Annals of Plastic Surgery最新文献

{"title":"Therapeutic Effect of Wharton's Jelly-Derived Mesenchymal Stem Cells and Conditioned Medium in a Carbon Dioxide Laser Burn Model: An Experimental Study.","authors":"Erden Erkut Erkol, İlhami Çelik, Mehmet Ünal, Gülsemin Çiçek, Fatma Öz Bağcı, Zekeriya Tosun","doi":"10.1097/SAP.0000000000004343","DOIUrl":"10.1097/SAP.0000000000004343","url":null,"abstract":"<p><strong>Introduction: </strong>Current burn animal models have disadvantages, such as standardization issues. Many mesenchymal stem cell studies have been conducted on burn treatments; however, the efficacy of Wharton's jelly mesenchymal stem cells (WJ-MSCs) and the conditioned medium (CM) on partial- and full-thickness burns remains unclear. Therefore, we aimed to investigate the healing potential of WJ-MSCs and CM in treating partial- and full-thickness skin burns using a new carbon dioxide (CO2) laser model.</p><p><strong>Materials and methods: </strong>Sixty-two male Wistar rats (200-250 g) were used, with 56 rats divided into 4 groups based on treatment after laser application. Furthermore, to create varying degrees of skin burns, a fractional CO 2 laser (10.2 mJ, 10,600 nm) was applied to 6 rats for 15-120 s. A 60-s and 120-s laser application was performed on the back of each animal to create partial-thickness and full-thickness burns, respectively. WJ-MSCs, CM, and minimal essential media (MEM) were applied to partial- and full-thickness skin burns determined in a pilot study 24 h later. However, no treatment was administered to the SHAM group. Treatment efficacy was evaluated semi-quantitatively through macroscopic, histopathological, and immunohistochemical analyses and quantitatively through real-time quantitative reverse transcription polymerase chain reaction on days 7 and 14.</p><p><strong>Results: </strong>Macroscopic and histopathological analyses (epidermal thickness, dermal thickness, number of skin appendages, and collagen scoring) showed significant improvements in the CM, WJ-MSCs, and MEM groups compared with the controls. Immunohistochemical staining indicated increased levels of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) in the treated groups compared with those in the SHAM group. quantitative reverse transcription polymerase chain reaction revealed the upregulation of VEGF, VEGF receptor 1, FGF, and FGF receptor 1 in the CM and WJ-MSCs groups compared with that in the SHAM and MEM groups, highlighting their roles in angiogenesis and re-epithelialization.</p><p><strong>Conclusions: </strong>This study highlights the potential of WJ-MSCs and CM to enhance wound healing in CO 2 laser-induced partial and full-thickness skin burns. Additionally, a new noncontact CO 2 laser burn model that creates burns at varying degrees and is easy to standardize was developed.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"258-267"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511414","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":"Course Review: 50th Week of Exercise in Microsurgery.","authors":"Georgios Skepastianos, Chrysoula Palazi, Vasileios Skepastianos","doi":"10.1097/SAP.0000000000004432","DOIUrl":"10.1097/SAP.0000000000004432","url":null,"abstract":"<p><strong>Abstract: </strong>Microsurgery plays a vital role in plastic surgery and orthopedic training curricula. Despite the availability of various practical microsurgery courses, it is challenging to find one that strikes the right balance between hands-on practice and educational content to help participants gain confidence in microsurgical techniques.Introducing the Microsurgery Week Course, a 5-day program designed for plastic surgery and orthopedic trainees. This course aims to impart the principles of microsurgery through a combination of self-directed learning, informative lectures, and practical workshops with hands-on training. The course boasts an international faculty and attracts delegates from all around the world, making it a truly diverse experience. The location for this course is Ioannina, Greece, and the registration fee is set at 500 euros.In my review, I will thoroughly evaluate the Microsurgery Week Course, shedding light on its effectiveness, strengths, and any areas that might need improvement.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"245-246"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537854","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":"Sensory Restoration With Breast Reconstruction: Approaches, Managing Expectations, and Measuring Outcomes.","authors":"Benjamin L Savitz, Erin N Abbott, Val Lumani, Yomna E Dean, Wesley P Thayer, Stephane A Braun, Galen Perdikis","doi":"10.1097/SAP.0000000000004459","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004459","url":null,"abstract":"<p><strong>Background: </strong>Loss of breast sensation following mastectomy and reconstruction significantly impacts quality of life, influencing body image, intimacy, and overall emotional well-being. Despite advances in reconstructive techniques, sensory outcomes remain inconsistent, limiting broader clinical adoption of reinnervation strategies. This educational review synthesizes the current scope of sensory restoration in breast reconstruction, examining approaches to reinnervation, sensory outcome measures, and management of patient expectations.