Annals of Plastic Surgery最新文献

{"title":"Leveraging Artificial Intelligence to Assess Perceived Age and Donor Facial Resemblance After Face Transplantation.","authors":"Sam Boroumand, Emily Gu, Omar Allam, Aliyar Zahedi Vafa, Lioba Huelsboemer, Viola A Stögner, Samuel Knoedler, Leonard Knoedler, Felix J Klimitz, Martin Kauke-Navarro, Siba Haykal, Bohdan Pomahac","doi":"10.1097/SAP.0000000000004334","DOIUrl":"10.1097/SAP.0000000000004334","url":null,"abstract":"<p><strong>Purpose: </strong>A major concern for patients undergoing facial transplantation relates to postoperative appearance. This study leverages artificial intelligence (AI) visual analysis software to provide an objective assessment of perceived age and degree of resemblance to the donor.</p><p><strong>Methods: </strong>Postoperative images of 15 face transplant patients were analyzed by Visage Technologies Visage|SDK™ AI facial analysis software to determine perceived age. A subgroup of eight face transplant patients, for which donor and patient pretrauma photographs were available, was analyzed using the same software to determine the percent similarity match to the patients' postoperative image. Mann-Whitney and Wilcoxon rank sum tests were utilized to evaluate for perceived age and facial recognition matching percentage, respectively.</p><p><strong>Results: </strong>AI perceived age was significantly more similar to the patient age (±3.5 years) than the donor age (±9.5, P = 0.0188). For facial resemblance, patients had a significantly higher average percent similarity match to their donor's face compared to their pretrauma native face (63% vs 57%, P = 0.0391).</p><p><strong>Conclusions: </strong>Although patients more closely resembled their donor's resemblance posttransplantation, their perceived age correlated more significantly with their actual age than their donor allograft age. The findings of this study provide a helpful framework for counseling prospective patients on their expected appearance postoperatively.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4","pages":"468-472"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673202","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":"Trends in Ancillary Procedures Following Staged Implant-Based Breast Reconstruction.","authors":"Annie B McVeigh, Matthew J Heron, Zachary H Zamore, Carisa M Cooney, Kristen P Broderick","doi":"10.1097/SAP.0000000000004313","DOIUrl":"10.1097/SAP.0000000000004313","url":null,"abstract":"<p><strong>Background: </strong>The shift from submuscular to prepectoral breast reconstruction has contributed to anecdotal changes in practices around ancillary procedures, such as autologous fat grafting and nipple-areola complex (NAC) reconstruction. Although prepectoral reconstruction carries a lesser risk for muscular injury, postoperative pain and animation deformity, it is associated with decreased soft-tissue coverage and may necessitate ancillary procedures. This study examines operative trends following staged implant-based breast reconstruction to determine if tissue expander (TE) plane is associated with changes in the utilization of supplemental procedures.</p><p><strong>Methods: </strong>We conducted a retrospective review using the TriNetX research database of deidentified patient data. Using Current Procedural Terminology codes, we identified adult female patients who underwent (1) mastectomy, (2) TE placement between 2013 and 2020, and (3) implant exchange. We grouped patients by year of TE placement and collected postimplant procedure characteristics.</p><p><strong>Results: </strong>We identified 10,984 patients who underwent TE placement between 2013 and 2020 and subsequent implant exchange. There were 854 patients in the 2013 cohort and 1634 in the 2020 cohort. Fat grafting was 2.76-fold more prevalent in the 2020 cohort compared to the 2013 cohort (43.0% vs 15.6%, P < 0.001). Notably, the percentage of patients undergoing more than one round of fat grafting increased from 4.1% in the 2013 cohort to 11.9% in the 2020 cohort (P < 0.001). Fat grafting at the time of implant exchange was also more common in later cohorts, increasing from 6.6% of patients in the 2013 cohort to 32.0% in the 2020 cohort (P < 0.001). Over the study period, rates of NAC reconstruction were observed to decrease. A total of 10.3% of patients in the 2020 cohort underwent NAC reconstruction compared to 24.6% in the 2013 cohort (P < 0.001). Nipple tattooing procedures were also performed less frequently in recent cohorts.</p><p><strong>Conclusions: </strong>In more recent cohorts, procedures aimed at correcting contour irregularities and rippling, specifically autologous fat grafting, have become more common. In contrast, the rates of NAC reconstruction and nipple tattooing have decreased, possibly because of challenges related to thin mastectomy skin flaps and limited soft-tissue coverage, which are more common in prepectoral reconstruction.