Annals of Plastic Surgery最新文献

{"title":"A 13-Year Experience With a 3-Stage Dermal Regeneration Matrix Approach to Hand Burns.","authors":"Tiffany Jeong, Mario Alessandri-Bonetti, Jose Antonio Arellano, Hilary Y Liu, Sumaarg Pandya, Alain C Corcos, Jenny A Ziembicki, Guy Stofman, Francesco M Egro","doi":"10.1097/SAP.0000000000004206","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004206","url":null,"abstract":"<p><strong>Introduction: </strong>Dermal regeneration matrix (DRM) has been demonstrated to be safe and beneficial in improving functional outcomes for the management of acute hand burns. DRM followed by split thickness skin graft (STSG) allows for a 2-stage reconstruction for most operative hand burn injuries. Our site routinely implements a 3-stage approach: allograft in the first stage, DRM in the second stage, and STSG in the final stage. This study aims to compare the surgical and functional outcomes of 2-stage DRM reconstruction and 3-stage reconstruction.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to review surgical and functional outcomes of patients treated for hand burns. All patients seen from April 2009 to December 2022 with hand burns, who were managed surgically, were considered for the study.</p><p><strong>Results: </strong>A total of 227 patients were treated for hand burns between 2009 and 2023. Out of these, 183 met the inclusion criteria. Most patients were male (72.9%, n = 129) and had burns covering an average of 19.2 ± 19.4% total body surface area, with the majority being full-thickness burns (84.2%, n = 154). Almost half of the patients (49.2%, n = 90) had bilateral hand burns, leading to a total of 273 hands treated. The treatments included a 3-stage DRM for 66.7% (n = 182), a 2-stage DRM for 20.9% (n = 23), direct grafting for 8.4% (n = 23), and skin substitutes only for 4.1% (n = 11). The 3-stage DRM significantly reduced the odds of requiring repeat grafting during acute management (odds ratio = 0.03) and was associated with lower complication rates and need for delayed reconstruction. Objective hand function examination showed no significant difference in baseline or end of treatment DASH scores between 3-stage and 2-stage DRM groups.</p><p><strong>Conclusions: </strong>These data suggest a 3-stage approach reduced the need for repeat STSG. This approach may be especially useful when autologous skin is limited or if the patient requires multiple rounds of excision and grafting due to the nature and severity of the burn injury. Patients who received a 3-stage approach had comparable mean DASH scores when compared to patients who received a 2-stage approach, suggesting that a 3-stage approach does not diminish the functional benefits of DRM previously demonstrated in the literature.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S469-S473"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974867","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":"Clinicopathological Characteristics, Gene Mutations, and Treatment of Fibro-adipose Vascular Anomaly: A Case Series From China and Literature Review.","authors":"Fei Xiong, Cai-Jun Jin, Shi-Qi Wang, Hai-Yan Zhong, Miao Zheng, Ming-Li Zou, Qian Wang, Si-Ming Yuan","doi":"10.1097/SAP.0000000000004303","DOIUrl":"10.1097/SAP.0000000000004303","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study is to offer a thorough overview of the clinical and pathological characteristics, potential pathogenic genes, treatment modalities, and prognoses of a cohort of Chinese individuals diagnosed with Fibro-adipose Vascular Anomaly (FAVA). This study aims to advance the comprehension of this specific medical condition.</p><p><strong>Methods: </strong>A total of 15 cases of FAVA patients admitted to our center between June 2015 and December 2023 were included in this study. Clinical symptoms, laboratory tests, imaging findings, and pathological data were systematically reviewed to outline the clinical and pathological features of FAVA. Furthermore, whole-exome sequencing was conducted on lesion samples from five patients to identify potential pathogenic genes. The treatment modalities encompassed sclerotherapy and surgical interventions, with treatment outcomes assessed based on clinical symptoms, imaging characteristics, and enhancement of limb functions.