</p><p><strong>Methods: </strong>The existing literature on breast reconstruction was reviewed along with evidence on nerve repair more generally to evaluate current microsurgical techniques and identify research gaps. Data extracted included quantitative outcomes, such as Semmes-Weinstein monofilament testing and 2-point discrimination, as well as qualitative or patient-reported outcome measures like BREAST-Q or VMP-B scores. Statistical analyses were performed using R software version 4.4.1.</p><p><strong>Results: </strong>Innervated deep inferior epigastric perforator (DIEP) flaps and targeted nerve grafting serve as promising techniques, achieving improved tactile recovery in both objective and qualitative measures. However, variability in long-term recovery, the diminishing returns of meaningful recovery in longer nerve grafts (R2 = 0.986), and their impact on quality-of-life metrics remain underexplored. Moreover, the inconsistent sensory outcomes heighten the need for psychosocial support to manage patient expectations.</p><p><strong>Conclusions: </strong>Longitudinal studies emphasizing innovative grafting strategies and integration of emerging technologies including bioengineered nerve conduits and regenerative therapies offer exciting opportunities to enhance sensory recovery. Advancing sensory restoration in reconstructive breast surgery requires a patient-centered approach to inform surgical practice by aligning clinical enthusiasm with robust evidence, ensuring meaningful and rigorous improvements in functional and emotional outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S21-S28"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005851","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":"Lipofibromatous Hamartoma of the Median Nerve in a Child.","authors":"Mohd Mir Altaf, Jaya Jain, Manjit Kaur Rana, Arvinder Wander, Taruna Singh, Rahul Kaushik","doi":"10.1097/SAP.0000000000004375","DOIUrl":"10.1097/SAP.0000000000004375","url":null,"abstract":"<p><strong>Abstract: </strong>Lipofibromatous hamartoma (LFH) is characterized by the infiltration of mature adipose tissue and fibrous elements along the course of the median nerve, leading to gradual compression and distortion of the nerve fibers. In our case, the median nerve was involved in an LFH tumor in an 8-year-old male child. After a comprehensive clinical evaluation, radiological findings, and histopathological examination, the patient underwent resection of LFH with dissection and resection of the median nerve and its digital branches, followed by sural nerve cable grafting. The patient had a full functional recovery of hand in 8 months. Till now, only 3 cases of LFH have been reported in children below 10 years of age.Both the surgical team and the patient were satisfied with the postoperative outcome.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"297-300"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511413","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":"Infrared Thermography for Early Detection of Vascular Compromise in Microvascular and Pedicled Flap Reconstruction.","authors":"Siddharth Mayakuntla, Joseph Thomas, Harshavardhan Shetty, Neha Mookim, Carlsen Pereira, Tanvi Rao","doi":"10.1097/SAP.0000000000004462","DOIUrl":"10.1097/SAP.0000000000004462","url":null,"abstract":"<p><strong>Background: </strong>Early detection of vascular compromise is pivotal for successful microvascular flap reconstruction, as tissue necrosis can begin within 6 to 8 hours of circulatory impairment. Although conventional monitoring relies on subjective clinical assessment of color, temperature, and capillary refill-methods with inherent observer variability and diminished utility in patients with darker skin tones-emerging technologies offer potential for more objective evaluation. This study compared the efficacy of infrared thermography (IRT), a noninvasive modality that quantifies perfusion through precise temperature mapping, with traditional clinical methods for postoperative flap monitoring. Given that the critical salvage window is time-limited, with intervention, success rates declining precipitously after 8 hours of ischemia, establishing monitoring protocols with enhanced sensitivity and earlier detection capabilities could significantly improve free flap survival rates and reduce revision surgeries. The efficacy of IRT with conventional clinical methods is compared for post-operative flap monitoring for free and pedicled flaps.</p><p><strong>Methods: </strong>This prospective observational study enrolled 40 patients undergoing flap reconstruction between August 2023 and October 2024. Post-operative monitoring included IRT using a forward-looking infrared camera and conventional clinical assessments at standardized intervals. Detection time, sensitivity, specificity, and flap salvage rates were analyzed.