our institution's integrated plastic surgery residency program for the 2022-2023 and 2023-2024 application cycles to gather demographic data and rate the most impactful factors influencing rank list decisions. This was done using a Likert scale to rank program characteristics from 1 (not important) to 5 (extremely important).</p><p><strong>Results: </strong>Our survey response rate was 27% (180/673). Female and underrepresented in medicine (URiM) applicants ranked the presence of URiM faculty within a program ( P = 0.002, P = 0.022), URiM faculty in administrative positions ( P = 0.005, P = 0.012), residents identifying as the same race/ethnicity ( P = 0.001, P < 0.001), and program participation in diversity, equity, and inclusion initiatives ( P = 0.001, P = 0.003) as more important than their male and White counterparts.</p><p><strong>Conclusions: </strong>Although quality of life and perceived fit are universal priorities, female and URiM applicants placed higher importance on diverse faculty, resident representation, and program initiatives related to diversity, equity, and inclusion. These results suggest residency programs may appeal to more applicants by considering these factors in their future recruitment strategies.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"e31-e35"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101054","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":"Comparative Outcome Study of Gynecomastia Surgery and Gender-Affirming Mastectomy With 100% Nipple Preservation.","authors":"Eric Swanson","doi":"10.1097/SAP.0000000000004308","DOIUrl":"10.1097/SAP.0000000000004308","url":null,"abstract":"<p><strong>Background: </strong>Gynecomastia and gender-affirming top surgery share similarities in objectives. Traditionally, a subcutaneous mastectomy using a semicircular incision has been recommended for most gynecomastia patients. In recent years, mastectomies and nipple grafting have become the most popular treatment for gender-affirming top surgery. Nipple grafting is very debilitating to this unique body part, which also provides erogenous sensation. This study was undertaken to compare methods, complications, and outcomes using an approach that preserves nipples in 100% of patients.</p><p><strong>Methods: </strong>A retrospective study was conducted, comparing all gynecomastia patients and gender-affirming top surgery patients treated by the author over the period 2016-2024. Most (92%) gynecomastia patients were treated with liposuction in combination with a semicircular incision and subcutaneous mastectomy. Twelve top surgery patients (71%) were also treated with this method. Two gynecomastia patients and 5 top surgery patients with pendulous breasts underwent vertical mammaplasties incorporating a medial pedicle. A telephone survey was also administered.</p><p><strong>Results: </strong>Fifty-three patients were evaluated, including 36 gynecomastia patients and 17 top surgery patients. The complication rate was 21%. Three patients (6%) developed hematomas. Five patients (9%) underwent revisions. No patient experienced complications of the nipple/areola complex. All surveyed patients reported that nipple preservation was important. Two patients (11%) reported reduced nipple sensation after surgery. No patient reported scar dissatisfaction. Fifteen patients (83%) were comfortable exposing their chest after surgery, compared with 1 patient (6%) before surgery.</p><p><strong>Discussion: </strong>Today, a major disparity exists in treatment recommendations, with almost all gynecomastia patients being offered nipple-preserving methods and the majority of top surgery patients undergoing mastectomies with nipple grafting, or even without grafting. In view of the importance of nipple sensation, and the success of an alternative approach, surgical priorities should be realigned to preserve nipple/areola complexes.</p><p><strong>Conclusions: </strong>Nipple preservation is offered to all patients. Subcutaneous mastectomies are often sufficient, and limit scarring. Vertical mammaplasties with a medial pedicle are effective in patients with pendulous breasts. Liposuction is offered as a second-stage procedure, although many patients are satisfied with some residual breast fullness. The need for secondary surgery of the nipple/areola complex and scar revisions is minimized.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"e1-e17"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447727","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":"Pedicled and Free Flap Lower Extremity Reconstruction in Acute Burn Injuries.","authors":"Mario Alessandri Bonetti, Tiffany Jeong, Hilary Y Liu, Jose Antonio Arellano, Sumaarg Pandya, Guy M Stofman, Francesco M Egro","doi":"10.1097/SAP.0000000000004344","DOIUrl":"10.1097/SAP.0000000000004344","url":null,"abstract":"<p><strong>Background: </strong>A paucity of studies investigates the outcomes of flap reconstruction in lower extremity acute burns. The aim of this study is to report outcomes of lower extremity acute burn requiring pedicled or free flap coverage.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to compare the outcomes of patients undergone pedicled versus free flap reconstruction of acute lower extremity burns, between August 2010 and December 2022. Collected data included demographics, injury and flap characteristics, complications, and reoperations. χ 2 tests were used to measure differences in complication rates between pedicled and free flaps.</p><p><strong>Results: </strong>A total of 28 patients were involved in the study. Among them, 17 patients underwent 28 pedicled flap procedures, while 11 patients received a single free flap surgery each. In the free flap group, the overall complication rate was 54.5%. In the pedicled flap group, the overall complication rate was 25.0%. Free flaps showed a significantly higher rate of total flap loss compared to pedicled flaps (18.2% vs 0%, P = 0.021). Other differences were not statistically significant.