</p><p><strong>Results: </strong>The FAVA lesions were predominantly located in the limbs in 14 patients and in the trunk in 1 patient. The clinical manifestations included pain (9/15, 60%), muscle contracture deformity (3/15, 20%), and joint dysfunction (3/15, 20%). Coagulation function assessments indicated that 3 patients exhibited localized intravascular coagulation (LIC). Magnetic resonance imaging (MRI) findings displayed mixed vascular malformation components and fibrofatty components within the muscles, showing isointense or hyperintense signals on T1-weighted images and heterogeneous hyperintense signals on T2-weighted images. Histopathological analysis revealed activation of the PI3K-AKT-mTOR signaling pathway. Whole-exome gene sequencing of 5 cases identified 10 genes potentially linked to pathogenicity. All patients underwent ethanol sclerotherapy. Surgical intervention was performed on five patients due to muscle contracture and joint dysfunction. Some patients reported pain relief following sclerotherapy, whereas those who underwent surgery demonstrated significant enhancement of joint function.</p><p><strong>Conclusions: </strong>The Chinese patients diagnosed with FAVA in this study presented characteristic clinical symptoms, imaging features, and pathological traits. The lesion tissue showed activation of the PI3K-AKT-mTOR signaling pathway, with only one patient (1/5, 20%) exhibiting a PIK3CA mutation. This finding underscores the intricate nature of the pathogenic genes and pathogenesis of FAVA. Although sclerotherapy demonstrated restricted efficacy in alleviating pain symptoms, surgical intervention was deemed necessary for addressing joint dysfunction resulting from muscle contracture.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"581-588"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490558","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":"An Analysis of Women's Representation of Plastic Surgery Residency and Fellowship Program Leadership From a National Lens.","authors":"Xinfei Miao, Madeleine Givant, Van Le, Katie Kyan, Ashley Choi, Reem Sarsour, Amber Leis","doi":"10.1097/SAP.0000000000004279","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004279","url":null,"abstract":"<p><strong>Background: </strong>Among all surgical specialties, plastic surgery has had the most significant growth in women trainees and leadership positions from 2008 to 2018. Despite this increase, studies have shown that from trainees to faculty to leadership roles, leakage occurs at all levels in the pipeline. We aim to investigate the gender distribution of leadership positions by plastic surgery program type and geographic region, as well as to compare the leadership representation across plastic surgery subspecialty fellowships.</p><p><strong>Methods: </strong>All integrated plastic surgery residency programs and four main subspecialty fellowship programs in the US were identified through the American Council of Academic Plastic Surgeons. Leadership roles, such as program director, assistant/associate program director (APD), fellowship program director, and departmental and divisional level leadership roles, which are occupied by women, were collected from program websites, along with the number of individuals holding additional leadership roles. Programs were classified as either university-based or nonuniversity-based types. Program location was cross-referenced with the US Census Bureau to determine their regions. Categorical variables were compared by χ2 or Fisher's exact tests, as appropriate, using Microsoft Excel 2021.</p><p><strong>Results: </strong>A total of 88 integrated plastic surgery residency programs were identified, along with 33 craniofacial surgery, 82 hand surgery, 61 microsurgery, and 47 aesthetic surgery fellowship programs. Overall, women represent 20.9% of program directors, 44.2% of APDs, 10.7% of fellowship program directors, and 18.1% of departmental and divisional level leadership roles. Fewer women are holding additional leadership roles (22.3% vs 77.7%). A significant difference was found in the APD position by program type. The aesthetic surgery fellowship has the lowest women's representation in leadership, while hand surgery has the highest (9.09% vs 17.1%). No significant difference in gender distribution was observed across fellowship types.</p><p><strong>Conclusions: </strong>While leadership gender distribution does not appear to be affected by region or program type, women plastic surgeons remain underrepresented at different leadership levels. Providing enhanced career advancement and support for diverse representation is vital to creating an inclusive plastic surgery leadership workforce.