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S168-S172"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750411","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":"Using Facial Recognition Software to Quantify Perceived Age Reduction in Patients Undergoing Blepharoplasty.","authors":"Jeffrey Khong, Alexandra J Davis, Oren Wei, Carisa M Cooney, Kristen P Broderick","doi":"10.1097/SAP.0000000000004319","DOIUrl":"10.1097/SAP.0000000000004319","url":null,"abstract":"<p><strong>Introduction: </strong>Changes to periorbital morphology, including decreased skin elasticity and ptosis, contribute to the appearance of an aging face. Consequently, many patients seek blepharoplasty surgery to address these changes. However, objective measures of surgical success remain sparse. Therefore, we investigated the ability of convolutional neural networks (CNNs) to assess differences in perceived age before and after blepharoplasty and examined correlations between CNN-generated results and human evaluations.</p><p><strong>Methods: </strong>Pre- and postoperative patient blepharoplasty images from inception through December 2023 were extracted from the American Society of Plastic Surgeons website. Patient age, follow-up time, gender, and type of procedure were recorded. Two CNN-based platforms, FacePlusPlus (Beijing, China) and Amazon Rekognition (Seattle, WA), were used to estimate patients' pre- and postoperative ages. Two trained volunteers rated patients' aesthetic changes using the Global Aesthetic Improvement Scale (GAIS). Statistical analyses to compare patients' pre- and postoperative CNN-estimated ages and factors associated with perceived age reduction included paired t tests, linear regressions, and ANOVA tests.</p><p><strong>Results: </strong>Ninety-four patients were included in the analysis (mean age, 52.4 ± 10.5 years; 84.0% female). Preoperatively, the CNNs estimated patients to be 2.4 years younger than their true ages (estimated age, 50.0 years; true age, 52.4 years; P < 0.05). Postoperatively, the CNNs perceived an average of 3.2 years of age reduction (estimated preoperative age, 50.0 years; estimated postoperative age, 46.8 years; P < 0.01). Perceived age reduction was not associated with gender, true preoperative age, or procedure type (P > 0.05). GAIS scores positively correlated with perceived age reduction (r = 0.33, P < 0.05). Patients estimated as older than their true preoperative age had greater CNN-perceived age reductions compared to those estimated as younger (5.0-year reduction vs. 2.3-year reduction, P < 0.05). The discrepancy between preoperative estimated age and true age correlated with postoperative age reduction (r = 0.31, P < 0.05).</p><p><strong>Conclusions: </strong>Convolutional neural networks quantified reductions in perceived age following blepharoplasty, with results aligning with human evaluations. CNN-perceived age reduction was greatest in patients who appeared older than their true age, particularly for those with larger discrepancies. These findings support the potential utility of CNNs as objective tools for assessing aesthetic outcomes and may help preoperatively guide patient expectations for postoperative age reduction.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S353-S358"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750528","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 Wound Healing Following Cervical Spine Surgery.","authors":"Michael P Saturno, Reanna Shah, Daniel Kwon, Olachi Oleru, Nargiz Seyidova, Jeffrey Russell, Andrew C Hecht, Arthur L Jenkins, Konstantinos Margetis, Peter J Taub","doi":"10.1097/SAP.0000000000004166","DOIUrl":"10.1097/SAP.0000000000004166","url":null,"abstract":"<p><strong>Introduction: </strong>The volume of cervical spine procedures continues to grow. Plastic and reconstructive surgeons (PRSs) commonly address complex wound-related issues in such cases. The present study investigates whether routine PRS closure of cervical spinal wounds improves outcomes compared with those performed without.</p><p><strong>Methods: </strong>Data of patients operated on for cervical spine procedures by the senior author (P.J.T.) between January 2016 and June 2023 were analyzed. Only posterior surgical approaches were included. Demographics, medical status, procedure indication, and surgical characteristics were reviewed. Wound-related and medical complications were examined within a 30-day postoperative period, along with incidences of unplanned reoperation or readmission. Outcomes were compared with 12,943 CPT-matched cases reported by the American College of Surgeons National Surgical Quality Improvement Program.</p><p><strong>Results: </strong>Five hundred eighty-eight cases were included: 511 (87%) were performed for degenerative spine conditions, 60 (10%) for traumatic injuries, 7 (1%) for neoplasms, 7 (1%) for congenital conditions, and 3 (0.5%) for infected cyst management. The PRS group demonstrated a greater prevalence of diabetes (27% vs 22%, P = 0.016) and chronic obstructive pulmonary disease (10% vs 6%, P < 0.001). Those who received PRS closure were less likely to return to the operating room (1% vs 3%, P = 0.005) or experience a wound-related readmission (2% vs 5%, P < 0.001).</p><p><strong>Conclusion: </strong>PRS closure of cervical spine cases minimizes the risk of reoperation and readmission, even among a population with comorbidities known to be associated with wound-related complications. Improved outcomes were especially observed for more complex wounds requiring local flap closure. Thus, there is strong evidence to support PRS involvement in cervical spine surgery.