</p><p><strong>Conclusions: </strong>Flap coverage in lower extremity acute burns is rarely employed. Yet, in case of critical structures exposure it is often necessary. However, it is important to be aware of the high risk of complications, especially for more complex reconstructions requiring free tissue transfer.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"46-50"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974929","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 University of Chicago Burn Fellowship.","authors":"Dallan P Dargan","doi":"10.1097/SAP.0000000000004347","DOIUrl":"10.1097/SAP.0000000000004347","url":null,"abstract":"<p><strong>Abstract: </strong>The burn fellowship at the University of Chicago Medicine Center is a comprehensive 12-month experience in burn care, encompassing acute and reconstructive surgery, burn resuscitation, laser, critical care, and academia. the burn center performs over 300 operations for burn care per year and treats adults and children with a dedicated 8-bed burn intensive care unit and excellent multidisciplinary team. The fellowship includes an opportunity to spend up to two months in the surgical intensive care unit. Regular outpatient burn clinics allow for follow-up and review of outcomes during the fellowship. The educational content of the burn fellowship is structured and is verified by the American Burn Association.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"13-16"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965709","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":"Professional Development for Early-Career Plastic Surgeons: A Snapshot of Opportunities for Involvement in Societies and Organizations.","authors":"Aniekanabasi I Ufot, Emily E Zona, Armin Edalatpour, Jacqueline S Israel","doi":"10.1097/SAP.0000000000004401","DOIUrl":"10.1097/SAP.0000000000004401","url":null,"abstract":"<p><strong>Background: </strong>Professional development is relevant to physicians at all stages of one's career, including early in practice. Specialty society membership offers opportunities for personal and professional growth and collaboration in many realms, including clinical practice, education, research and leadership. For early-career plastic surgeons, engagement in professional societies can facilitate career development as young surgeons navigate decision making and challenges at the start of their practices. The purpose of this article is to provide information regarding opportunities for early-career involvement and growth in professional societies related to plastic surgery.</p><p><strong>Methods: </strong>We sought to collate a single resource for early-career plastic surgeons as they hone their \"brand\" and seek additional engagement with their field. After web-based searches and seeking expert opinion from a variety of plastic surgeons, we generated a list of professional organizations and relevant opportunities.</p><p><strong>Results: </strong>For each professional organization, we created tables with programs and corresponding descriptions in the categories of leadership development, mentorship, research, and financial awards and scholarships. We identified dozens of opportunities for early-career plastic surgeons, from leadership committees to advocacy groups to grant funding.</p><p><strong>Conclusions: </strong>Regardless of practice type, given the many advantages of pursuing opportunities within and supported by professional societies, we advocate for engagement of early-career plastic surgeons in these organizations.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"e18-e30"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155914","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: Breast Implant Pocket Irrigation, Capsular Contracture, and Simplifying Treatment.","authors":"Eric Swanson","doi":"10.1097/SAP.0000000000004425","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004425","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332364","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":"Comparing 90-Day Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Direct-to-Implant or Autologous Reconstructions.","authors":"Kathryn E Royse, Tina M Smith, Cissy M Tan, Eric Y Lin, Robert G Neumann, Jessica E Harris, Elizabeth W Paxton, Winnie Tong","doi":"10.1097/SAP.0000000000004421","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004421","url":null,"abstract":"<p><strong>Background: </strong>In recent years, breast reconstruction following mastectomy has gained popularity. This study aimed to compare short-term unplanned return to the operating room (OR) for women undergoing breast reconstruction after mastectomy for malignancy by reconstruction timing, delayed compared to immediate (IBR). Subcategories of direct-to-implant and primarily autologous reconstruction were analyzed.</p><p><strong>Methods: </strong>Data from an integrated electronic medical record system identified patients undergoing breast reconstruction after mastectomy at Kaiser Permanente facilities between 2010-2022. Reconstruction timing was the exposure of interest, with stratification based on reconstructive techniques including tissue expander followed by either implant or autologous reconstruction, direct-to-implant, or primarily autologous reconstruction. Univariable and multivariable logistic regression models assessed the association between reconstruction timing and 90-day reoperations in direct-to-implant or primarily autologous reconstruction, using delayed reconstruction as the reference.