Annals of Plastic Surgery最新文献

{"title":"Comparison of the Effect of Delay Phenomenon and Quercetin Application on the Viability of Dorsal Skin Island Flaps in Rats: An Experimental Study.","authors":"Kübra Bi, Murat Livaoğlu","doi":"10.1097/SAP.0000000000004172","DOIUrl":"10.1097/SAP.0000000000004172","url":null,"abstract":"<p><strong>Background: </strong>Surgical delay is any surgical intervention performed 7-14 days before flap elevation, separating part of flap from its vascular bed and aiming to decrease flap necrosis. However, delay surgery needs to be planned and performed as a separate surgical operation. Quercetin is a flavonoid with anti-inflammatory, and vasodilator effects. This study compares the effects of quercetin and surgical delay on flap survival.</p><p><strong>Materials and methods: </strong>The study included 32 male Wistar rats divided into four groups: control group (group 1), surgical delay group (group 2), quercetin group (group 3), and both surgical delay and quercetin group (group 4). All dorsal skin island flaps were elevated based on deep circumflex iliac artery and 7 days were selected as waiting period after flap elevation, 50 mg/kg (0.5 mL) intraperitoneal quercetin administration period, and surgical delay period. Macroscopically flap necrosis rates were calculated and histopathological examination was performed to evaluate number of vessels, vessel lumen diameters, inflammation, epidermal damage, and dermal fibrosis scores. All rats were euthanized.</p><p><strong>Results: </strong>Flap necrosis rates, inflammation, epidermal damage, and dermal fibrosis scores of group 3 and 4 were found to be lower than group 1 and 2 ( P < 0.05). Vascular lumen diameter of group 2, 3, and 4 were found to be higher than group 1 ( P < 0.05) but no statistically significant difference was found for this parameter between group 2, 3, and 4 ( P > 0.05). The number of vessels were found to be higher in group 2, group 3, and group 4 compared with group 1, but this difference was not to be found statistically significant ( P = 0.534).</p><p><strong>Conclusions: </strong>This study shows that quercetin application is more effective in reducing flap necrosis rates and anti-inflammatory effect than surgical delay and also has superior effect in terms of vasodilation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"357-364"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799257","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 Rule of Fours-Clinical and Radiographic Parameters for Trans-articular Distal Interphalangeal Joint Kirschner Wire Insertion.","authors":"Conor Honeywill, Vanessa Giddins, Harrison Faulkner, Richard Lawson, David Graham, Brahman Shankar Sivakumar","doi":"10.1097/SAP.0000000000004157","DOIUrl":"10.1097/SAP.0000000000004157","url":null,"abstract":"<p><strong>Background: </strong>Distal phalangeal and interphalangeal joint injuries are common, and confer a significant burden to the individual, healthcare system and society. Operative intervention (when required) may involve retrograde trans-articular Kirschner wire (K-wire) fixation. Safe wire passage through the center of the distal interphalangeal joint (DIPJ) and associated phalanges is key in maintaining alignment and reducing complications. There is little evidence to guide optimal wire entry point and passage.</p><p><strong>Purpose: </strong>The aim of this study was to determine soft tissue and radiographic landmarks to guide optimal trans-articular k-wire placement at the DIPJ.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a single institute, with 100 uninjured lateral phalangeal radiographs with a clear sagittal projection assessed by 3 independent assessors. Each assessor drew a line of ideal insertion, traversing the isthmus of the middle and distal phalanges, and the midline of the DIPJ, with soft tissue and bony parameters identified.</p><p><strong>Results: </strong>The mean distance from the dorsal aspect of the nail plate to the line of ideal insertion was 3.86 mm, with a disparity between sexes noted. The distance from the dorsum of the soft tissue to the line of ideal insertion was expressed as a proportion of the total soft tissue diameter-the line of ideal insertion traversed approximately 40% of total width at the DIPJ and DIPJ soft tissue crease.</p><p><strong>Discussion: </strong>The results suggest that a simple 'rule of fours' can be utilized to allow expedient and optimal passage. The entry point should be midline in the coronal plane, approximately 4 mm volar to the dorsal surface of the nail plate and aimed at a point 40% volar to the dorsal aspect of the soft tissue envelope at the level of the DIPJ crease. These guidelines are easily replicable and conveyable; additionally, they can guide insertion in the absence of fluoroscopy.