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S238-S242"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750760","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":"Aesthetic and Sensory Preferences for the Nipple-Areola Complex Among Postmastectomy Women.","authors":"Matthew J Heron, Siam K Rezwan, Sai L Pinni, Erica B Lee, Justin M Sacks, Kristen P Broderick","doi":"10.1097/SAP.0000000000004312","DOIUrl":"10.1097/SAP.0000000000004312","url":null,"abstract":"<p><strong>Background: </strong>Nipple areola complex (NAC) reconstruction is the final stage in breast reconstruction for many women. Although general population preferences on NAC aesthetics and sensation have been studied, it is unclear if these preferences align with the preferences of women who have undergone mastectomy. Therefore, this study aimed to assess the aesthetic and sensory preferences of women who have undergone mastectomy to inform subsequent NAC reconstruction and neurotization.</p><p><strong>Methods: </strong>We conducted a cross-sectional, Facebook-based, crowdsourcing campaign to distribute a survey on NAC aesthetics (e.g., position, size, pigmentation) and sensation to women with a history of mastectomy. Analyses assessed aesthetic and sensory preferences stratified by breast shape.</p><p><strong>Results: </strong>We received 109 responses from women with a median age of 51 years (interquartile range, 47-58 years). Most women were White (94%) and married (68%), with more than a high school education (83%) and a family income of $100,000 or more (39%). Their surgical histories included mastectomy (n = 109, 100%), autologous breast reconstruction (n = 59, 54.1%), implant-based breast reconstruction (n = 49, 45.0%), and NAC reconstruction (n = 26, 23.7%). On round breasts, respondents preferred NACs positioned in the middle of the vertical axis and laterally on the horizontal axis. On teardrop-shaped breasts, respondents preferred inferolateral NAC positioning. The most popular NAC diameter was one third the base width of the breast. Respondents preferred NAC pigmentation one shade darker than skin tone. Respondents indicated that NAC appearance, tactile sensation, and erogenous sensation were more important for sexuality and quality of life than for self-esteem, body image, or gender identity.</p><p><strong>Conclusions: </strong>Optimal NAC aesthetics included a NAC one third the base width of the breast, pigmented one tone darker than skin tone, and positioned in the middle of the vertical axis and laterally on the horizontal axis on round breasts or inferolaterally on teardrop-shaped breasts.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S145-S149"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750796","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 Primary Coaptation and Allograft in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Long-Term Sensory and BREAST-Q Outcomes.","authors":"Ashley Zhang, Sophia Salingaros, Sophia Arbuiso, Grant G Black, Marcos Lu Wang, Hao Huang, David Otterburn","doi":"10.1097/SAP.0000000000004266","DOIUrl":"10.1097/SAP.0000000000004266","url":null,"abstract":"<p><strong>Background: </strong>Loss of breast sensation after mastectomy and breast reconstruction is associated with decreased psychosocial outcomes and quality-of-life, spurring applications of peripheral nerve repair to autologous breast reconstruction. While direct nerve coaptation is the gold standard for neurotization, the development of nerve allografts has increased candidacy for neurotization. Herein, we investigate long-term sensory and BREAST-Q outcomes in patients receiving deep inferior epigastric perforator (DIEP) flap reconstruction neurotized by direct coaptation and nerve allograft.</p><p><strong>Methods: </strong>Patients with neurotized DIEP reconstruction with direct coaptation or nerve allograft were retrospectively identified and invited to undergo breast sensation testing with a pressure-specified sensory device. Patients also completed the Reconstruction and Breast Sensation modules of the BREAST-Q questionnaire.</p><p><strong>Results: </strong>30 patients (53 flaps) were included in this study, with 18 flaps reconstructed with direct nerve coaptation and 35 flaps reconstructed with an allograft. The overall breast cutaneous sensitivity measurement was 64.58 g/mm2 [40.06, 78.99] in the direct coaptation group and 78.28 g/mm2 [40.60, 82.06] in the nerve allograft group, with no significant differences overall (P = 0.680) or at any specific breast area. BREAST-Q surveys were completed at an average follow-up time of 94.42 months in the direct coaptation group and 61.56 months in the allograft group. The two groups had comparable scores for all survey scales (P > 0.05).</p><p><strong>Conclusion: </strong>DIEP flaps neurotized by direct coaptation and nerve allograft have comparable long-term objective and patient-reported breast sensation. Nerve grafting is a viable alternative for patients who are not candidates for direct end-to-end nerve coaptation.