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S425-S428"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954436","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":"Pediatric Scar Management Using Tangential Excision With Intralesional Injections and Laser-Assisted 5-Fluorouracil Delivery.","authors":"Kelli Lopes, Samuel Lance, Cyril Harfouche, Robert Clark, Miriam Becker, RocNeil Nguyen, Amanda Gosman","doi":"10.1097/SAP.0000000000004207","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004207","url":null,"abstract":"<p><strong>Background: </strong>Pediatric hypertrophic and keloid scars have traditionally been treated via intralesional steroid injections. The advent of modalities such as 5-fluorouracil (5-FU) and tangential excision present opportunities for improved therapy; however, 5-fluorouracil (5-FU) safety and efficacy in the pediatric population are not well established. The aim of this study is to compare the risk and efficacy of 5-FU in pediatric scar management.</p><p><strong>Methods: </strong>A multi-institution retrospective study from 2012 to 2023 was designed with identification of 108 patients aged ≤17, undergoing CO2 laser-assisted 5-FU delivery, or tangential excision with immediate or delayed 5-FU/triamcinolone injections. Modified Scar Rating Scale assessed individual scar outcomes comparing the following groups: 5-FU alone versus triamcinolone use; tangential excision with immediate versus delayed injections; and number of injections above/below the median of 4 episodes of injections. Mann-Whitney U test determined significance. Fisher exact test compared complication and recurrence rates.</p><p><strong>Results: </strong>Total scar quality scores improved (P < 0.05) with tangential excision plus <4 injections (n = 44; Δ = -0.581) and tangential excision with 5-FU only (n = 39; Δ = -0.775). Tangential excision with 5-FU alone decreased height (P < 0.05; Δ = -0.5878) compared to tangential excision with triamcinolone use (n = 46). Color match improved (P < 0.05) with tangential excision plus <4 injections (Δ = -0.449) and tangential excision with delayed injections (n = 29; Δ = -0.380).Tangential excision with any 5-FU use (n = 62) had higher complication rates (4.84%) than tangential excision with triamcinolone only (n = 30; 0%) or tangential excision with 5-FU only (n = 37; 5.41%), but complication rates did not significantly differ. CO2 laser-assisted 5-FU (n = 16) complication rates (6.25%) did not significantly differ from tangential excision with 5-FU or triamcinolone. No systemic complications were identified. Recurrence rates between all groups did not differ significantly.</p><p><strong>Conclusions: </strong>Tangential excision with 5-FU monotherapy demonstrated lower scar height and improved overall scar quality, further solidifying the benefits of 5-FU. CO2 laser-assisted 5-FU delivery had similar complication rates as the other studied modalities. This pediatric study had no systemic complications and overall similar complication rates compared to adult studies. This study demonstrates the utility of 5-FU in pediatric scar therapy and provides data regarding novel approaches to difficult pediatric scar management.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S429-S434"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954919","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":"Endoscopic Versus Open In situ Decompression of Cubital Tunnel Syndrome: A Systematic Review and Meta-analysis of 686 Cases.","authors":"Abdulaziz M Alghamdi, Osama A Alkulli, Dania E Faidah, Mohamed K Alqazenli, Abdulaziz B Fathi, Yousof F Allarakia, Arwa Alghamdi, Rasha Baaqeel","doi":"10.1097/SAP.0000000000004248","DOIUrl":"10.1097/SAP.0000000000004248","url":null,"abstract":"<p><strong>Introduction: </strong>Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper extremity. Several surgical approaches are available for a definitive treatment. This systematic review and meta-analysis aimed to comprehensively assess and compare the efficacy and safety of endoscopic in situ decompression (EISD) and open in situ decompression for CuTS.</p><p><strong>Methods: </strong>A systematic search was conducted using online databases (PubMed/MEDLINE, Embase, and Cochrane) on the 14th of April 2024. All human RCTs and observational studies in English were included in this review.</p><p><strong>Results: </strong>Eleven studies, involving 686 patients, met the inclusion criteria. Pairwise meta-analyses showed that EISD had significantly increased surgery time [MD = 9.32 minutes, 95% confidence interval (CI) (3.54, 15.11), P = 0.002], higher risk of postoperative hematoma [RR = 4.44, 95% CI (1.30, 15.20), P = 0.02], higher risk of postoperative surgical-site pain [RR = 1.50, 95% CI (1.09, 2.05), P = 0.01], lower risk of postoperative elbow numbness [RR = 0.06, 95% CI (0.01, 0.48), P = 0.007], and better postoperative grip and pinch strength [MD = 6.29, 95% CI (1.35, 11.24), P = 0.01]. In addition, it trended insignificantly toward lower rates of chronic painful scarring recurrence rates. Other measured variables did not show significant differences between the 2 surgical techniques, including the functional outcomes assessed by Bishop's score, disabilities of the arm, shoulder, and hand score, and neurophysiologic data, in addition to the postoperative infection rate, subluxation of the ulnar nerve, and reoperation rates.