Annals of Plastic Surgery最新文献

{"title":"A Comparison of Thermal Imaging to Doppler in Perforator Vessel Identification.","authors":"Nikitha Potturi, Stephanie H Carpentier, Mark E Feldmann","doi":"10.1097/SAP.0000000000004390","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004390","url":null,"abstract":"<p><strong>Background: </strong>Precise identification of perforators is necessary for perforator flap planning and success. Various localizing modalities are currently utilized. Doppler is the perioperative modality of choice but can be time consuming and operator dependent. Thermal imaging is an affordable, easy-to-use technology that produces a color image based on surface temperature. This study aims to compare the proficiency and speed of thermal imaging to Doppler in perforator identification.</p><p><strong>Methods: </strong>Twenty-one participants (42 thighs) were studied. A circle with a 5-cm radius at the midpoint between theanterior superior iliac spine and lateral patella was marked. Two investigators independently utilized either Doppler or thermal imaging to identify perforators within the marked territory. Thermal hotspots were marked first with invisible UV ink to blind the other investigator, who then scanned the same territory with Doppler. Concordance was determined if respective perforator markings between modalities aligned within 1 cm. After first pass, any nonconcordant thermal hotspots were rescanned with Doppler. Initial time taken and number of perforators found at first pass, first-pass concordance, and overall concordance after Doppler rescan were recorded.</p><p><strong>Results: </strong>At first pass, average time to identify perforators using Doppler was 3.57 minutes and 1.06 minutes using thermal imaging (P < 0.001). Among 42 ALT flap territories, 143 perforators were identified by Doppler and 142 by thermal imaging on initial scan, from which there was 72.5% initial concordance between modalities. Of the 39 nonconcordant thermal hotspots on first pass, an additional 29 then had a Doppler signal confirmed on rescan, resulting in an overall concordance of 93%.</p><p><strong>Conclusions: </strong>When used as an adjunct for flap planning, thermal imaging allows more efficient perforator identification by more quickly scanning a cutaneous territory and unmasking perforators missed by handheld Doppler alone.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S568-S571"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207424","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":"Early Results of Optimized Nerve Management With Electrical Stimulation for Lower Extremity Neuroma.","authors":"Jesse Chou, Janice Choi, Minton T Cooper, Joseph S Park, A Bobby Chhabra, Brent R DeGeorge","doi":"10.1097/SAP.0000000000004380","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004380","url":null,"abstract":"<p><strong>Background: </strong>Nerve injury is the most common complication following foot and ankle surgery, with painful neuroma reported in up to 10% of procedures. Current treatment often yields varying degrees of pain relief. Electrical stimulation (ES) through peripheral neuromodulation is an emerging technology associated with improvement in nerverelated pain and acceleration of neural regeneration. This study assessed the short-term outcomes of combining nerve reconstruction techniques with ES in providing early pain relief for patients with symptomatic lower extremity neuromas.</p><p><strong>Methods: </strong>We describe a single-institution, prospective, cohort study including adult patients with lower extremity neuroma subjected to a nerve management procedure (neurolysis, targeted muscle reinnervation, or nerve allograft reconstruction) with concomitant peripheral nerve stimulator placement. Patients were treated postoperatively with ES (phase duration: 100 μs, pulse rate: 80 Hz) for 4 hours daily. Patient demographics, surgical details, and outcomes data were evaluated.</p><p><strong>Results: </strong>Eight female patients (mean age: 49 ± 13 years) were included. Peripheral nerve injuries were identified at the following locations: sural nerve (n = 5), medial plantar nerve (n = 1), tibial nerve (n = 1), superficial peroneal nerve (n = 2), and saphenous nerve (n = 1). Mean Brief Resilience Scale (BRS) was 3.11 ± 0.61. At 3 months postintervention, NRS Pain scores decreased from a mean of 8.5 ± 1.2 to 1.5 ± 1.2, PROMIS Pain Interference scores decreased from 61.5 ± 3.4 to 53.7 ± 4.9, and PROMIS Pain Behavior scores decreased from 65.8 ± 3.5 to 56.1 ± 4.2.