Annals of Plastic Surgery最新文献

{"title":"Efficacy of Botulinum Toxin Applied Immediately After Wound Closure on Scars Quality Assessment: A Systematic Review and Meta-analysis.","authors":"Rafael Andrade Sampaio Silva, André Nishizima, Pedro Lucas Machado Magalhães, Eduardo Louly Santos Dallastra, Axel Ravanello, Antomir Santos Pereira, Milena Gonçalves Guerreiro, Bernardo Bastian Pinto","doi":"10.1097/SAP.0000000000004368","DOIUrl":"10.1097/SAP.0000000000004368","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin (BTX) is considered an efficient and safe therapy for postoperative scars that improves visual and functional quality. However, the optimal timing for injection remains under debate due to conflicting evidence.</p><p><strong>Objective: </strong>The aim of this study is to evaluate the efficacy and safety of BTX applied immediately after wound closure in the quality assessment of postoperative scars.</p><p><strong>Methods: </strong>This is a systematic review and meta-analysis following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. Searches were performed in PubMed, EMBASE, Web of Science, and Cochrane until September 10, 2024, including randomized or prospective studies on BTX applied immediately after wound closure, with exclusions for keloids or hypertrophic scars treatment studies, non-English studies, reviews, case reports, letters, and abstracts. The quality of scars was assessed using appropriate and widely validated tests and scales when at least 3 studies selected in the meta-analysis utilized them. The mean difference (MD) was used to explore the difference among different groups.</p><p><strong>Results: </strong>Nine randomized trials and 1 prospective study in a total of 521 were identified in this meta-analysis. BTX showed no significant difference in Vancouver Scar Scale score (MD = -0.35, 95% confidence interval [CI] = -1.01 to 0.30, P = 0.29) compared with control, higher visual analog scale score (MD = 1.29, 95% CI = 0.68 to 1.90, P < 0.01), and reduced scar width (MD = -0.19, 95% CI = -0.30 to -0.09, P < 0.01). No adverse events were found in the included studies.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrated that BTX injections immediately after wound closure are safe and improve scars quality. BTX time of injection requires further studies to provide better clinical applications.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"212-220"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473801","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":"Impact of Obesity on Surgical Complications in Gender-Affirming Mastectomy: A Systematic Review and Meta-analysis.","authors":"Matthew F McLaughlin, Alexandra J Lopes, Nisha Parmeshwar, Peggy Tahir, Esther A Kim","doi":"10.1097/SAP.0000000000004365","DOIUrl":"10.1097/SAP.0000000000004365","url":null,"abstract":"<p><strong>Background: </strong>Body mass index (BMI) is sometimes used to determine surgical eligibility for gender-affirming mastectomy (GAM) but there is insufficient data informing these criteria. Given the limitations of single-institution studies, which lack the ability to generalize the potential impact of BMI on GAM complications across various surgical practices, a systematic review is needed.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was performed for all studies that evaluated the relationship between BMI and surgical outcomes after GAM. Our institution's GAM cohort (n = 457) was also included. Obesity was defined as BMI ≥ 30 kg/m 2 . The random-effects DerSimonian-Laird method was used to synthesize results across studies.</p><p><strong>Results: </strong>Of 605 studies screened, 10 met the inclusion criteria. There were a total of 1195 patients, of whom 441 (37%) were obese and 754 (63%) were nonobese. There were significantly higher odds of nipple-areola complex [odds ratio (OR) = 4.13, P = 0.04] and wound complications (OR = 4.27, P = 0.03) in patients with obesity compared to those without obesity. There were no significant differences in hematoma (OR = 1.16, P = 0.62), seroma (OR = 2.49, P = 0.14), or infection (OR = 1.63, P = 0.24).</p><p><strong>Conclusions: </strong>While some GAM complications were more common in patients with obesity, serious complications like hematoma and infection were as likely to occur among obese and nonobese patients. Patients with higher BMIs should be counseled about their increased risk for these complications. However, BMI cutoffs alone should not determine surgical eligibility, as these findings provide more generalizable evidence confirming the low morbidity associated with GAM.