Annals of Plastic Surgery最新文献

{"title":"Prevention of Oronasal Fistula Formation in Palatoplasty With Acellular Dermal Matrix: A Systematic Review and Meta-analysis.","authors":"William R Clifton, Julia C Stager, Emily V Clifton, Spencer R Anderson","doi":"10.1097/SAP.0000000000004483","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004483","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of the study were to update the current trends in acellular dermal matrix (ADM) utilization during palatoplasty procedures and to evaluate its effectiveness in reducing postoperative oronasal fistula formation.</p><p><strong>Design: </strong>This is a systematic review and meta-analysis.</p><p><strong>Patients or participants: </strong>Patients undergoing primary or secondary cleft palate repair.</p><p><strong>Interventions: </strong>A comprehensive literature search was conducted via PubMed, Embase, Cochrane, and OVID for relevant studies published between July 2016 and June 2024 involving patients undergoing primary or secondary cleft palate repair with ADM versus without. All records were screened by two independent investigators using Covidence. Studies were excluded if they were not published in English, did not use ADM, were nonhuman, or had no reported outcome.</p><p><strong>Main outcome measures: </strong>Postoperative oronasal fistula formation.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria. This meta-analysis alone found a nonsignificant decrease in relative risk reduction of postoperative fistula formation with the use of ADM; however, when combined with data from the most recent meta-analysis, a statistically significant decrease was found. Overall, the addition of ADM resulted in 47% lower risk of developing fistulas. Furthermore, with the combined data, the pooled proportion of fistula recurrence for primary and secondary palate repair was 6.58%, which is favorable compared to previous studies' rates with the use ADM.</p><p><strong>Conclusions: </strong>This systematic review found a statistically significant decrease in postoperative fistula recurrence when using ADM for both primary and secondary palatoplasty. Therefore, ADM can be considered as a reliable adjunct to palatoplasty for reducing the risk of oronasal fistulas.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939283","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":"10.1097/SAP.0000000000004412","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"230-232"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278757/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-Wing Flap for Polysyndactyly of the Fifth Toe.","authors":"Junfang Xu, Yunheng Jia, Yanzhao Dong, Guoming Feng, Ruquan Jiang, Yu Liu, Han Xue","doi":"10.1097/SAP.0000000000004408","DOIUrl":"10.1097/SAP.0000000000004408","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to investigate the long-term clinical outcomes of the double-wing flap in the treatment of polysyndactyly of the fifth toe fused with the fourth toe.</p><p><strong>Methods: </strong>Between January 2016 and November 2019, 31 feet (4 bilateral, 23 unilateral) with polysyndactyly of the fifth toe fused with the fourth toe (27 patients) undergoing surgery using the double-wing flap with a follow-up higher than 5 years were included consecutively and retrospectively. Postoperatively, the toe function, slope and height of the reconstructed web were assessed in all feet and the measurements of the 23 unilateral polysyndactyly were compared with the normal side. D'Arcangelo criterion was used to grade the quality of the toe webbing and Vancouver Scar Scale score describes the quality of scar in all patients.</p><p><strong>Results: </strong>The patients were followed up for 5.1 to 8.3 years, a mean of 6.2 years. Two patients (2 feet) experienced web creep as a long-term complication, while the remaining feet showed no significant complications such as flexion contractures, angulation deformity or clinically significant keloid formation. The toe abduction, the slope and height of the reconstructed web of the 23 unilateral polysyndactyly showed no statistically significant difference compared with the normal side. Based on D'Arcangelo's criterion, 23 webs were rated as good, 6 as fair, and 2 as poor. The median Vancouver Scar Scale score was [1 (1, 2)].</p><p><strong>Conclusions: </strong>The technique is a simple, safe, and easily performed method, which does not require skin grafts. It could be an alternative in the treatment of polysyndactyly of the fifth toe fused with the fourth toe, especially in cases with high cosmetic priority.