</p><p><strong>Results: </strong>Nine of 40 flaps (22.5%) developed vascular compromise. IRT detected complications significantly earlier than clinical methods (34.8 vs 38.8 hours, P = 0.02). IRT demonstrated superior sensitivity (96%) and specificity (89%) compared with clinical assessment.</p><p><strong>Conclusion: </strong>IRT enables earlier detection of vascular compromise compared with conventional clinical methods, potentially improving flap salvage rates. Integration of IRT into standard monitoring protocols may enhance patient outcomes following microvascular and pedicled flap reconstruction.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S49-S54"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005857","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":"Compressive Neuropathy in the Upper Extremity: Pathophysiology, Diagnosis, and Treatment.","authors":"Ronald M Cornely, Akeem Henry, Jordan Johnson, Ricardo Torres-Guzman, Benjamin L Savitz, William Lineaweaver, Panambur L Bhandari, J Bradford Hill","doi":"10.1097/SAP.0000000000004415","DOIUrl":"10.1097/SAP.0000000000004415","url":null,"abstract":"<p><strong>Background: </strong>Compressive neuropathy in the upper extremity is a common and often debilitating condition that significantly impacts function and quality of life. Despite its prevalence, the diagnosis, and management of compressive neuropathies remain complex with promising innovations. Plastic surgeons play a critical role in both surgical and nonsurgical interventions for these conditions.</p><p><strong>Methods: </strong>This comprehensive review synthesizes current literature on the pathophysiology, diagnostic evaluation, and management strategies for upper extremity compressive neuropathies, including carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome. We explore the underlying mechanisms of nerve compression, key anatomical considerations, and advancements in diagnostic modalities, including electrodiagnostic studies, ultrasound, and magnetic resonance neurography.</p><p><strong>Diagnosis and management: </strong>A thorough clinical evaluation is critical in diagnosing compressive neuropathies, incorporating a detailed patient history, physical examination, and provocative maneuvers (ie, Tinel's sign, Phalen's maneuver, and the Durkan test) is essential to the workup. Electrodiagnostic studies, including electromyography and nerve conduction studies, remain first-line diagnostic tools, aiding in localization and severity assessment. Advanced imaging modalities, such as magnetic resonance neurography and diffusion tensor imaging, offer enhanced visualization of nerve pathology and may play an increasing role in diagnosis.Management strategies range from conservative interventions-including activity modification, splinting, nerve gliding exercises, and corticosteroid injections-to surgical decompression in cases of persistent symptoms or progressive functional decline. Emerging techniques, such as endoscopic decompression and ultrasound-guided carpal tunnel release, provide promising outcomes with reduced morbidity.</p><p><strong>Conclusions: </strong>Advancements in diagnostic and therapeutic approaches continue to improve outcomes for patients with upper extremity compressive neuropathies. Plastic surgeons remain integral to the multidisciplinary care of these conditions, particularly in complex cases requiring surgical intervention. Future research should focus on optimizing minimally invasive techniques and enhancing early diagnostic capabilities through novel imaging modalities and artificial intelligence applications.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S60-S67"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005833","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":"Operative Techniques in Mandibular Fracture Repair: A Cross-specialty Comparison of Plastic and Reconstructive Surgery, Otolaryngology, and Oral and Maxillofacial Surgery.","authors":"Julia Isber, Grayson P Hetherington, Armaan Dhanoa, Barite Gutama, Devra B Becker","doi":"10.1097/SAP.0000000000004473","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004473","url":null,"abstract":"<p><strong>Background: </strong>Mandibular fractures are the most common facial fractures treated in the emergency setting, with significant variability in operative management across surgical specialties. Plastic and reconstructive surgery (PRS), otolaryngology (ENT), and oral and maxillofacial surgery (OMFS) each approach mandibular fracture repair with different philosophies, particularly regarding tooth extraction within the fracture line. However, few studies directly compare these practices.</p><p><strong>Objective: </strong>This study assessed differences in operative techniques, specifically tooth extraction and fixation strategies, across PRS, ENT, and OMFS in the treatment of isolated mandibular fractures at a level 1 trauma center.