Annals of Plastic Surgery最新文献

{"title":"Ganglion Cyst in Zone 2 of Guyon's Canal Causing Ulnar Neuropathy With Claw Hand Deformity: A Case Report and Literature Review.","authors":"Liang-Jui Chiang, Shyh-Jou Shieh","doi":"10.1097/SAP.0000000000004199","DOIUrl":"10.1097/SAP.0000000000004199","url":null,"abstract":"<p><strong>Abstract: </strong>Guyon's canal, a fibro-osseous anatomical tunnel, sometimes harbors underlying pathologies such as a ganglion cyst, leading to symptoms including dysesthesia, paresthesia, and motor weakness in the ulnar nerve distribution. Surgical excision is often the recommended approach to restore normal hand function. Ulnar nerve palsy caused by mechanical compression can benefit from surgical decompression; however, a timely diagnosis is often difficult. In this report, we describe the successful tumor excision and nerve decompression of a ganglion cyst in Guyon's canal. The observed intraoperative findings challenge the conventional classification of compression zones. The processes of diagnosing and treating tumors within Guyon's canal were thoroughly explained and elaborated. A 40-year-old female patient presented with right-sided ulnar wrist pain, progressive weakness of the intrinsic muscles, and a claw hand deformity, typically suggestive of a zone 1 compression within Guyon's canal. Magnetic resonance imaging revealed a cystic mass at the ulnar side of the wrist, prompting a referral to the Department of Plastic and Reconstructive Surgery for further management. Intraoperatively, a transparent cystic tumor was identified in zone 2 of the Guyon's canal, causing significant compression of the motor branch, while displacing the superficial branch upward, which mimicked the clinical presentation of zone 1 compression. The tumor was excised, and the nerve was successfully decompressed. A pathological report confirmed the diagnosis of a ganglion cyst. At the 1-year follow-up, the patient showed no signs of complications or recurrence. Her initial symptoms, including pain and intrinsic muscle weakness, improved significantly. Complete resolution of claw hand deformity indicated successful functional recovery. Compression of the ulnar nerve within Guyon's canal due to a ganglion cyst is uncommon, and the significance of the resulting neuropathy in the wrist is underrated. Meticulous clinical assessments, a thorough anatomical understanding and appropriate tests, are essential for accurate diagnosis. Timely decompression and surgical removal of the ganglion can facilitate a promising postoperative recovery.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S90-S94"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490405","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":"Heart Rate Variability Subsequent to Auriculotherapy Among Individuals Afflicted by Major Burn Scars.","authors":"Cha-Chun Chen, San-Pei Chen, Chung-Hua Hsu","doi":"10.1097/SAP.0000000000004193","DOIUrl":"10.1097/SAP.0000000000004193","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Auriculotherapy is commonly used to reduce and alleviate discomfort in patients who suffer pain, itchiness, sleep disturbances, or heightened anxiety; these symptoms of discomfort are known to be influenced by the autonomic nervous system. Patients with extensive burns may experience more serious symptoms such as pain, itching, and sleep disturbances after the wound has healed. Auriculotherapy is suitable for patients affected by significant burn scars, who often encounter severe symptoms of discomfort. The administration of auriculotherapy as an adjuvant therapy has been demonstrated to potentially mitigate the clinical manifestations of these symptoms in individuals with major burn scarring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To address the lack of up-to-date data on the effects of auriculotherapy on the autonomic nervous system, we performed an analysis of parameters of heart rate variability (HRV) to evaluate the function of the autonomic system before and after administration of auriculotherapy in patients who had experienced significant burns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Paired-samples t tests and linear regression analysis were used to compare HRV parameters and explore the correlations between these parameters and the total burn scar area before and after auriculotherapy in a cohort of 39 survivors of the 2016 Formosa Color Dust Explosion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant changes in specific HRV parameters, including standard deviation of RR interval (SD), total power, and high-frequency power, were observed before and after auriculotherapy, and a significant negative correlation was detected between the total burn scar area and the total activity of autonomic activity (ANS) was noted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;With auriculotherapy, we could find significant increases in the data SD and total power, both of them standing for total activity of the autonomic system. In addition, increase on the parameter high-frequency power, which stands for the activity of parasympathetic system, is more significant. In this study, significance with the activity of sympathetic system is not