Annals of Plastic Surgery最新文献

{"title":"Neuromas and Persistent Postoperative Pain Following Total Knee Arthroplasty.","authors":"Rachana Suresh, Anirudh Buddhiraju, Visakha Suresh, A Lee Dellon, Vishal Hegde, Sami H Tuffaha, Ala Elhelali","doi":"10.1097/SAP.0000000000004426","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004426","url":null,"abstract":"<p><strong>Purpose: </strong>Persistent postoperative knee pain after primary total knee arthroplasty (TKA) is often an indication for revision surgery and has a multifactorial etiology. Periarticular neuromas of nerves innervating the joint, ligaments, or overlying skin are important but misdiagnosed causes of persistent knee pain following knee surgery. This study aimed to characterize the incidence and sequelae of peripheral neuromas in TKA patients.</p><p><strong>Methods: </strong>We utilized the TriNetX research network to identify TKA patients experiencing persistent knee pain lasting more than 3 months between 2016-2024, excluding cases with acute postoperative pain and implant-related causes, and identified patients diagnosed with neuromas. We then compared the rate of revision between patients with persistent knee pain with confirmed neuroma diagnoses and those without, and evaluated the utilization of surgical and nonsurgical interventions.</p><p><strong>Results: </strong>Of 446,969 primary TKA patients, 111,533 (25.0%) experienced persistent pain, of whom 5785 (5.2%) were diagnosed with neuromas. Among those diagnosed, 19% received a diagnosis within 1 year of TKA, 25.8% between one and 3 years, and 55.2% after 3 years. Revision rates were similar in both groups (0.5% vs 0.5%). While 10.5% of neuroma patients received an intervention, only 3.6% underwent definitive surgical intervention.</p><p><strong>Conclusions: </strong>One-fourth of TKA patients have persistent knee pain not associated with joint or implant-related factors, yet only around 5% are definitively diagnosed with a neuroma, suggesting potential underdiagnosis. The high risk of nerve injury during standard TKA incisions should warrant a high index of suspicion for neuromas in patients with refractory persistent knee pain.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537855","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":"An Indocyanine Green Light for Cross-Leg Free Flap Division: Presentation of the Technique and Review of Literature.","authors":"Can Ege Yalcin, Ece Davutluoglu, Levent Demir, Mehmet Demir, Berrak Karatan, Hakan Arslan","doi":"10.1097/SAP.0000000000004438","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004438","url":null,"abstract":"<p><strong>Background: </strong>Cross-leg free flaps (CLFFs) and cross-leg cable bridge flaps (CLCBFs) are essential techniques in reconstructive surgery for complex lower limb defects when local options or suitable recipient vessels are unavailable. Although the surgical approaches are well established, standardized protocols for flap division, ischemic preconditioning, and perfusion assessment are lacking.</p><p><strong>Methods: </strong>This study presents a systematic review of the literature on CLFFs and CLCBFs, focusing on division timing, conditioning methods, and perfusion evaluation. A total of 38 studies involving 319 patients were identified through PubMed and EuroPMC searches in March 2025. Additionally, we present a case of a 23-year-old man with a 25 × 15-cm tibial defect reconstructed using a cross-leg latissimus dorsi free flap, where indocyanine green (ICG) angiography was employed to assess perfusion prior to flap division.</p><p><strong>Results: </strong>Pedicle division was most commonly performed between 3 and 6 weeks postoperatively. Ischemic preconditioning-typically through intermittent clamping-was reported in 54% of studies. Among studies that described perfusion assessment, 75% used clinical pedicle clamping, whereas 25% utilized ICG angiography. Our case demonstrated the successful application of ICG imaging to confirm neovascularization and enable safe, early flap division without complications.</p><p><strong>Conclusion: </strong>CLFF and CLCBF techniques are effective for limb salvage but require individualized postoperative protocols. Ischemic preconditioning and objective perfusion assessment, particularly using ICG angiography, may support earlier and safer flap division, minimizing patient morbidity and hospital stay.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537842","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":"A Retrospective Review: Treatment of Congenital Muscular Torticollis.","authors":"Brian Macias Martinez, John Stella, Marla C Fortoul, Chaimae Oualid, Jason Kim, George Kamel","doi":"10.1097/SAP.0000000000004436","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004436","url":null,"abstract":"<p><strong>Background: </strong>Congenital muscular torticollis (CMT) is characterized by unilateral contraction of the sternocleidomastoid muscle, which causes head tilting and rotation. Treatment follows a stepwise approach, in which physical therapy (PT) serves as the first-line intervention, followed by botulinum toxin (Botox) injections for nonresponders and surgical lengthening of the sternocleidomastoid muscle in refractory cases. This study aims to evaluate the effectiveness of a stepwise treatment approach for CMT by assessing resolution rates following PT, Botox injections, and surgery.