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"293-295"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765823","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":"Brachial Plexus Schwannoma: A Systematic Review of Clinicopathological Features, Surgical Outcomes, and Prognosis of 341 Cases.","authors":"Abdulaziz M Alghamdi, Mohamed K Alqazenli, Arwa Alghamdi, Tala Aletani, Dania E Faidah, Osama A Alkulli, Yousof F Allarakia, Abdulaziz B Fathi, Zahir T Fadel","doi":"10.1097/SAP.0000000000004224","DOIUrl":"10.1097/SAP.0000000000004224","url":null,"abstract":"<p><strong>Introduction: </strong>Although primary tumors of the brachial plexus (BP) are rare, schwannomas are the most frequently encountered type. This study evaluated the clinicopathological presentation, surgical outcomes, and prognosis of patients with BP schwannomas.</p><p><strong>Methods: </strong>A systematic review was conducted using PubMed/MEDLINE, Embase, and Cochrane on the 25th of March 2024. All English human studies that reported surgically managed BP schwannomas were included.</p><p><strong>Results: </strong>This review included 341 patients from 82 studies, with a mean age of 41.49 years and a female majority (55.72%). The most common clinical presentation was swelling, observed in 245 patients (71.85%). Surgical intervention was performed in all cases, with gross total resection (86.80%) being the most common approach. Surgical complications included new motor deficits in 41 (12.02%), sensory deficits in 33 (9.68%), and new-onset pain in 6 cases (1.76%). Prognostic information was available for all the 280 patients. At the last follow-up, only a small number of patients showed no postoperative improvement. Of the 164 patients initially presenting with pain, 3 (1.83%) reported persistent symptoms. In addition, continued sensory deficits were noted in 13 (8.67%) of the 150 cases, and continued motor deficits in 4 (9.30%) of the 43 cases. Furthermore, 14 (19.71%) of 71 postoperative new-onset symptoms persisted at the last follow-up. One (16.67%) of the 6 patients experienced constant pain. Additionally, sensory deficits persisted in 8 (28.57%) of the 28 patients, and motor deficits persisted in 5 (13.51%) of the 37 patients. No local recurrence has been reported.</p><p><strong>Conclusions: </strong>This systematic review highlights the complexity of BP schwannoma. Despite the occurrence of postoperative complications, the overall prognosis remains favorable with minimal rates of persistent preoperative symptoms and permanent surgical complications. Accurate diagnosis and effective surgical management are necessary to improve the outcomes of patients with this rare, yet clinically significant condition.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"330-339"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021890","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 on \"A Comparative Analysis of Patient-Reported Outcomes Following Free Tissue Transfer, Partial Foot Amputation, and Below-Knee Amputation in High-Risk Limb Salvage Patients\".","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1097/SAP.0000000000004165","DOIUrl":"https://doi.org/10.1097/SAP.0000000000004165","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3","pages":"396"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490563","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":"Could Periodic Laser Doppler Imaging Monitoring Enhance Insights Into Perfusion Challenges in Anterolateral Thigh Flaps? A 5-Year Retrospective Analysis.","authors":"Yow-Jye Shiue, Yu-Te Lin, Che-Hsiung Lee","doi":"10.1097/SAP.0000000000004200","DOIUrl":"10.1097/SAP.0000000000004200","url":null,"abstract":"<p><strong>Background: </strong>Postoperative monitoring after free flap transfer is challenging, and clinical observation alone remains subjective and unquantifiable. Furthermore, re-explored flaps often have a poor appearance, making it challenging for surgeons to decide whether further aggressive treatments are necessary. Laser Doppler (LD) imaging can provide noninvasive, real-time, and quantifiable monitoring for flap perfusion. This study aimed to utilize fixed-timing LD to assist in postoperative free flap monitoring, especially in re-explored flaps.</p><p><strong>Material and methods: </strong>We retrospectively analyzed free anterolateral thigh (ALT) flap transfers with at least 1 re-exploration surgery from 2018 to 2022. Fixed-timing LD scans were conducted once a day on weekdays, and the flux mean of the flap and its adjacent reference healthy skin was obtained via an LD imager. The perfusion index (PI) was calculated as the percentage difference of flux mean between the flap and the reference. Timing of compromise, surgical findings and flap outcomes were recorded. Re-explored cases were matched with non-re-explored cases by propensity score matching for age, sex, and recipient site. Receiver operating characteristic curves and Youden's index were used to identify a PI cutoff value to define flap compromise. Post re-exploration outcomes were categorized into flap survival, partial necrosis, and failure. Post re-exploration LD data were analyzed with the Wilcoxon test.