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrated that both surgical techniques were effective in treating CuTS. Although it was inferior in some of the measured short-term outcomes, EISD showed better results in some of the long-term measured outcomes with questionable clinical significance. The choice of the surgical approach should be tailored for each case to optimize the quality of care and overall outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"561-576"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188144","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":"Degree and Timing of Sensory Return Following Nipple-Areolar Complex Neurotization During Nipple-Sparing Mastectomy.","authors":"Gabrielle Guido, Ziv M Peled, Anne Warren Peled","doi":"10.1097/SAP.0000000000004282","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004282","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional expectations around sensation following nipple-sparing mastectomy include significant or often complete sensory loss of the nipple-areolar complex. Nipple neurotization at the time of mastectomy has proven promising in restoring sensation to the area postoperatively. However, minimal data are available on the degree and timing of sensory return following neurotization.</p><p><strong>Methods: </strong>Forty-seven patients (representing 94 breasts) underwent nipple-sparing mastectomy (NSM) with direct-to-implant, prepectoral reconstruction. During the mastectomy, branches of the T4 and T5 lateral intercostal nerves were identified and dissected to preserve length before transection was required oncologically to complete the mastectomy. The nerves were then reconstructed using a nerve allograft or autograft with coaptation to an identified subareolar nerve. Neurosensory testing with a pressure-specified sensory device was performed at several time points postoperatively to quantify return of sensibility. Patients were also given modified BREAST-Q questionnaires at similar time points to assess their perception of sensation return.</p><p><strong>Results: </strong>Nipple sensation decreased markedly in the early months after mastectomy and then slowly returned to baseline by 1 year postoperatively, with 74% of patients achieving pressure-specified sensory device results in the excellent range by 12-month testing. Overall, patients having bilateral risk-reducing mastectomy achieved higher rates of nipple sensory return at 1 year than those having mastectomies as part of cancer treatment. On patient-reported outcomes, 53% of patients reported having a lot or some nipple sensation by 6 months postoperatively, which increased to 70% by 1 year. Ninety-two percent of patients reported responsiveness to touch in their nipples at the 12-month postoperative time point.</p><p><strong>Conclusions: </strong>Nipple-areolar complex neurotization allows for return to baseline nipple sensation on quantitative testing by 1 year postoperatively for the vast majority of patients undergoing the procedure. Similar results are seen for patient-reported outcomes on overall nipple sensation and responsiveness to touch. As adoption of sensation preserving mastectomy techniques becomes more widespread, further investigation into optimal assessment tools and protocols will continue to improve understanding of outcomes and help with patient expectation setting.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S452-S456"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960360","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":"In-House 3D Printing for Craniofacial Trauma: 7-Year Review.","authors":"Kevin Chen, Caroline C Kreh, Alexander Y Lin","doi":"10.1097/SAP.0000000000004281","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004281","url":null,"abstract":"<p><strong>Introduction: </strong>Complex facial trauma presents a challenge to the reconstructive surgeon, as the loss of facial buttresses makes accurate reduction of fractures more and more difficult. Accurate 3D-printed models and virtual surgical planning have become a mainstay in many other aspects of craniomaxillofacial surgery. However, turnaround times from industry produced models frequently preclude their use in the unplanned acute surgical setting.