</p><p><strong>Methods: </strong>A retrospective review was conducted on 109 patients diagnosed with CMT and treated at the Atlantic Center of Aesthetic and Reconstructive Surgery between 2016 and 2021. Data on patient demographics, onset of torticollis, treatment interventions, and resolution rates were collected. Statistical analysis assessed differences in treatment outcomes and timing of intervention.</p><p><strong>Results: </strong>All patients initially underwent PT, and 71% (n = 77) achieved resolution. Botox injections were administered to nonresponders to PT (29%, n = 32), resulting in successful treatment in 56% (n = 18) of cases. Patients who were unresponsive to Botox (13%, n = 14) required surgical intervention. Earlier treatment initiation was significantly associated with improved outcomes (P < 0.00001). No major complications were reported with Botox or surgery. The average follow-up duration was the longest in the surgery group (27.2 months).</p><p><strong>Conclusions: </strong>This study highlights the role of each treatment within a progressive management strategy for CMT. Both Botox and surgery are safe and effective options for cases that do not respond to PT, with surgery reserved for most refractory cases. These findings reinforce the importance of early intervention for optimizing patient outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537840","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":"https://doi.org/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":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","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":"Is Plastic Surgery Resident Learning and Assessment Consistent? A Comparison of American Society of Plastic Surgery Educational Network Topics, In-Service Examinations, and Residency Core Curriculums.","authors":"Daniel Najafali, Farrah C Liu, Thomas M Johnstone, Shannon Choi, Paige M Fox","doi":"10.1097/SAP.0000000000004433","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004433","url":null,"abstract":"<p><strong>Introduction: </strong>The Plastic Surgery In-Service Examination (PSISE) objectively compares plastic and reconstructive surgery (PRS) residents' knowledge, while the ASPS' Education Network (EdNet) is a \"gold standard,\" which programs use to design their curricula. This study aims to quantify the degree to which critical PRS learning modalities align. We also sought to understand the rationale behind how program leadership designed PRS residency core curricula.</p><p><strong>Methods: </strong>Questions from ASPS EdNet resident courses and 2018 to 2022 PSISEs were tabulated and assigned to EdNet topics. Then, curricula from 15 PRS residencies were assigned to EdNet topics. Topic alignment between curricula, PSISEs, and EdNet courses was tested with Pearson's χ2 and Fisher's exact tests. Program directors (PDs) and associate program directors (APDs) from PRS residencies were surveyed and/or interviewed regarding their PRS residency core curricula design.</p><p><strong>Results: </strong>A total of 2038 questions corresponding to 102 topics were queried from EdNet. A total of 1170 PSISE questions and 910 curricula lectures were assigned to these topics. Program curricula taught 30 topics at significantly different frequencies than those taught by EdNet. The past 5 PSISEs tested 28 topics at significantly different frequencies than those taught by EdNet.</p><p><strong>Conclusions: </strong>One-third of gold-standard EdNet topics are taught and tested at significantly different frequencies. Comparison of these teaching tools shows that progress can be made to further align PRS educational modalities to improve resident learning and assessment.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473830","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":"Quality and Readability of Online Rhinoplasty Information: A Systematic Review and Meta-analysis.","authors":"Antoinette T Nguyen, Rena A Li, Robert D Galiano","doi":"10.1097/SAP.0000000000004441","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004441","url":null,"abstract":"<p><strong>Background: </strong>Patients increasingly rely on online resources for rhinoplasty education, yet the readability and reliability of these materials remain inconsistent. This systematic review and meta-analysis evaluated the quality and accessibility of online rhinoplasty-related patient education materials using DISCERN scores for reliability and Flesch-Kincaid Grade Level for readability.</p><p><strong>Methods: </strong>A systematic search identified 12 studies analyzing 882 websites and 259 videos. Meta-analyses were conducted using random-effects models. Subgroup analyses and meta-regression explored differences in information quality by source type and publication year.</p><p><strong>Results: </strong>The pooled mean DISCERN score across 5 studies (n = 197) was 42.96 (95% confidence interval: 36.28-49.63), indicating moderate quality. Heterogeneity was high (I2 = 93.8%, Q = 80.43, P < 0.0001), reflecting inconsistencies in study methodologies and content sources. Academic websites trended toward higher quality (mean DISCERN: 43.36) than private websites (36.40), but the difference was not statistically significant (P = 0.05906). Readability analysis (n = 95) showed a pooled Flesch-Kincaid Grade Level of 10.31 (95% confidence interval: 10.26-10.37), well above the recommended 6th-8th grade level. Heterogeneity was minimal (I2 = 0.0%, Q = 0.84, P = 0.3597), suggesting consistently excessive readability demands. No significant improvements in information quality were observed over time (pre-2020 DISCERN: 42.04 vs post-2020: 43.81; P = 0.8272).