significant. Auriculotherapy in this study could stimulate the acupoints related to parasympathetic system may explain this scene because the goal of this treatment is to relieve clinical burn scar disorders and insomnia. Negative correlation between burn surface and pre-SD could tell us that after the more server the burn injury may bring more changes in the autonomic activity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Many researches about HRV show that even if it is variable and may researches are ongoing, it could reflect the psychological and physiological status in patients after major trauma. In our study, major burn, even in scar condition, could change the autonomic activity. With auriculotherapy by stimulation on parasympathetic system more, it may increase the equilibrium and activity of the autonomic nervous","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S63-S68"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Intraoperative Somatosensory Evoked Potential Monitoring for Resection of Brachial Plexus Schwannomas: A Pilot Study.","authors":"Wen-Teng Yao, Hsiu-Han Hsu, Muh-Lii Liang, Hsuan-Yu Huang, Amy Hsuan-Chih Lao, Chia-Meng Yu, Kwang-Yi Tung, Hsuen-Li Chen, Shan-Chiao Yang, Chih-Peng Tu, Ming-Feng Tsai","doi":"10.1097/SAP.0000000000004204","DOIUrl":"10.1097/SAP.0000000000004204","url":null,"abstract":"<p><strong>Objectives: </strong>The complex anatomical location of brachial plexus tumors is a formidable diagnostic and therapeutic challenge for surgeons. Intraoperative neurophysiologic monitoring enables the surgeon to proceed with more aggressive maneuvers for near total removal of the spinal cord tumor, such as somatosensory evoked potentials (SSEPs) monitoring. The present study aimed to describe the SSEP-assisted microsurgical excision technique and to evaluate the surgical outcomes of brachial plexus schwannomas.</p><p><strong>Methods: </strong>Thirteen patients who underwent SSEP-guided microsurgery for brachial plexus schwannomas between October 2011 and December 2020 were included in our study.</p><p><strong>Results: </strong>The mean age of the patients was 50 years (range, 29-64 years), with six tumors localized on the right, six on the left side and one on bilateral sides. Eight patients had preoperative motor/sensory dysfunction. Compared to preoperative Visual Analogue Scale (VAS) pain score, the postoperative VAS score significantly decreased in these patients (P = 0.005). No postoperative neurovascular injury was observed in the patients. Among patients who had a preoperative neurologic deficit, these preoperative neurologic deficits were relieved or improved after surgery. There was a low disability in the arm, shoulder, and hand after surgery.</p><p><strong>Conclusions: </strong>Brachial plexus schwannomas is able to completely excised by SSEP-assisted delicately surgical techniques, contributing to a surgical benefit for the excision of brachial plexus schwannomas, particularly in patients with lower trunk involvement.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S52-S57"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490394","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":"Patient-Reported Outcomes and Aesthetic Evaluations in Autologous Breast Reconstruction at Taipei Veterans General Hospital.","authors":"Qi-Rui Cheng, Chin-Jung Feng, Fu-Yin Hsiao, Ling-Ming Tseng, Chi-Cheng Huang, Yi-Fang Tsai, Yen-Shu Lin, Shyh-Jen Wang, Wen-Chan Yu, Cherng-Kang Perng","doi":"10.1097/SAP.0000000000004201","DOIUrl":"10.1097/SAP.0000000000004201","url":null,"abstract":"<p><strong>Background: </strong>Improving the quality of life increases patients' expectations of postmastectomy breast reconstruction. Increased incidence of breast implant-associated anaplastic large cell lymphoma encourages patients to choose autologous breast reconstruction over implantation. This study aimed to analyze the aesthetic outcomes of autologous breast reconstruction and define factors associated with the results.</p><p><strong>Methods: </strong>We recruited patients for immediate or delayed autologous tissue reconstruction after mastectomy from October 2015 to June 2021 at a single institute in Taiwan. Patient demographic data, operative complications, and secondary cosmetic revisions were identified through a medical chart review. Patient-reported outcomes (PROs) and perioperative imaging records were analyzed using the BREAST-Q questionnaire and Breast Cancer Conservation Treatment (BCCT).core, respectively, for aesthetic outcome evaluations.</p><p><strong>Results: </strong>Eighty-three women were enrolled, with a 73% BREAST-Q questionnaire response rate, and followed-up for a mean 36 (6-78) months. The mean BREAST-Q score for satisfaction with breasts was 60.46 (standard deviation = 19.09). The postoperative BCCT.core evaluation did not differ significantly from the preoperative evaluation (P = 0.245), and most patients (70.59%) reported similar (50%) or better results (20.59%) after reconstruction. Postmastectomy radiotherapy impacted negatively on psychosocial well-being (P = 0.012), sexual well-being (P = 0.002), and satisfaction with breast (P = 0.026). Three-dimensional breast molds might improve psychosocial well-being BREAST-Q scores, sexual well-being, and breast satisfaction but was not statistically significant.