</p><p><strong>Purpose: </strong>We seek to evaluate the use of in-house printed 3D models for facial trauma and the efficacy and safety of the procedures performed with the aid of these models.</p><p><strong>Methods: </strong>All patients from January 2017 to August 2023 who received an in-house 3D-printed model to help treat facial fractures were analyzed. Chart review was performed to extract demographic data, fracture type, mechanism, complications, comorbidities, and operative time. Analysis was performed in Microsoft Excel.</p><p><strong>Results: </strong>A total of 24 patients had 3D models created for facial fractures. The average age was 24.5 years. Motorized vehicles were involved in 15 cases (62.5%). The most commonly injured region was the midface (19 patients; 79.2%), and 8 patients had true panfacial fractures (33.3%). Seventeen patients (71%) had complex fractures involving multiple buttresses. For acute treatments, average time from presentation to operative treatment was 9 days. Average operative time was 268.3 minutes. Three patients (12.5%) had minor complications, including localized infection treated with antibiotics and a small wound dehiscence. Two patients (6.25%) had major complications: a draining sinus tract that required excision and a cicatricial lagophthalmos due to a laceration near the eyelid margin. Ninety-six percent of patients had satisfactory facial contour.</p><p><strong>Conclusions: </strong>3D printing anatomical models can be helpful in assisting surgical decision making for patients with facial fractures as well as the process of surgery itself by allowing for prebending of plates. In the acute setting, when turnaround times are short, in-house 3D printing can produce models in a timely fashion to help surgeons operate safely and efficaciously.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S435-S440"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958514","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":"Navigating the Rare Medial Rectus Entrapment in Orbital Fractures: A 5-Year Series and Systematic Review of the Literature.","authors":"Stephanie Holzmer, Erin O'Rorke, Mark Martin, Subhas Gupta","doi":"10.1097/SAP.0000000000004205","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004205","url":null,"abstract":"<p><strong>Background: </strong>Inferior rectus muscle entrapment associated with orbital floor fractures is commonly described in the literature. Less commonly described, however, is the phenomenon of medial rectus entrapment found in association with medial orbital wall fractures. This study primarily aims to bring further attention to this rare occurrence through the presentation of three medial rectus entrapments encountered at a single institution. Additionally presented are a systematic review of the literature and a discussion of the authors' preferred surgical technique for management of acute medial rectus entrapment in the setting of medial orbital wall fractures.</p><p><strong>Methods: </strong>A systematic review of the literature was conducted via use of Medline/PubMed databases, and publications describing cases of medial rectus entrapment secondary to medial orbital wall fractures were included. Key data points included laterality of fracture, time to operative intervention, surgical approach, and outcomes pertaining to extraocular muscle motility. These results were pooled with the findings of our three-patient case series to report the postoperative rate of extraocular movement deficit/diplopia.</p><p><strong>Results: </strong>Each patient in our series presented with inability to abduct the affected eye, diplopia with straight gaze, and a positive oculocardiac reflex. All three were managed emergently in the operating room with medial rectus release and repair of fracture with an alloplastic implant via a retrocaruncular approach with retroseptal floor extension. Diplopia resolved completely in two of the cases and remained at extremes of gaze at 1 month postoperatively for the third, at which time the patient was lost to follow-up. These results were pooled with those obtained from the literature resulting in a 62.1% rate of full recovery with 37.9% of patients experiencing some degree of diplopia at longest follow-up reported (which was limited in several cases).</p><p><strong>Conclusions: </strong>This study serves to bring awareness to the phenomenon of medial rectus entrapment, so clinicians may keep an appropriate level of suspicion when evaluating patients with orbital fractures, as well as counsel patients appropriately regarding the long-term sequelae of this condition. Additionally, we have found that the retrocaruncular approach for surgical management of these fractures is safe and reliable, even in instances of significant chemosis and periorbital edema.