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"221-229"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109523","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":"Successful Abdominal Wall Reconstruction Following Liposuction Catastrophe: A Case Report and Literature Review.","authors":"Osama Darras, Sara Yacoub, Isaac Mordukhovich, Diwakar Phuyal, Kimberly P Woo, Michael J Rosen, Raffi Gurunian, Sarah N Bishop","doi":"10.1097/SAP.0000000000004404","DOIUrl":"10.1097/SAP.0000000000004404","url":null,"abstract":"<p><strong>Background: </strong>Devastating abdominal injuries may result from liposuction, which can lead to necrotizing fasciitis and loss of abdominal domain. This may necessitate reconstructing the abdominal wall to improve the patient's quality of life.</p><p><strong>Objectives: </strong>The study aims to raise awareness among the readers of this catastrophic complication. Guidelines for preoperative assessment, and intraoperative measures to reduce abdominal complications along with the importance of early recognition, diagnostic tools, and treatment strategies were provided.</p><p><strong>Methods: </strong>We reported a patient who underwent abdominal wall reconstruction following liposuction-inflicted abdominal injury and necrotizing fasciitis. Subsequently, a literature search was conducted to review abdominal wall reconstructive techniques following liposuction-inflicted abdominal injuries. Algorithms for patient safety followed this.</p><p><strong>Results: </strong>The patient developed necrotizing fasciitis due to liposuction cannula bowel perforation leading to loss of abdominal domain. This was reconstructed with a transversus abdominis release trial with mesh followed by bilateral pedicled neurotized anterolateral thigh flaps with vastus lateralis. The review of the literature included 10 papers describing different techniques of abdominal reconstruction. Common treatment techniques following liposuction-inflicted abdominal injuries were negative pressure wound therapy and skin grafting.</p><p><strong>Conclusions: </strong>Anterolateral thigh flaps are an excellent option that provides functional and structural repair. Neurotization of the muscle helps protect the muscle from atrophy. The review of the literature showed a lack of abdominal wall reconstruction using musculocutaneous flaps following liposuction-inflicted abdominal injuries.Communicating symptom awareness to patients and the medical team is essential for quickly identifying potential visceral injury after liposuction, ensuring prompt management and improved outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"132-137"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109546","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":"Surgical Techniques for Cleft Lip Repair: Insights From Latin America and the Caribbean.","authors":"Atenas Bustamante, Jonathan Diaz, Emily Jones, Laura Herrera Gomez, Karel-Bart Celie, José Nuñez, Allyn Auslander, William P Magee, Wieslawa De Pawlikowski","doi":"10.1097/SAP.0000000000004379","DOIUrl":"10.1097/SAP.0000000000004379","url":null,"abstract":"<p><strong>Background: </strong>Cleft lip (CL) repair techniques vary significantly, often depending on surgeons' experience, preference, and cleft characteristics. In Latin America and the Caribbean (LAC), where CL prevalence is high, research on surgical practices remains limited. This study aims to document and analyze preferences for unilateral (UCL) and bilateral cleft lip (BCL) repair among Operation Smile surgeons in LAC to support improved cleft care.</p><p><strong>Methods: </strong>A 22-question survey was distributed anonymously electronically to credentialed LAC surgeons performing UCL and BCL repairs. The survey explored demographics, preferred repair techniques, and surgical approaches such as nasal floor closure, gingivoperiosteoplasty, and setback techniques. Responses were analyzed using descriptive and inferential statistics.</p><p><strong>Results: </strong>A total of 101 surgeons from 13 countries participated, with Peru (20%) having the highest representation. Most respondents were male (71%), with 36% having less than 5 years of experience. The Fisher technique was the most preferred method for UCL (66%) and BCL (29%), particularly among less experienced surgeons. Technique preferences varied significantly by country ( P < 0.001). For UCL, most surgeons (78%) closed the nasal floor by joining septal and lateral mucosa, and 50% performed gingivoperiosteoplasty. For BCL, 58% used labial adhesion for maxillary protrusion, and 24% performed premaxillary setbacks, both varying significantly by experience and technique ( P < 0.001).</p><p><strong>Conclusions: </strong>This study reveals substantial variability in cleft repair techniques across LAC, with the Fisher technique emerging as a dominant preference. These findings provide a foundation for future research focusing on outcomes and complications to optimize cleft care in the region.