</p><p><strong>Conclusions: </strong>Breast reconstruction with autologous tissue had an acceptable complication rate and favorable aesthetic outcomes in PROs and BCCT.core. Postmastectomy radiotherapy resulted in worse PROs and a 3-dimensional breast mold may facilitate better outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S44-S51"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490412","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":"Potential of a Genicular Artery Perforator Keystone Flap for the Reconstruction of Defects in the Knee to the Upper Third of the Leg.","authors":"Ching-En Chen","doi":"10.1097/SAP.0000000000004188","DOIUrl":"10.1097/SAP.0000000000004188","url":null,"abstract":"<p><strong>Introduction: </strong>The reconstruction of defects in the area extending from the knee to the upper third of the leg is challenging due to the intricate anatomy and limited local tissue options in this area. The genicular artery perforator keystone (GAP-K) flap is a promising solution for such reconstructions. In this study, the feasibility and outcomes of GAP-K flap use in the reconstruction of defects in the knee to upper third of the leg were assessed.</p><p><strong>Materials and methods: </strong>Data on patients who underwent GAP-K flap reconstruction of defects in the knee to upper third of the leg in a single department between June 2021 and May 2023 were reviewed retrospectively. Patients' demographic characteristics, diagnoses, defect size, complications, and functional outcomes were analyzed.</p><p><strong>Results: </strong>The sample comprised seven patients with a mean age of 44.9 years. Four GAP-K flaps were harvested from the medial aspect, and the remainder was harvested from the lateral aspect. Three flaps were type IIa, three were omega variants, and one was a Sydney Melanoma Unit variant. Mild wound dehiscence requiring management occurred in one patient. At 6 months postoperatively, the average range of motion of the affected knees was 126.7°, the average revised Musculoskeletal Tumor Society Rating Scale score was 25.5, and the average Eastern Cooperative Oncology Group performance status rating was 0.83.</p><p><strong>Conclusions: </strong>The GAP-K flap shows promise as a viable option for the reconstruction of defects in the knee to upper third of the leg. It provides reliable tissue coverage and satisfactory aesthetic outcomes. Further research with larger samples is warranted to confirm these findings and refine related surgical techniques.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S38-S43"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490414","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":"Utilization of Computer-Assisted Navigation Technology Within Craniomaxillofacial Fracture Surgery: A Systematic Review.","authors":"Jenna Thuman, Erika Andrade, Rebecca Brantley, Fernando A Herrera, Isis Raulino Scomacao","doi":"10.1097/SAP.0000000000004156","DOIUrl":"10.1097/SAP.0000000000004156","url":null,"abstract":"<p><strong>Background: </strong>Use of intraoperative computer-assisted navigation (iCAN) has been well-established in otolaryngology and neurosurgery; however, its use in surgical management of facial fractures is yet to be reported on a large scale. This study aimed to review the existing literature to determine the outcomes, limitations, risks, and benefits of iCAN use in facial fracture management.</p><p><strong>Methods: </strong>A systematic review of iCAN use in craniomaxillofacial fracture surgery was performed by 2 authors in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted on 3 databases, PubMed, Cochrane Library, and Embase, using the search terms \"navigation,\" \"intraoperative,\" and \"brain lab\" in combination with \"facial fractures\" or \"facial reconstruction.\" Study type, demographics, fracture characteristics, surgery characteristics, iCAN devices, intraoperative fracture fixation accuracy, postoperative outcomes, complications, navigation limitations, and risks and benefits were analyzed.</p><p><strong>Results: </strong>There were 909 studies identified in the initial search, of which 42 were chosen for final use. iCAN use was most commonly reported in unilateral (57.1%) and complex (50%) facial fracture cases. Surgical accuracy ranged from 0.7 to 4 mm and postoperative discrepancy ranged from 0.05 to 8 mm. Benefits included improved intraoperative surgical accuracy (95.2%), improved postoperative surgical discrepancy (52.4%), and decreased total surgical time (35.7%). Limitations reported with iCAN device use included operative technical difficulties (23.8%) and persistent systematic errors during device registration (21.4%). None of the studies discussed cost analysis or risks compared to conventional fixation methods.</p><p><strong>Conclusions: </strong>Advancements in and increasing familiarity with iCAN technology have preliminarily shown favorable surgical outcomes in facial fracture fixation, which include improved operative accuracy and discrepancy and decreased surgical time.