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 5S Suppl 3","pages":"S446-S451"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969292","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":"Positioning of the Inferior Alveolar Nerve and Surgical Implications: A Study on Thai Mandibles.","authors":"Chirakan Charoenvicha, Wachiranun Sirikul, Ditsayanin Thaweethanasit, Pailin Kongmebhol, Chakri Madla, Puttan Wongtriratanachai","doi":"10.1097/SAP.0000000000004185","DOIUrl":"10.1097/SAP.0000000000004185","url":null,"abstract":"<p><strong>Background: </strong>The inferior alveolar nerve (IAN), a crucial branch of the trigeminal nerve, innervates the mandible. Precise knowledge of IAN positioning ensures surgical safety.</p><p><strong>Methods: </strong>This cross-sectional study analyzed head and neck computed tomography scans from Maharaj Nakorn Chiang Mai Hospital. Inclusion criteria comprised dentate adults. Exclusion criteria included mandibular trauma/pathology or prior surgery. The study aimed to determine IAN positioning relative to key surgical landmarks: the first molar, lingula, and mental foramen.</p><p><strong>Results: </strong>A total of 450 Thai mandibles (900 hemimandibles) with a mean age of 36 years (58.2% male) were included. No significant differences were observed in IAN positioning relative to the first molar between the left and right sides in superior and inferior landmarks. However, the buccal distance was significantly closer on the left. The lingula distance was higher on the left, whereas that to the mental foramen was lower.</p><p><strong>Conclusion: </strong>Surgical implications suggest maintaining a 15-mm distance from the lower mandibular border during osteotomy and upper plate placement, restricting horizontal cuts within this 15-mm range from the lingula, and ensuring screws do not extend more than 7 mm from the buccal surface. This study provides valuable guidance for minimizing the risk of iatrogenic injury to the IAN.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"589-594"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891443","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 Early Landscape of Gender Affirmation Surgery in the United States.","authors":"Sophia Hu, Daniel Hartman, Michaela Asher, Gennady Vulakh, Charles Raymer, Aron Wahrman","doi":"10.1097/SAP.0000000000004302","DOIUrl":"10.1097/SAP.0000000000004302","url":null,"abstract":"<p><strong>Background: </strong>Gender affirmation surgeries (GASs) are procedures that help patients align their body and gender identity. European surgeons are widely credited with pioneering GAS surgical techniques in the 1930s, whereas knowledge of GAS in the United States (US) prior to the 1960s is sparser. This study explores the early leaders, techniques, and obstacles encountered by physicians performing GAS in the US in the 1950s to 1970s.</p><p><strong>Methods: </strong>Archives from the Harry Benjamin Collection and Elmer Belt Papers were reviewed for patient, physician, and operative details.</p><p><strong>Results: </strong>A total of 39 physician and academic collaborators and 72 patients were identified. Most physicians and academic collaborators were from the US (28/39, 71.8%) or Germany (3/39, 7.7%). Urology was the most common specialty (8/36, 22.2%), followed by plastic surgery (7/36, 19.4%) and psychiatry (5/36, 13.9%). Forty patients underwent GAS, of which the majority underwent vaginoplasty (31/40, 77.5%), orchiectomy (7/40, 17.5%), and penectomy without vaginoplasty (4/40, 10.0%). Belt preferred to implant testicles into the retroperitoneum rather than perform orchiectomies during his vaginoplasties, and vaginoplasty complications were commonly reported (13/31, 41.9%). Patients and providers faced challenges obtaining and providing GAS due to the indeterminate legal status of the procedures, shifting hospital policies, and discouragement from family and colleagues.</p><p><strong>Conclusions: </strong>Despite records of professional, familial, and even legal censure, the legacy of these early physicians and patients persists in the continued practice and refinement of GAS surgical techniques, often through the same organizations that housed these early practitioners. This article seeks to deepen our understanding of the lives and professional struggles of these medical innovators, upon whose work the contemporary American practice of GAS is built.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"507-511"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623306","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}