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"125-131"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155919","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":"Efficacy of Wharton Jelly-Derived Mesenchymal Stem Cells Implanted on 3-Dimensional Hyaluronan-Based Scaffold in Tendon-Bone Interface Healing.","authors":"Ahmet Rıfat Doğramacı, Gokce Yildiran, Gülsemin Çiçek, Zeliha Esin Çelik, Fatma Öz Bağcı, Zekeriya Tosun","doi":"10.1097/SAP.0000000000004357","DOIUrl":"10.1097/SAP.0000000000004357","url":null,"abstract":"<p><strong>Introduction: </strong>The establishment of the enthesis unit remains a significant challenge due to the inability to reconstitute the native histological zones postrepair. In this study, the authors investigated the effect of 3-dimensional hyaluronan-based scaffold implanted with Wharton jelly-derived mesenchymal stem cells on enthesis healing in rat model.</p><p><strong>Methods: </strong>Three-dimensional hyaluronan-based scaffold was seeded with mesenchymal stem cells. Bilateral supraspinatus injury model created tendon-bone interface of 48 Sprague-Dawley rats reconstructed with one of the following: group 1: sham surgery; group 2: control group; group 3: surgery, scaffold and conditioned medium; group 4: surgery, scaffold and Wharton jelly-derived mesenchymal stem cells. The rats were killed on day 30, and supraspinatus-humerus tendon to bone unit was harvested en bloc for evaluations. Histopathological, immunohistochemical, mechanical, and micro-computed tomography evaluations were performed.</p><p><strong>Results: </strong>Group 4 was found to be superior to the others in terms of collagen organization and density, fibroblast growth factor, collagen II, and bone morphogenetic protein 2 immunoreactivity, as well as biomechanical tensile strength ( P < 0,05). Additionally, groups 3 and 4 exhibited superior bone mineral density and trabecular thickness compared with the other groups.</p><p><strong>Conclusions: </strong>Wharton jelly-derived mesenchymal stem cells implanted into 3-dimensional hyaluronan-based scaffold have shown promising results in achieving a high strength enthesis unit resembling native histological zones.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"206-211"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118622","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":"Practical Lymphatic Ultrasound for Supermicrosurgical Lymphaticovenous Anastomosis: Preoperative Lymphatic Mapping Using Conventional High-Frequency Ultrasound.","authors":"Paloma Malagón, Takumi Yamamoto","doi":"10.1097/SAP.0000000000004406","DOIUrl":"10.1097/SAP.0000000000004406","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound (US) has many advantages and is useful for mapping lymph vessels and veins for lymphovenous anastomosis (LVA) and improving their outcomes. However, it is operator-dependent and required some experience. Our aim was to describe how to perform preoperative mapping of LVA using high-frequency US (HFUS) in B mode.</p><p><strong>Methods: </strong>Experiences about preoperative planning of LVA surgeries in patients with upper and lower limb lymphedema using HFUS were the basis of our guide. In addition, data of women with secondary lower limb lymphedema who undergone LVA was analyzed. US examination was performed on the previous day of surgery for mapping lymph vessels and veins using a linear transducer of 18 MHz and B mode.</p><p><strong>Results: </strong>A standardized method to perform step by step the preoperative planning of LVA using HFUS was described. A total of 349 incisions performed in 97 lower limbs were analyzed. The overall success rate for identifying lymph vessels was 99.7%. Mean diameters of lymph vessels and veins were 0.65 mm and 0.81 mm, respectively. Skin incision length was 1.97 cm (range, 1.2-3.8 cm). Surgical time for each LVA was 21.7 minutes (range, 13-47 min). There were a reduction of limb volume index (281.2 vs 267.6, P = 0.002) and an improvement in the quality of life of patients (48.3 vs 21.9, P < 0.001).</p><p><strong>Conclusions: </strong>A standardized method can be followed to effectively perform the preoperative mapping of LVA using HFUS to reduce the limb volume and improve the quality of life of patients with lymphedema.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"163-169"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118640","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":"Clinical Efficacy of Double Skin Paddle Anterolateral Thigh Flap in High-Voltage Electrical Burns of the Wrist and Hand.","authors":"Lin Cheng, Qiang Dai, Wei-Li Du, Ke-Xin Che, Tong-Yu Cao, Yu-Ming Shen","doi":"10.1097/SAP.0000000000004370","DOIUrl":"10.1097/SAP.0000000000004370","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the clinical efficacy of a free double skin paddle anterolateral thigh (ALT) flap in treating 2 separate high-voltage electrical burn wounds affecting the wrist and hand.