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"384-395"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613604","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":"Refinements in Gender-Affirming Feminizing Chest Surgery.","authors":"Puja Jagasia, Westby R Briggs, Sriya Nemani, Bachar Chaya, Salam Kassis, Patrick Assi","doi":"10.1097/SAP.0000000000004154","DOIUrl":"10.1097/SAP.0000000000004154","url":null,"abstract":"<p><strong>Background: </strong>Feminizing top surgery, or mammaplasty augmentation, has multiple variables that surgeons can adjust to work synergistically with patient anatomy including plane of implant placement, pocket size, and inframammary fold (IMF) location. In the gender diverse population receiving this procedure to reduce symptoms of gender dysphoria, surgeons should be aware of differing anatomy and surgical approaches for feminizing top surgery.</p><p><strong>Methods: </strong>A retrospective chart review was conducted using our institution's electronic health record between December 2019 and May 2023 with a minimum follow up period of 12 months. Inclusion criteria included transgender women, nonbinary patients, and all patients who did not identify as cis-gender women and who underwent feminizing top surgery. Demographic data including age, race, ethnicity, and gender were collected. Complication rates were recorded for hematoma, infection, seroma, wound dehiscence, hypertrophic scar, minor contour abnormalities, implant asymmetry, and revision surgery.</p><p><strong>Results: </strong>Our surgeons' subfascial approach, which uses 2 equations to calculate dissection pocket dimensions and determine placement of pocket and incision based on desired implant base diameter and projection, was performed on 140 gender-diverse patients and resulted in a hematoma rate of 4.29%, an infection rate of 2.86%, and a seroma rate of 1.42% with good cosmetic outcomes, as evidenced by our low rates of minor contour abnormalities (5.71%) and implant asymmetry (1.43%). Only 5 patients (3.57%) required revision surgery.</p><p><strong>Conclusions: </strong>Bilateral breast augmentation with round implants in a subfascial plane using a concealed IMF incision following equations to determine the dissection pocket size and new IMF position and incision position is a reproducible technique that results in good aesthetic outcomes and minimizes complications.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"277-280"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613623","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":"Factors Affecting Patient Outcomes of Abdominoplasty After Bariatric Surgery: A Retrospective Cohort Study.","authors":"William West, Mehdi Rizk, Nicholas Alford, Monica Khadka, Salvatore Docimo, Joseph Sujka, Rahul Mhaskar, Christopher DuCoin","doi":"10.1097/SAP.0000000000004217","DOIUrl":"10.1097/SAP.0000000000004217","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications in body contouring surgery have been linked to several factors, including body mass index, diabetes, cardiovascular disease, and skin resection weight. Prior weight loss by surgical means is another predisposing factor for postoperative complications following body contouring. This study aims to examine these previously identified variables, and several others, in the context of a spectrum of abdominal body contouring techniques following bariatric surgery. Our goal is to highlight that current evidence supports the notion that the prior history of bariatric surgery does not significantly impact body contouring surgery's success and its associated complications.</p><p><strong>Methods: </strong>A retrospective cohort study including all consecutive patients (N = 198) who underwent abdominal body contouring between January 2011 and January 2022 following bariatric surgery was performed. Data collected included patient demographics, medical history, perioperative variables, and postoperative outcomes. Univariate and multivariate statistical analysis was performed.</p><p><strong>Results: </strong>Sixty-four (32%) patients developed a postoperative complication. In the univariate analysis, patients who developed a postoperative complication were more likely to have a mental health disorder (63% vs 44%, P = 0.015) and to have undergone abdominal surgery other than panniculectomy ( P = 0.002). They also had significantly longer median operative time (160 minutes, σ = 68.9, vs 140 minutes, σ = 72.3, P = 0.037) and longer follow-up time (99 days, σ = 471.1 vs 23 days, σ = 430.5, P < 0.001). In a multivariate logistic regression model including diabetes, hypertension, abdominoplasty type, operative time, skin excision weight, and concurrent body contouring procedure, the only significant factor in complication rate was the type of abdominal body contouring. Specifically, the traditional (odds ratio: 2.72, 95% confidence interval: 1.25-5.93) and vertical abdominoplasty (odds ratio: 5.50, 95% confidence interval: 1.17 to 25.87) techniques were more likely to lead to complications compared with panniculectomy abdominoplasty, respectively.</p><p><strong>Conclusions: </strong>Previously cited risk factors such as diabetes, body mass index, and skin resection weight did not increase the chance of complications. Panniculectomy appears to be a safer option for those with a history of bariatric surgery.