</p><p><strong>Methods: </strong>Following institutional review board approval, a retrospective chart review was conducted at Regional One Health from May 2019 to May 2020. Ninety patients with isolated mandibular fractures were identified using relevant Current Procedural Terminology codes. Statistical analysis included χ2 and analysis of variance testing with significance set at P < 0.05.</p><p><strong>Results: </strong>Among 90 patients (80% male; mean age, 33 years), assault was the leading cause of injury. These cases were managed by 3 specialties: ENT (24 patients), PRS (24 patients), and OMFS (42 patients). All 3 specialties utilized MMF and ORIF with similar frequency. However, OMFS demonstrated significantly higher tooth extraction rates (50%) compared with ENT (8%) and PRS (4%) (P < 0.00005). ENT had the longest average time to surgery (9 days) compared with PRS (2 days) and OMFS (1 day). No significant differences were observed in reoperation rates, operative duration, or hospital stay among the specialties.</p><p><strong>Conclusions: </strong>Significant differences were identified in the frequency of surgical tooth extractions and time to operation for mandibular fracture repairs across different specialties. These differences may impact resource allocation and patient outcomes. Further research is needed to explore the origins of these variations and their long-term effects.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"95 3S Suppl 1","pages":"S2-S5"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005876","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":"Overcoming Challenges in Osmidrosis Surgery: Managing Fibrotic Bands and Preserving Skin Flaps.","authors":"Wen-Tsao Ho","doi":"10.1097/SAP.0000000000004373","DOIUrl":"10.1097/SAP.0000000000004373","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"340-341"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473834","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":"10.1097/SAP.0000000000004425","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"338-340"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","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":"Pretreatments of Ex Vivo Vascularized Composite Allografts: A Scoping Review.","authors":"Caroline E Baker, Thor S Stead, Dominika Pullmann, Alay R Shah, Sachin Chinta, David L Tran, Hilliard T Brydges, Matteo Laspro, Bruce E Gelb, Eduardo D Rodriguez, Piul S Rabbani","doi":"10.1097/SAP.0000000000004420","DOIUrl":"10.1097/SAP.0000000000004420","url":null,"abstract":"<p><strong>Purpose: </strong>The various physiological profiles comprising vascularized composite allografts (VCAs) pose unique challenges to preservation. Minimizing ischemia, reperfusion injury, and rejection remains a primary focus of graft pretreatments (PTs). Currently, the gold standard PT consists of flushing the graft and placing it in static cold storage in the University of Wisconsin solution. With this method, graft viability is limited to 4 to 6 hours. Prolonging this time limit will increase donor allocation radius, access to care, and positive patient outcomes. We aimed to evaluate novel PTs that could potentially enhance and lengthen VCA viability.</p><p><strong>Methods: </strong>Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, we conducted a comprehensive literature search of EMBASE, Cochrane, and PubMed. Studies had to be published prior to June 15, 2022. PTs had to target cell physiology, rather than immunogenicity. We extracted data including study design, PT details, evaluation metrics, and outcomes.</p><p><strong>Results: </strong>We identified 13 studies, categorized into 3 groups: solution-based alterations to the gold standard, ex vivo perfusion, and other novel techniques. The incorporation of hydrogen sulfide and Perfadex as solutions in the gold standard protocol demonstrated a 6-day delay in rejection and limited reperfusion injury markers, respectively. In an ex vivo perfusion study, after 24 hours of PT and 12 hours posttransplant, VCA muscle contractility remained close to normal. The gold standard PT did not demonstrate the same success. However, graft weight gain, up to 50% of baseline among the reviewed articles, is a prominent adverse effect of perfusion. Another technique, cryopreservation, displayed 90% graft failure by venous thrombosis, despite high free graft viability following 2 weeks of storage.</p><p><strong>Conclusions: </strong>This study of PT modalities found a variety of encouraging preservation techniques for grafts with high levels of tissue diversity. Ex vivo perfusion dominated PT innovation with promising results in preserving the viability and functionality of muscle, which is central to the restoration of movement. Future studies are necessary to evaluate long-term graft outcomes and to optimize PT protocols for extended preservation times to ensure clinical relevance.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"318-326"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324345","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}