</p><p><strong>Methods: </strong>A retrospective observational study was conducted, involving 25 patients who met the inclusion criteria between January 2019 and December 2023. The initial treatment protocol included an early emergency fasciotomy and vascular reconstruction. This was subsequently followed by wound repair employing a double skin ALT flap in the next stage of treatment.</p><p><strong>Results: </strong>Twenty-five double skin paddle ALT flaps were utilized for treating wrist and hand burn wounds in 25 male patients, aged 15-61 years. They comprised 21 cases of classic double skin paddle ALT flaps, 3 cases of artificial double skin paddle ALT flaps, and 1 case of a flow-through double skin paddle ALT flap. The dimensions of skin flaps ranged from 8 cm × 6 cm to 22 cm × 13 cm. Twenty-five ALT flaps were utilized, with 22 surviving completely. Complications included venous congestion (1 case), arterial thrombosis (1 case), and abscess (1 case), all managed surgically. The donor site was directly sutured and healed primarily in 19 cases, while a partial-thickness skin graft was used for closure in the remaining 6 cases. During a follow-up period ranging from 3 to 22 months, both the recipient and donor sites exhibited satisfactory healing, with no reported episodes of infection or abnormal discharge.</p><p><strong>Conclusions: </strong>The utilization of a free double skin paddle ALT flap has led to satisfactory outcomes in treating 2 separate complex high-voltage electrical burn injuries to the wrist and hand. This technique achieves favorable reconstructive results, marked by minimal donor site morbidity, and it provides valuable insights into the management of similar cases.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"151-155"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118619","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":"Location, Payer Type, and Gender as Drivers of Burn Scar Reconstruction Utilization: A Burn Model Systems National Database Study.","authors":"Erin E Ross, Alyssa Bamer, Samuel Mandell, Jeremy Goverman, Barclay Stewart, Haig A Yenikomshian","doi":"10.1097/SAP.0000000000004360","DOIUrl":"10.1097/SAP.0000000000004360","url":null,"abstract":"<p><strong>Background: </strong>There are demographic and socioeconomic disparities in physical and psychosocial outcomes after burn injury. Here, we assess the demographic and geographic variation in utilization of burn scar reconstruction to assess if such barriers to these procedures may be contributing to disparities in outcomes.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using prospectively collected data from adults enrolled in the Burn Model System National Database between 2015 and 2022. Undergoing burn scar reconstruction, defined as surgery for burn scars or laser scar revision, by 24 months after discharge was compared across age group (18-64 vs 65+ years), gender, race/ethnicity, payer type, and enrollment site. Multiple logistic regression was used to assess use of burn scar reconstruction by demographic characteristics while adjusting for presence of range of motion deficits at discharge, hand burn, head/neck burn, and upper arm/shoulder burn.</p><p><strong>Results: </strong>In the unadjusted analysis (N = 836), burn scar reconstruction use by 24 months differed by age group (<0.001), race/ethnicity ( P = 0.014), payer type ( P < 0.001), and enrollment site ( P < 0.001). By multiple logistic regression (n = 717), burn scar reconstruction was associated with female sex (odds ratio [OR] 1.89, P = 0.002), workers' compensation (OR 3.41, P < 0.001), enrollment at site 1 or site 2 (OR 6.02, P < 0.001; OR 4.09, P < 0.001), hand burns (OR 2.35, P < 0.001), and upper arm/shoulder burns (OR 2.34, <0.001).</p><p><strong>Conclusions: </strong>Location, payer type, and gender were primary drivers of burn scar reconstruction use after adjusting for burn characteristics. Geographic variability in burn scar reconstruction use may reflect less dependence on surgery to achieve favorable functional outcomes; however, these differences may represent barriers requiring further evaluation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"146-150"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109524","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":"Plastic Surgery in the Context of Shifting Federal Funding Priorities: An Analysis of Residency Position Trends.","authors":"Anitesh Bajaj, Gabrielle C Rodriguez, Jason Zhang, Nikhil Sriram, Emily George, Parul Rai, Kathryn R Reisner, Arun K Gosain","doi":"10.1097/SAP.0000000000004371","DOIUrl":"10.1097/SAP.0000000000004371","url":null,"abstract":"<p><strong>Purpose: </strong>This study characterizes the number of trainee positions allocated to residency programs across surgical and nonsurgical specialties from 2010 to 2024.