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"273-276"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021892","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":"Comparison of the Effect of Delay Phenomenon and Quercetin Application on the Viability of Dorsal Skin Island Flaps in Rats: An Experimental Study.","authors":"Kübra Bi, Murat Livaoğlu","doi":"10.1097/SAP.0000000000004172","DOIUrl":"10.1097/SAP.0000000000004172","url":null,"abstract":"<p><strong>Background: </strong>Surgical delay is any surgical intervention performed 7-14 days before flap elevation, separating part of flap from its vascular bed and aiming to decrease flap necrosis. However, delay surgery needs to be planned and performed as a separate surgical operation. Quercetin is a flavonoid with anti-inflammatory, and vasodilator effects. This study compares the effects of quercetin and surgical delay on flap survival.</p><p><strong>Materials and methods: </strong>The study included 32 male Wistar rats divided into four groups: control group (group 1), surgical delay group (group 2), quercetin group (group 3), and both surgical delay and quercetin group (group 4). All dorsal skin island flaps were elevated based on deep circumflex iliac artery and 7 days were selected as waiting period after flap elevation, 50 mg/kg (0.5 mL) intraperitoneal quercetin administration period, and surgical delay period. Macroscopically flap necrosis rates were calculated and histopathological examination was performed to evaluate number of vessels, vessel lumen diameters, inflammation, epidermal damage, and dermal fibrosis scores. All rats were euthanized.</p><p><strong>Results: </strong>Flap necrosis rates, inflammation, epidermal damage, and dermal fibrosis scores of group 3 and 4 were found to be lower than group 1 and 2 ( P < 0.05). Vascular lumen diameter of group 2, 3, and 4 were found to be higher than group 1 ( P < 0.05) but no statistically significant difference was found for this parameter between group 2, 3, and 4 ( P > 0.05). The number of vessels were found to be higher in group 2, group 3, and group 4 compared with group 1, but this difference was not to be found statistically significant ( P = 0.534).</p><p><strong>Conclusions: </strong>This study shows that quercetin application is more effective in reducing flap necrosis rates and anti-inflammatory effect than surgical delay and also has superior effect in terms of vasodilation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"357-364"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799257","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 Rule of Fours-Clinical and Radiographic Parameters for Trans-articular Distal Interphalangeal Joint Kirschner Wire Insertion.","authors":"Conor Honeywill, Vanessa Giddins, Harrison Faulkner, Richard Lawson, David Graham, Brahman Shankar Sivakumar","doi":"10.1097/SAP.0000000000004157","DOIUrl":"10.1097/SAP.0000000000004157","url":null,"abstract":"<p><strong>Background: </strong>Distal phalangeal and interphalangeal joint injuries are common, and confer a significant burden to the individual, healthcare system and society. Operative intervention (when required) may involve retrograde trans-articular Kirschner wire (K-wire) fixation. Safe wire passage through the center of the distal interphalangeal joint (DIPJ) and associated phalanges is key in maintaining alignment and reducing complications. There is little evidence to guide optimal wire entry point and passage.</p><p><strong>Purpose: </strong>The aim of this study was to determine soft tissue and radiographic landmarks to guide optimal trans-articular k-wire placement at the DIPJ.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a single institute, with 100 uninjured lateral phalangeal radiographs with a clear sagittal projection assessed by 3 independent assessors. Each assessor drew a line of ideal insertion, traversing the isthmus of the middle and distal phalanges, and the midline of the DIPJ, with soft tissue and bony parameters identified.</p><p><strong>Results: </strong>The mean distance from the dorsal aspect of the nail plate to the line of ideal insertion was 3.86 mm, with a disparity between sexes noted. The distance from the dorsum of the soft tissue to the line of ideal insertion was expressed as a proportion of the total soft tissue diameter-the line of ideal insertion traversed approximately 40% of total width at the DIPJ and DIPJ soft tissue crease.</p><p><strong>Discussion: </strong>The results suggest that a simple 'rule of fours' can be utilized to allow expedient and optimal passage. The entry point should be midline in the coronal plane, approximately 4 mm volar to the dorsal surface of the nail plate and aimed at a point 40% volar to the dorsal aspect of the soft tissue envelope at the level of the DIPJ crease. These guidelines are easily replicable and conveyable; additionally, they can guide insertion in the absence of fluoroscopy.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"293-295"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765823","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}