</p><p><strong>Conclusion: </strong>Early results of optimized neurotherapy with electrical stimulation demonstrate improved short-term pain relief for patients with symptomatic lower extremity neuromas.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S497-S501"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207473","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":"Nonsurgical Aesthetic Treatment Conversion to Surgery: Implications for Patient Selection and Practice Modeling.","authors":"Mario S Blondin, Jaimie L Bryan, Gayle S Wiesemann, David T Kerekes, Jonathan Dang, Bruce A Mast","doi":"10.1097/SAP.0000000000004386","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004386","url":null,"abstract":"<p><strong>Background: </strong>Nonsurgical treatments for facial aging have become a mainstay in plastic surgery practices. Two practice models exist, one in which the plastic surgeon provides both the nonsurgical and surgical treatments and the other in which an advanced practice provider (APP) performs the nonsurgical treatment.</p><p><strong>Objectives: </strong>This study aims to provide objective data on the practice model in which APPs provide nonsurgical treatments.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients treated with either botulinum toxin or dermal fillers at our division between 2015 and 2021. Patients who had cosmetic surgery at our institution before nonsurgical treatments were excluded.</p><p><strong>Results: </strong>Of the 737 patients included, 39 underwent surgical treatment, for an overall conversion rate of 5.3%. Patients with a history of prior cosmetic surgery had a higher conversion rate than those without (12.5% vs 4.1%, P < 0.0004). Patients undergoing surgical treatment were more likely to have had prior aesthetic surgery (P < 0.0004), received fillers (P < 0.0009), and were older at the time of the first filler visit (P < 0.0098). The most common surgical procedures were facelifts and liposuction.</p><p><strong>Conclusions: </strong>Due to the low conversion to surgical procedures, the results of this study support the practice model in which APPs perform the chemodenervation and dermal filler treatment. Additionally, patients who are older and are treated with fillers are more likely to have surgical procedures, indicating a potential provider focus on treatment counseling and optimization of outcomes. These findings also indicate that nonsurgical aesthetic treatments remain a mainstay in the plastic surgery practice.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S493-S496"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207479","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":"Extended Anterolateral Thigh Flaps: Maximum Size for Covering Cancerous Defects.","authors":"Kiichi Furuse, Daisuke Kageyama, Masaki Arikawa, Satoshi Akazawa, Takuya Higashino","doi":"10.1097/SAP.0000000000004330","DOIUrl":"10.1097/SAP.0000000000004330","url":null,"abstract":"<p><strong>Background: </strong>The anterolateral thigh perforator flap is frequently used for massive soft-tissue defect reconstruction. Cadaver perfusion examinations of isolated anterolateral thigh flaps have suggested a maximum skin area that may be vascularized based on the perforating vessels (ie, 250 cm 2 ). Therefore, this study aimed to evaluate a series of consecutive cases involving use of extended anterolateral thigh flaps for oncologic reconstruction of massive soft-tissue defects. To our knowledge, this is the largest study of extended anterolateral thigh flaps at a single center.</p><p><strong>Methods: </strong>Patients who underwent transfers of anterolateral thigh flaps exceeding 250 cm 2 at our institution between April 2018 and December 2022 were retrospectively identified. The operative data and results were analyzed.</p><p><strong>Results: </strong>Thirty-eight flaps in 36 cases were included. The 38 flaps consisted of 31 free flaps and 7 pedicled flaps. The average skin paddle size was 363 ± 101 cm 2 (range, 250-660 cm 2 ). The donor site was primarily closed in 7 flaps. The remaining 31 flaps required skin grafting to ensure donor-site closure. Neither total nor partial flap loss was observed. Four patients had wound dehiscence due to tightness. Three patients had surgical-site infections. Two patients had seromas. The postoperative courses of the 5 patients were complicated by partial skin graft loss at the donor sites.</p><p><strong>Conclusions: </strong>The anterolateral thigh flap is versatile and reliable for the treatment of massive oncological defects. Even flaps much larger than 250 cm 2 can usually be harvested safely based on 2 to 4 perforators without special techniques, such as compound flaps or additional vessel anastomoses.