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"183-187"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155952","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":"Comparing 90-Day Reoperations in 23,301 Breast Reconstructions: Immediate Versus Delayed Direct-to-Implant or Autologous Reconstructions.","authors":"Kathryn E Royse, Tina M Smith, Cissy M Tan, Eric Y Lin, Robert G Neumann, Jessica E Harris, Elizabeth W Paxton, Winnie Tong","doi":"10.1097/SAP.0000000000004421","DOIUrl":"10.1097/SAP.0000000000004421","url":null,"abstract":"<p><strong>Background: </strong>In recent years, breast reconstruction following mastectomy has gained popularity. This study aimed to compare short-term unplanned return to the operating room (OR) for women undergoing breast reconstruction after mastectomy for malignancy by reconstruction timing, delayed compared to immediate (IBR). Subcategories of direct-to-implant and primarily autologous reconstruction were analyzed.</p><p><strong>Methods: </strong>Data from an integrated electronic medical record system identified patients undergoing breast reconstruction after mastectomy at Kaiser Permanente facilities between 2010-2022. Reconstruction timing was the exposure of interest, with stratification based on reconstructive techniques including tissue expander followed by either implant or autologous reconstruction, direct-to-implant, or primarily autologous reconstruction. Univariable and multivariable logistic regression models assessed the association between reconstruction timing and 90-day reoperations in direct-to-implant or primarily autologous reconstruction, using delayed reconstruction as the reference.</p><p><strong>Results: </strong>A total of 23,272 cases were identified (immediate = 18,248, delayed = 5025). The IBR patients exhibited higher odds of reoperations [odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.65-2.33, P < 0.0001] compared to delayed reconstruction after covariate adjustment. Among patients with expanders, IBR increased reoperation odds (OR = 1.83, 95% CI = 1.43-2.33, P < 0.0001). Immediate direct-to-implant reconstruction had the highest reoperation odds (OR = 5.55, 95% CI = 2.08-4.67, P = 0.039). No significant differences were observed between immediate and delayed approaches in autologous reconstruction, regardless of whether it was conducted in a single- or 2-stage process.</p><p><strong>Conclusions: </strong>Immediate reconstruction, involving expanders or direct-to-implant reconstructions, showed increased 90-day reoperation risks compared to delayed reconstruction. Conversely, no significant differences were identified between IBR and delayed reconstruction with autologous reconstruction conducted in a single- or 2-stage process.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"138-145"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324340","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":"Incentive to Publish in Plastic Surgery: Does It Continue After the Match?","authors":"Diego A Gomez, Caitlin M Blades, Evan J Haas, Zain Aryanpour, David W Mathes, Phuong D Nguyen, Katie G Egan","doi":"10.1097/SAP.0000000000004377","DOIUrl":"10.1097/SAP.0000000000004377","url":null,"abstract":"<p><strong>Purpose: </strong>Plastic surgery remains one of the most competitive specialties, with a 58.8% match rate during the 2023-2024 cycle. Research productivity is a well-established predictor of match success, yet its persistence throughout residency remains unclear. This study evaluates publication trends among residents before and during training to identify factors that promote sustained research productivity.</p><p><strong>Methods: </strong>Data from US integrated plastic surgery residents during the 2024-2025 academic year, covering match cycles from years 2019 to 2024, were analyzed. Indexed publications were retrieved from PubMed and categorized as prematch or postmatch. Multivariate regression was used to assess how residency program characteristics and prematch publications influenced research productivity during training.</p><p><strong>Results: </strong>A total of 1214 residents across 89 programs were identified. Average prematch publications increased from 4.7 in 2019 to 8.6 in 2024, reflecting an 83.0% rise. First-author publications grew by 53.0%. During residency, average total publications increased from 1.1 in PGY-1 to 7.1 by PGY-6, with average first-author contributions rising from 0.3 to 2.3. Training at top 25 NIH-funded or Doximity-ranked residency programs, advancing through postgraduate years, and prematch first-author publications were significant positive predictors of research productivity during residency ( P < 0.05). However, neither attending a top 25 NIH-funded medical school nor total prematch publications correlated with increased research output during residency.