</p><p><strong>Conclusions: </strong>Online rhinoplasty materials remain difficult to read and of suboptimal quality, with no meaningful improvements over time. Standardized, accessible, and high-quality patient education resources are needed to support informed decision making.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537857","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":"Evaluating Authorship Guidelines of Top Medical Schools and Plastic Surgery Journals: A Comparative Analysis.","authors":"Nicholas A Mirsky, Sara E Munkwitz, Wrood M Kassira, Pawan Pathagamage, Paulo G Coelho, Seth R Thaller","doi":"10.1097/SAP.0000000000004435","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004435","url":null,"abstract":"<p><strong>Background: </strong>Authorship in research is crucial for academic recognition and accountability; however, there remain discrepancies throughout institutions regarding authorship inclusion. This review aimed to evaluate the similarities, variations and distinct approaches to authorship criteria. We intend to focus on how guidelines address issues like honorary authorship, authorship order, and the resolution of disagreements.</p><p><strong>Methods: </strong>Authorship criteria from the top 10 NIH-funded medical schools and the top 10 plastic surgery journals as defined by their Journal Citation Reports (JCR) quartiles were collected from August 30, 2024, to September 5, 2024.</p><p><strong>Results: </strong>Our findings revealed significant differences in authorship policies, with medical schools generally providing more comprehensive and educational approaches compared to journals. While most organizations referenced International Committee of Medical Journal Editors criteria, there was variability in addressing key issues such as ghost and honorary authorship, authorship order determination, and the use of AI in research. Medical schools more frequently defined and prohibited ghost and honorary authorships, offered guidance on authorship order, and provided mechanisms for dispute resolution. Notably, guidelines regarding AI usage in research were largely absent or ambiguous across all organizations.</p><p><strong>Conclusions: </strong>This study highlights the need for greater standardization and clarity in authorship guidelines, particularly in light of emerging challenges posed by AI and increasingly collaborative research environments. Implementing standardized contribution declaration systems, such as CRediT, could enhance transparency and fairness in authorship attribution. As research practices continue to evolve, regular reassessment and updating of authorship guidelines will be crucial to maintain the integrity of scientific publication in academic medicine.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473827","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: The Case for Nipple Preservation Over Grafts in Gynecomastia Surgery.","authors":"Eric Swanson","doi":"10.1097/SAP.0000000000004412","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004412","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":"144473829","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":""},"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":"Lymphatic Regeneration Visualized on Magnetic Resonance Imaging After Placement of Aligned Nanofibrillar Collagen Scaffolds for Treatment of Lymphedema.","authors":"Alison S Bae, Andreas Markus Loening, Kassandra Carrion, Victoria Posternak, Hui He, Stanley P Leong, Dung H Nguyen","doi":"10.1097/SAP.0000000000004429","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004429","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lymphatic regeneration has been shown after placement of aligned nanofibrillar collagen scaffolds (BioBridge) in animal models and humans with multiple imaging modalities including indocyanine green lymphography, histology, and computed tomography. The aim of our study is to demonstrate new lymphatic regeneration visualized on magnetic resonance imaging (MRI) after aligned nanofibrillar collagen scaffold placement.</p><p><strong>Methods: </strong>We retrospectively studied patients with extremity lymphedema who underwent placement of BioBridge. Additionally, most of these patients had lymphaticovenous bypass, vascularized lymph node transfer, or liposuction. MR lymphangiogram was performed at least a year postoperatively.</p><p><strong>Results: </strong>The postoperative MRI images demonstrate new lymphatic collectors in both upper and lower extremities where aligned nanofibrillar collagen scaffolds were implanted from sites of lymphaticovenous bypass or vascularized lymph node transfer in the distal limb to proximal lymph node basins in the groin or axilla. Additionally, new lymphatic collectors are visualized between left and right lymph node basins in the groin or supraclavicular region when aligned nanofibrillar collagen scaffolds were placed from the effected extremity to the contralateral lymph node basin.</p><p><strong>Conclusions: </strong>For these patients, lymphatic regeneration along with decrease in limb volume suggests that Aligned nanofibrillar collagen scaffold placement generates functional lymphatic collectors that improve lymphedema.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473833","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}