</p><p><strong>Results: </strong>A total of 23,272 cases were identified (immediate = 18,248, delayed = 5025). The IBR patients exhibited higher odds of reoperations [odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.65-2.33, P < 0.0001] compared to delayed reconstruction after covariate adjustment. Among patients with expanders, IBR increased reoperation odds (OR = 1.83, 95% CI = 1.43-2.33, P < 0.0001). Immediate direct-to-implant reconstruction had the highest reoperation odds (OR = 5.55, 95% CI = 2.08-4.67, P = 0.039). No significant differences were observed between immediate and delayed approaches in autologous reconstruction, regardless of whether it was conducted in a single- or 2-stage process.</p><p><strong>Conclusions: </strong>Immediate reconstruction, involving expanders or direct-to-implant reconstructions, showed increased 90-day reoperation risks compared to delayed reconstruction. Conversely, no significant differences were identified between IBR and delayed reconstruction with autologous reconstruction conducted in a single- or 2-stage process.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324340","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":"Characterizing the Industry Payments Received by Plastic Surgeons at the American Association of Plastic Surgeons 2022 Meeting.","authors":"Ariel J Harsinay, Zachary Tamweber, Katherine Kozlowski, Eric Shuren, Jordan Frey","doi":"10.1097/SAP.0000000000004417","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004417","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the financial relationships held by attendees of the American Association of Plastic Surgery (AAPS) conference in 2022 utilizing the Center for Medicare and Medicaid Services (CMS) Open Payments database.</p><p><strong>Methods: </strong>Plastic surgeons practicing in the United States who were listed in the AAPS 2022 program were included in the study. Internet searches were used to obtain demographic information for each participant, including sex, region, fellowship training, years of practice, and practice setting. Industry payments for the year 2022 were collected. Statistical analyses were completed in SPSS.</p><p><strong>Results: </strong>A total of $11,107,403.13 was received in general payments by the 390 plastic surgeons included in this study, with the 10 highest paid physicians encompassing 84% of these total payments. A total of 120 companies provided payments to included physicians. Surgical Innovation Associates, Inc., was responsible for 71.6% of payments made. Over 50% of plastic surgeons included in the AAPS program received payments from the second highest paying company, Allergan Inc. Males with 16-20 years of practice received the greatest industry payments; practice setting, fellowship training, and R1 institution affiliation were not reliable predictors of industry payments.</p><p><strong>Conclusions: </strong>The average plastic surgeon who contributed to the 2022 AAPS program earned significantly more in industry payments compared to the average plastic surgeon nationwide, warranting concerns that conference content may be influenced by the financial relationships held by these speakers.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324339","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":"Pectoralis Major Flaps for Sternal Reconstruction: Multidisciplinary Considerations and Patient Outcomes.","authors":"David Chi, Rachel Skladman, Reme E Arhewoh, Sarah N Chiang, Linh Vuong, Ryan J Sachar, Muhammad F Masood, Ida K Fox","doi":"10.1097/SAP.0000000000004409","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004409","url":null,"abstract":"<p><strong>Background: </strong>Sternal wounds following cardiothoracic surgery are a challenging surgical problem, and pectoralis muscle flaps are a mainstay for reconstruction. Multiple variations of this strategy exist, and this study seeks to characterize key decision factors and patient outcomes to increase accessibility of this technique to surgeons.</p><p><strong>Materials and methods: </strong>This is a retrospective cohort study of adult sternal wound patients at a tertiary referral center between 2010-2020. Patient demographics, comorbidities, wound characteristics, and perioperative data were collected. Multinomial logistic regression determined factors significantly associated with reconstructive technique. Binomial logistic regression was used to analyze 90-day readmission and reoperation for sternal wounds.</p><p><strong>Results: </strong>In total, 114 patients underwent reconstruction with pectoralis flaps. Bilateral advancement flaps were the most common strategy (64%) followed by bilateral advancement/turnover (15%), unilateral advancement (11%), unilateral turnover (8%), and bilateral turnover (2%). The absence of the internal mammary artery was significantly associated with bilateral vs unilateral pectoralis flap reconstruction (P < 0.01). Deep space sternal wounds were most likely to be treated with a turnover flap component (P < 0.001). Type of flap reconstruction was associated with sternal wound recurrence (P < 0.03). However, multivariable logistic regression modeling identified coronary artery disease [odds ratio (OR) = 8.18, P < 0.02], prior cardiothoracic surgeries (OR = 2.95, P < 0.01), and discharge before plastic surgery consultation (OR = 3.73, P < 0.04) as significant predictors of 90-day readmission or reoperations for sternal wound recurrence.</p><p><strong>Conclusions: </strong>Multiple configurations of the pectoralis major can be utilized for treating sternal wounds. The absence of the internal mammary artery is an important factor given its association with bilateral flap reconstruction, while the turnover pectoralis is more frequently used for deep space wounds. Internal mammary artery patency should be clearly communicated to improve multidisciplinary management of these challenging problems.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324344","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}