</p><p><strong>Conclusions: </strong>Prematch first-author publications and training at highly ranked, well-funded residencies are key predictors of sustained academic productivity. These findings provide valuable insights for programs seeking applicants who are likely to demonstrate long-term research engagement.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"201-205"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473828","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":"Comment to: \"Comparative Outcome Study of Gynecomastia Surgery and Gender-Affirming Mastectomy With 100% Nipple Preservation\".","authors":"Alice Letizia Andreoli, Alessandro Innocenti","doi":"10.1097/SAP.0000000000004411","DOIUrl":"10.1097/SAP.0000000000004411","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"230"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473800","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 the Impact of Diabetes and Metformin on Painful Neuromas After Lower Extremity Amputations.","authors":"Isabel Snee, Keith T Kuo, Rachana Suresh, Alec J Chen, Abel Lindley, Abdul Jabar Chekfa, Sami H Tuffaha, Ala Elhelali","doi":"10.1097/SAP.0000000000004419","DOIUrl":"10.1097/SAP.0000000000004419","url":null,"abstract":"<p><strong>Background: </strong>Painful neuromas are common cause of residual limb pain following lower extremity amputation, yet its incidence in diabetic populations remains unestablished. While diabetes is thought to reduce neuroma risk due to impaired nerve regeneration, the role of metformin on this process remains unclear. This study aims to explore the association of diabetes severity and metformin therapy on painful neuroma formation following lower extremity amputations.</p><p><strong>Methods: </strong>This retrospective cohort study used TriNetX Research Network to identify adult patients (≥18 years) who underwent lower extremity amputation between January 2016 to February 2024. Patient cohorts were identified using International Classification of Disease-10 and Current Procedural Terminology codes. Patients were stratified by diabetic status, hemoglobin A1c levels, and metformin use. Propensity score matching was performed and adjusted for demographics, comorbidities, and medications. Risk differences, risk ratios, and odds ratios with corresponding 95% confidence intervals were calculated to quantify the association between the exposure and the outcome. Statistical significance was set at P < 0.05.</p><p><strong>Results: </strong>A total of 16,090 patients underwent lower extremity amputation, 9994 (62.1%) were diabetic, while 6096 (37.9%) were nondiabetic. The overall incidence of symptomatic neuromas was lower in diabetic patients (0.61%) compared to the nondiabetic group (1.67%). After propensity score matching, 5196 diabetic and 5104 nondiabetic amputees were identified. Diabetes was associated with a significant reduction in neuroma risk [risk difference of -0.893% (95% CI: -1.29% to -0.496%); P < 0.0001]. Patients using metformin at the time of surgery had a higher incidence of painful neuroma (0.718%) compared to nonusers (0.424%) ( P = 0.127, odds ratio = 1.69). There was no significant difference in neuroma rates between those with hemoglobin A1c levels 6.5%-8.0%, 8.1%-10%, and >10%.</p><p><strong>Conclusions: </strong>Diabetes was associated with a lower painful neuroma risk after amputation, suggesting a possible protective role of hyperglycemia-induced nerve regeneration alterations. Metformin use had no significant impact on painful neuroma rates. These findings challenge assumptions about glycemic control and neuroma formation, highlighting the need for further research on metabolic influences in postamputation nerve healing and pain management.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"170-177"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324341","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":"Isolated Squamosal Synostosis: Defining the Phenotype.","authors":"Matthew E Pontell, Connor S Wagner, Neil Reddy, Lauren K Salinero, Carlos E Barrero, Jesse A Taylor, Shih-Shan Lang Chen, Jordan W Swanson, Scott P Bartlett","doi":"10.1097/SAP.0000000000004356","DOIUrl":"10.1097/SAP.0000000000004356","url":null,"abstract":"<p><strong>Abstract: </strong>This study aims to characterize the clinical manifestations of isolated squamosal synostosis (ISS) and review the relevant published literature. Computed tomography imaging from 2008 to 2022 was reviewed to identify patients with ISS. Patients were reviewed for age at presentation, signs of intracranial pressure, and management. A systematic review was conducted of all studies