</p><p><strong>Results: </strong>Forty-seven re-explored free ALT flaps were included. Ten re-explored cases with LD scans before compromise on postoperative day 1 were matched with 20 nonreopened cases. A PI threshold value < -0.62 could identify flap compromise with 80% sensitivity and 70% specificity. In the flap survival group, the mean PI mean was -0.61 ± 0.03 in 32 cases within 24 hours after re-exploration, which was higher than the PI threshold. A significant difference in PI mean was found between the survival and partial necrosis groups (-0.61 ± 0.03 vs -0.86 ± 0.02, P = 0.034).</p><p><strong>Conclusions: </strong>When facing uncertain circulation after free flap transfers, LD imaging can provide reliable and objective method for postoperative monitoring. A PI value ≤ -0.62 could identify free ALT flap compromise. This PI threshold value could be applied to re-explored flaps, providing an option to evaluate those in which compromise is suspected.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S69-S74"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490390","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 Management of Giant Basal Cell Carcinoma in the Maxillofacial Region: Ablative and Reconstructive Strategies.","authors":"Jure Pupić-Bakrač, Ana Pupić-Bakrač, Lovro Matoc, Josip Knežević","doi":"10.1097/SAP.0000000000004227","DOIUrl":"10.1097/SAP.0000000000004227","url":null,"abstract":"<p><strong>Introduction: </strong>Giant basal cell carcinoma (GBCC) is a rare and aggressive subtype of basal cell carcinoma (BCC), characterized by a diameter of ≥5 cm and a potential for deep tissue invasion. This study aimed to present our experience with the surgical management of GBCC in the maxillofacial region, focusing on resection and immediate reconstruction strategies.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 5926 patients with BCC in the maxillofacial region from 2010 to 2020, with a specific emphasis on 32 patients diagnosed with GBCC. Associations between patient and tumor characteristics were analyzed, treatment approaches evaluated, and clinical outcomes assessed.</p><p><strong>Results: </strong>The cohort comprised 20 males (62.5%) and 12 females (37.5%) ( P > 0.05), with a median age of 71 years (range: 40-86 years). The median time from tumor onset to presentation was 4 years (range: 2-7 years). A total of 24 GBCCs (75%) developed de novo, whereas 8 (25%) were recurrent BCCs ( P < 0.05). The median tumor diameter was 8 cm (range: 5-15 cm), with local invasiveness extending to cartilage in 31.25% of cases, facial muscles in 29.41%, neural tissues in 21.87%, and bone in 18.75%. Surgical resections included orbital exenteration (3 cases, 9.38%), total parotidectomy (2 cases, 6.25%), partial maxillectomy (2 cases, 6.25%), frontal craniofacial resection (2 cases, 6.25%), partial petrosectomy with mastoidectomy (1 case, 3.13%), and near-total rhinectomy (1 case, 3.13%). For reconstruction, a skin graft was used in 3 patients (9.38%), local skin flaps in 15 (46.88%), locoregional flaps in 10 (31.25%), and free flaps in 4 (12.5%). The 5-year overall survival, disease-free survival, and disease-specific survival for the cohort were 87.5%, 93.75%, and 96.88%, respectively.</p><p><strong>Conclusions: </strong>Our findings suggest that a single-stage procedure featuring aggressive surgical resection and reconstruction achieves low complication rates, excellent oncologic control, and acceptable cosmetic outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"312-319"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021894","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":"Comparison of the Outcomes of Perforator-Based Adipofascial Flaps and Local Muscle Flaps in Distal Lower Extremity Reconstruction: A Retrospective Study.","authors":"Chia-Chi Lee, Dun-Hao Chang","doi":"10.1097/SAP.0000000000004195","DOIUrl":"10.1097/SAP.0000000000004195","url":null,"abstract":"<p><strong>Introduction: </strong>Soft tissue reconstruction in the distal lower extremities is challenging because of the inherent vulnerability of tendons, bones, and implants to being easily exposed, and scanty local tissue makes it more complicated. Local flaps that avoid the donor-site morbidity and the need of microsurgery gain popularity among the treatment choices. This study aims to compare the outcomes of 2 common local flaps: adipofascial flaps and muscle flaps in distal lower leg reconstruction.</p><p><strong>Materials and methods: </strong>From November 2019 to November 2023, the patients with distal lower leg defects undergoing perforator-based adipofascial flaps or muscle flaps were included and reviewed. The patient demographics, injury characteristics, outcomes, and complications were evaluated.