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"670-675"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623292","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":"Explantation With Concomitant Autologous Augmentation Mammoplasty Utilizing De-epithelialized Intercostal Perforator Flaps.","authors":"Maxine S Garcia, Jennifer Ross-Comptis, Logan Bassoff, Yoav Barnavon","doi":"10.1097/SAP.0000000000004399","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004399","url":null,"abstract":"<p><strong>Purpose: </strong>Women undergo breast explantation surgery for a variety of reasons. Some do not want to have reaugmentation with implants. Autologous augmentation mammoplasty with de-epithelialized intercostal perforator (IP) flaps have shown improved long-term breast shape. However, previous breast augmentation may disrupt the circulation to IP flaps and increase the risk of postoperative complications. We have developed a technique incorporating medial, anterior, and lateral IPs to create reliable IP flaps in patients undergoing concomitant explantation.</p><p><strong>Methods: </strong>We retrospectively reviewed our database between January 2016 and January 2024. All patients who underwent simultaneous explantation and autologous augmentation mammoplasty were identified. Outcomes were tabulated, and photometric analysis was performed.</p><p><strong>Results: </strong>Thirty-six patients underwent explantation of 69 breasts with concomitant IP flaps. Thirteen patients had simultaneous or subsequent fat grafting, 2 patients had concomitant reduction mammoplasty, and the majority had some form of mesh fixation. None of the patients had any major complications. Review of preoperative and postoperative photographs and photometric analysis showed visible and statistically significant lasting improvement in breast shape.</p><p><strong>Conclusion: </strong>Breast explantation with concomitant autologous augmentation mammoplasty utilizing de-epithelialized IP flaps can be done safely with long-lasting improvements in breast shape and proportions.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S517-S521"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207474","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":"Basics of Wrist Arthroscopy: A Step-by-Step Guide for the Plastic Surgeon.","authors":"Kristen L Stephens, Shane H Stephens, Colby Newson, Ava G Chappell, Brent R DeGeorge","doi":"10.1097/SAP.0000000000004389","DOIUrl":"10.1097/SAP.0000000000004389","url":null,"abstract":"<p><strong>Abstract: </strong>Wrist arthroscopy is an essential tool in the diagnosis and treatment of a wide range of wrist pathologies, offering a minimally invasive alternative to traditional surgical approaches. This article aims to serve as a comprehensive guide for the plastic surgeon providing an overview of the indications, contraindications, relevant anatomy, and procedural techniques, including portal creation, diagnostic evaluation, and arthroscopic instrumentation. Emphasis is placed on the identification of critical structures of the radiocarpal and midcarpal joints, optimizing visualization techniques, and addressing complications. By adopting systematic approaches and adhering to best practices, surgeons can achieve improved outcomes and expand their capabilities in managing complex wrist conditions.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S584-S588"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207428","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 Assessment of External Nasal Valve Efficiency After Le Fort I Surgery: Erratum.","authors":"","doi":"10.1097/SAP.0000000000004140","DOIUrl":"10.1097/SAP.0000000000004140","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"706"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456584","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 Letter to the Editor in Response to \"Resection Weight Formulas for Reduction Mammoplasty: A Systematic Review and Regression Analysis\".","authors":"Alexander F Dagi, Jarrod T Bogue","doi":"10.1097/SAP.0000000000004352","DOIUrl":"10.1097/SAP.0000000000004352","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6","pages":"702-703"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967536","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":"Safety of Combined Deep Inferior Epigastric Artery Perforator Flaps and Gynecologic Procedures.","authors":"Kristen L Stephens, Robert G DeVito, Chris A Campbell, John T Stranix","doi":"10.1097/SAP.0000000000004388","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004388","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary breast cancer treatment is essential. For some patients, risk-reducing gynecologic procedures are a necessary addition. The deep inferior epigastric artery perforator (DIEP) flap for autologous breast reconstruction shares a common abdominal surgical site with open gynecological procedures, but the impact of concurrent surgery remains to be seen.