on ISS from 1990 to 2023. Eighteen patients from our institution were included. Three unilateral cases were diagnosed at 1.4 ± 0.6 years. None had signs of intracranial hypertension nor required surgery. Of the 15 bilateral cases, 6 were completely fused and 9 were partially fused. Concern for intracranial hypertension was more frequent in patients with bilateral complete ISS (66%) than partial (22%). Vault remodeling was pursued in 5/6 patients with bilateral complete ISS and 4/9 patients with bilateral partial ISS. Systematic review yielded 13 cases of ISS. Four had unilateral ISS diagnosed at 5.2 ± 2.8 months. None had intracranial hypertension. Nine had bilateral ISS diagnosed at 31 ± 47.3 months. Three patients had signs of elevated intracranial pressure. ISS presentation seems to vary based on laterality. Unilateral ISS typically presents without intracranial hypertension. Bilateral ISS is often associated with intracranial hypertension, more so in cases of complete suture fusion. Bilateral ISS warrants close observation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"156-162"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101051","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":"Perception of Risk and the Choice Between Smooth and Textured Breast Implants.","authors":"Eric Swanson","doi":"10.1097/SAP.0000000000004333","DOIUrl":"10.1097/SAP.0000000000004333","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"121-124"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690523","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":"Wound Complications After Breast Reconstruction: The Limited Role of Hemoglobin A 1c Compared With Body Mass Index in Preoperative Risk Assessment.","authors":"Emily E Zona, Doruk Orgun, Caroline C Bay, Robert E George, Sarah M Thornton, M Kristine Carbullido, Aaron M Dingle, Samuel O Poore","doi":"10.1097/SAP.0000000000004369","DOIUrl":"10.1097/SAP.0000000000004369","url":null,"abstract":"<p><strong>Background: </strong>Hemoglobin A 1c (HbA 1c ) and body mass index (BMI) are routinely evaluated before both alloplastic and autologous breast reconstruction to assess postoperative complication risk. However, evidence-based guidelines regarding accepted cutoffs for these measures are limited. This study aimed to elucidate the associations between HbA 1c levels or BMI with wound complications following reconstructive breast surgery.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program database to assess 30-day wound complications among patients who underwent autologous or alloplastic breast reconstruction after mastectomy for breast cancer between January 1, 2021, and December 31, 2022. Wound complications included wound dehiscence, superficial incisional surgical site infections (SSIs), deep incisional SSI, or organ space SSI. Statistical analyses including multivariable Cox regression and Kaplan-Meier curve comparisons were performed based on the distribution of HbA 1c or BMI in the cohort.</p><p><strong>Results: </strong>A total of 2809 patients underwent breast reconstruction with preoperative HbA 1c measurements. Among these, 2025 (72.1%) underwent alloplastic reconstruction, whereas 784 (27.9%) underwent autologous reconstruction. For the entire cohort, the median age was 54 years, the median HbA 1c was 5.7 (interquartile range, 5.3-6.4), and the median BMI was 29.4 kg/m 2 (interquartile range, 25.5-33.9). The 30-day complication rates in the autologous and alloplastic groups were 11.7% and 7.5%, respectively. Kaplan-Meier curves for the comparison of absolute risk of 30-day wound complications showed no significant differences between HbA 1c quartile curves (log-rank P = 0.46). For BMI, compared with the first quartile, the third (median BMI, 31.5 kg/m 2 ) and fourth quartiles (median BMI, 37.3 kg/m 2 ) had more than double the complication rates (Q1: 5.0%, Q2: 7.3%, Q3: 11.1%, Q4: 11.4%; P < 0.001). Adjusted hazard ratios for 30-day complication risk were 1.83 (95% confidence interval, 1.21-2.77; P = 0.004) for the third BMI quartile and 1.80 (95% confidence interval, 1.18-2.76; P = 0.007) for the fourth.</p><p><strong>Conclusion: </strong>This study demonstrates that higher BMI is associated with wound complications after breast reconstruction. With the first BMI quartile as reference, patients in BMI quartile 4 had a 75% increased risk of complications in the alloplastic group, whereas the risk increased more than 1.4-fold in the autologous group. No similar associations were observed with HbA 1c levels.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"188-195"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473837","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}