</p><p><strong>Results: </strong>A total of 32 patients were included in the study of which, 17 received perforator-based adipofascial flaps, and 15 received muscle flaps. The backgrounds of the 2 groups were similar, except that the patients in the adipofascial flap group were older and had more comorbidities. All flaps survived except for one muscle flap that failed. The flap survival, infection rates, and donor-site complications were comparable in both groups; however, the adipofascial flap group had less daily drainage volume and seemed to have a shorter hospital stay, although the difference was not significant (8.06 ± 3.33 days vs 11.93 ± 7.63 days, P = 0.085).</p><p><strong>Conclusions: </strong>For distal lower leg reconstruction, the adipofascial flaps are comparable to the muscle flaps but avoid the functional impairment. If available, the adipofascial flap can be considered as a prior treatment option, even for patients with implant exposure.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S75-S81"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490387","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":"Customized 3-Dimensional-Printed Finger Splints for Mallet Finger.","authors":"Chih-Chun Hou, Chin-Chieh Yi, Chien-Wei Wu, Sheng-Lin Tsai, Dun-Wei Huang, Yuan-Sheng Tzeng","doi":"10.1097/SAP.0000000000004190","DOIUrl":"10.1097/SAP.0000000000004190","url":null,"abstract":"<p><strong>Abstract: </strong>We aimed to evaluate the feasibility and effectiveness of customized 3-dimensional (3D)-printed finger splints in the treatment of mallet fingers. We categorized 21 patients into those who received the traditional finger splint (group A) and those treated with a customized 3D-printed finger splint (group B). We retrospectively analyzed the functional outcomes and patient satisfaction in the 2 groups. During the follow-up period, 3 patients in group A failed treatment, of which 2 underwent extended immobilization and one 1 transferred to surgery. All 3 patents in group B who failed treatment received extended immobilization and did not require transfer to surgery. In patient satisfaction assessments, group B patients scored better in dimension and comfort than did group A patients. Customized 3D-printed finger splints provided a more comfortable and fitting treatment option for mallet finger. Although they did not result in a significant difference in treatment success rate, these splints significantly improved patient compliance with treatment and wearing.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S9-S12"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490391","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":"Introduction of 2025 JTSPS for APS Supplement.","authors":"Tim-Mo Chen, Chih-Hsing Wang, Chieh-Feng Chen, Nai-Chen Cheng","doi":"10.1097/SAP.0000000000004231","DOIUrl":"10.1097/SAP.0000000000004231","url":null,"abstract":"","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 3S Suppl 1","pages":"S1-S2"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490409","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":"Outcomes of 100 Squamous Cell Carcinomas of the Upper Limb: 100 Squamous Cell Carcinomas of the Upper Limb.","authors":"Felicity Page, Darren Chester","doi":"10.1097/SAP.0000000000004225","DOIUrl":"10.1097/SAP.0000000000004225","url":null,"abstract":"<p><strong>Background: </strong>Rates of recurrence, metastases, and mortality for squamous cell carcinoma (SCC) of the upper limb have not been clearly defined.</p><p><strong>Objective: </strong>We aimed to characterize these tumors and assess the long-term outcomes, comparing with current literature.</p><p><strong>Methods and materials: </strong>A retrospective review was performed on 100 consecutive primary cutaneous upper limb SCCs managed surgically by a single hand surgeon between 2012 and 2019. Data collection included patient demographics and tumor factors from the electronic patient records.</p><p><strong>Results: </strong>One hundred SCCs were identified in 93 patients. Sixty-six percent of patients were male, and the median age was 80 years. Median follow-up was 25 months. Ninety-seven percent of cases were completely excised. The local recurrence rate was 1%, 2% presented with metastases, 4% developed metastases during follow-up, and the mortality related to SCC was 3% with a 33% overall mortality rate.</p><p><strong>Conclusions: </strong>SCCs of the upper limb behave in a similar manner to those located elsewhere. The local recurrence, metastases, and mortality rates were all low, as such the majority of upper limb SCCs can be managed effectively with a single, low morbidity procedure.Deep margin clearance can be particularly challenging to achieve and an acceptable margin should be considered on an individual basis.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"296-301"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057837","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}