</p><p><strong>Methods: </strong>A retrospective chart review of all patients undergoing DIEP flap breast reconstruction with and without gynecologic procedures at our institution from 2017 to 2022 was performed.</p><p><strong>Results: </strong>Patients undergoing combined DIEP flaps and gynecologic procedures were younger (44.6 vs 51.9, P = 0.0066) and more likely to undergo bilateral (88.2% vs 44.3%, P = 0.0004) and prophylactic (35.3% vs 9.7%, P = 0.0013) mastectomies. Concurrent surgery was associated with longer operating time (500 vs 401 minutes, P = 0.0039), greater estimated blood loss (299.1 vs 150.8 cc, P < 0.000001), but unchanged length of stay (2.59 vs 2.81 days, P = 0.51) and opioid usage (115.2 vs 122.2 morphine milligram equivalent, P = 0.80). There were increased rates of hernia and bulge in the combined procedure cohort (17.6% vs. 5.5%, P = 0.0464). Rates of flap loss, infection, and wounds were similar between the 2 cohorts. Total cost increased ($33,700 vs $28,416, P = 0.0231) but cost margin was unchanged.</p><p><strong>Conclusions: </strong>Combining DIEP flap and gynecologic procedures is safe and well tolerated without differences in flap loss, length of stay, opioid use, or cost margins. However, operative time and postoperative hernia/bulge rates are higher. Plastic surgeons must be vigilant with patient selection and with abdominal wall preservation when considering combining abdominally based autologous breast reconstruction and gynecologic procedures.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S534-S538"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207492","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":"Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface for Myoelectric Prosthesis Control: The State of Evidence.","authors":"Benjamin L Savitz, Yomna E Dean, Nikolas K Popa, Ronald M Cornely, Victor Byers, Barite W Gutama, Erin N Abbott, Ricardo Torres-Guzman, Noah Alter, Justin D Stehr, J Bradford Hill, Shady Elmaraghi","doi":"10.1097/SAP.0000000000004273","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004273","url":null,"abstract":"<p><strong>Abstract: </strong>Prosthetic rehabilitation after amputation poses significant challenges, often due to functional limitations, residual limb pain (RLP), and phantom limb pain (PLP). These issues not only affect physical health but also mental well-being and quality of life. In this review, we describe targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) and explore their clinical role in the evolution of myoelectric prosthetic control as well as postamputation pain and neuroma management. Early myoelectric prostheses, which detected electrical potentials from muscles to control prosthetic limbs, faced limitations such as inconsistent signal acquisition and complex control modes. Novel microsurgical techniques at the turn of the century such as TMR and RPNI significantly advanced myoelectric prosthetic control. TMR involves reinnervating denervated muscles with residual nerves to create electromyography (EMG) potentials and prevent painful neuromas. Similarly, RPNI relies on small muscle grafts to amplify EMG signals and distinguish from stochastic noise for refined prosthetic control. Techniques like TMR and RPNI not only improved prosthetic function, but also significantly reduced postamputation pain, making them critical in improving amputees' quality of life. Modern myoelectric prostheses evolved with advancements in microprocessor and sensor technologies, enhancing their functionality and user experience. Today, researchers have developed more intuitive and reliable prosthetic control by utilizing pattern recognition software and machine learning algorithms that may supersede reliance on surgically amplifying EMG signals. Future developments in brain-computer interfaces and machine learning hold promise for even greater advancements in prosthetic technology, emphasizing the importance of continued innovation in this field.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 6S Suppl 4","pages":"S572-S576"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207493","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}