</p><p><strong>Methods: </strong>Data from the National Resident Matching Program and San Francisco Match were collected on entry-level trainee positions across specialties from 2010 to 2024. Entry positions into either the plastic surgery integrated residency (PGY-1) and independent positions were summed to evaluate \"plastic surgery (total)\" positions. Linear regressions analyzed changes in position numbers and year-over-year percent changes. The relative share of positions within surgical specialties and in total was calculated, along with the distribution of new PGY-1 residency positions across the study period.</p><p><strong>Results: </strong>Total PGY-1 positions offered by National Resident Matching Program rose from 22,809 in 2010 to 38,494 in 2024. From 2010 to 2024, the average surgical specialty gained 14.9 positions annually, and the average primary care field gained 208.6 positions per year ( P < 0.001). Primary care was allocated 54.3% of new PGY-1 positions in 2010-2011 and 70.4% of new PGY-1 positions in 2023-2024. From 2010 to 2024, 6.8 plastic surgery (total) trainee positions were added annually, compared with 14.9 in the average surgical specialty and 208.6 in the average primary care field. Entry-level plastic surgery (total) trainee positions increased in number by 59.6% from 2010 to 2024. From 2010 to 2024, the share of total positions occupied by entry-level positions in plastic surgery decreased by 0.04%, whereas the average primary care field increased its share of total positions by 1.4%.</p><p><strong>Conclusions: </strong>Entry-level positions in plastic surgery are growing at a rate comparable to other surgical specialties, but new PGY-1 positions heavily favor primary care, likely due to GME funding focusing on rural and underserved areas. To increase trainee numbers in the surgical specialties, including plastic surgery, training programs should enhance rural surgery rotations and highlight the demand for surgical specialists in those settings.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"196-200"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109545","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":"Optimizing Ventral Hernia Repairs With a Concomitant Panniculectomy: A Combined Approach Using Component Separation and Onlay Acellular Dermal Matrix.","authors":"Hector Caceres, Luke Anderson, Alexandra Savage, Edgar Alvarado Muñoz, Jorge de la Torre","doi":"10.1097/SAP.0000000000004361","DOIUrl":"10.1097/SAP.0000000000004361","url":null,"abstract":"<p><strong>Purpose: </strong>The use of a concomitant panniculectomy (PAN) during a ventral hernia repair (VHR) has been debated because of concerns of higher wound complications and longer operative times. However, PAN offers significant advantages including increased intraoperative exposure, improved patient quality of life, and offering an aesthetic benefit. In the treatment of large hernia defects the senior author utilizes the component separation technique with onlay placement of acellular dermal matrix (ADM). Additionally, the ADM is secured using progressive quilting suturing. This study aimed to evaluate the outcomes of patients who underwent VHR + PAN utilizing the component separation technique alongside onlay placement of ADM.</p><p><strong>Methods: </strong>A single-center retrospective analysis was conducted on the senior author's technique in treating VHR + PAN over 10 years. The patients were identified utilizing Current Procedural Codes for ventral hernia repairs and myofascial muscle flaps. Following identification of patients, they were further stratified for undergoing a panniculectomy. Patients treated without the use of onlay acellular dermal matrix placement or with fewer than 6 months of follow-up time were excluded from the study. Descriptive statistics were used to summarize the findings.</p><p><strong>Results: </strong>A total of 29 patients met the inclusion criteria, with the majority being obese (79.3%) and female (93.1%). Most patients (82.8%) had a history of previous hernia repair, with majority undergoing previous mesh placement. No hernia recurrences were observed during an average follow-up period of 21.3 months. Seromas were the most common postoperative complication (34.4%, all managed in clinic), followed by wound necrosis (20.7%) and infection (6.9%).</p><p><strong>Conclusions: </strong>Combining VHR with panniculectomy offers potential functional, aesthetic, and quality-of-life benefits while reducing the need for multiple surgeries, particularly in patient populations with large hernia defects and prior hernia repairs. The absence of recurrences and acceptable complication rates in this study highlights the safety and efficacy of utilizing the component separation technique with onlay placement of ADM secured by progressive quilting sutures. Further research with larger, multicenter cohorts is warranted to validate these outcomes and explore strategies for optimizing complication management.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"178-182"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101052","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}