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S291-S296"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750803","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":"High-Volume Fat Grafting With and Without Goldilocks Mastectomies Show Successful Clinical Outcomes for Breast Reconstruction.","authors":"Shayan M Sarrami, Pooja Humar, Michael J Marallo, Eva Roy, Meeti Mehta, Carolyn De La Cruz","doi":"10.1097/SAP.0000000000004212","DOIUrl":"10.1097/SAP.0000000000004212","url":null,"abstract":"<p><strong>Abstract: </strong>High-volume fat grafting is an autologous reconstructive technique that provides women with a minimally invasive surgical option, yet there remains a paucity of literature examining details about the reconstructive timeline and outcomes of this procedure. This study presents a retrospective review of a single surgeon's experience performing total autologous breast reconstruction using fat grafting alone or in combination with Goldilocks mastectomies. Our population included 39 breast reconstructions in 25 patients. Nineteen patients (28 breasts) had fat grafting only and 6 patients (11 breasts) had Goldilocks and fat grafting. On comparison, the fat grafting only group averaged 4 grafting sessions while the Goldilocks combined group averaged 2.64 sessions (P = 0.03). In the fat grafting only group, the total average volume of fat injected into each breast was 664 mL, and it was not significantly different from the Goldilocks combined group with 495 mL of fat (P = 0.111). In the fat grafting only group, there was a similar amount of fat injected in the first 5 grafting sessions; following the 5th session, there was a significant drop in volume grafted (P < 0.001). Four fat grafting-related complications were reported (10%) and 3 patients developed seromas following their Goldilocks mastectomies (27%). There were no tumor recurrences. We can conclude from this data that high-volume fat grafting is a successful and safe form of breast reconstruction. We show good volume achieved with minimal procedures necessary, especially when combined with Goldilocks mastectomies. This study depicts a reliable timeline for this autologous and safe reconstructive option.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S233-S237"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750806","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":"National Analysis of Surgical Intervention for Orbital Floor Fractures: Implications on Early Versus Late Repair.","authors":"Chen Shen, Jennifer K Shah, Rahim Nazerali, Michael K Matthew","doi":"10.1097/SAP.0000000000004270","DOIUrl":"10.1097/SAP.0000000000004270","url":null,"abstract":"<p><strong>Introduction: </strong>The timing of intervention for patients with orbital floor fractures is controversial. Some data suggest that symptomatic patients have improved outcomes with early surgery, whereas other studies demonstrate equivalent outcomes even if patients were observed for weeks to months. Our study aims to evaluate national trends and safety outcomes of timing of intervention for isolated orbital floor fractures.</p><p><strong>Methods: </strong>From the Merative™ MarketScan® Research Databases, patients were queried from January 2007 to December 2022. ICD-9, ICD-10, and CPT codes were used to identify patients with orbital floor fractures, without entrapment, intracranial injuries, other face/skull fractures, or ocular injuries. Rates of enophthalmos and diplopia were examined relative to timing of intervention (no repair, early repair [≤2 weeks], or late repair [>2 weeks]).</p><p><strong>Results: </strong>Of the 75,882 patients identified, 11,728 were included in the study. The mean age was 39.11 years. A total of 174 (1.5%) presented with enophthalmos, and 721 (6.2%) presented with diplopia. Among the cohort, 9180 (78.3%) underwent no repair, 2043 (17.4%) underwent early repair, and 505 (4.3%) underwent late repair. Intervention was correlated with presentation of enophthalmos (OR, 7.960; P = 0.003) and diplopia (OR, 4.111; P < 0.001). Late versus early repair was not associated with presentation of enophthalmos (OR, 0.830; P = 0.453) or diplopia (OR, 0.956; P = 0.761). Provider specialty, specifically subspecialty providers, was significantly associated with undergoing early repair. At 1-year follow-up, enophthalmos and diplopia were diagnosed in 50 (0.5%) and 261 (2.8%) patients who underwent no repair, 87 (4.3%) and 296 (14.5%) patients who underwent early repair, and 24 (4.8%) and 70 (13.9%) patients who underwent late repair. Patients who underwent early repair were more likely to undergo revision surgery (OR, 0.245; P < 0.001). There were similar rates of enophthalmos and diplopia at 1-year follow-up between patients who underwent early repair versus late repair within the asymptomatic at day of injury cohort.</p><p><strong>Conclusions: </strong>Decision to intervene on orbital floor fractures is strongly correlated with symptoms on initial presentation. From our analysis, rates of enophthalmos and diplopia were similar at 1-year follow-up. Early repair was associated with providers of surgical subspecialties and multiple repairs.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S246-S252"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750814","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":"Sensation in Neurotized Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Different Donor Nerves: Comparing T11 and T12.","authors":"Ashley Zhang, Sophia Arbuiso, Marcos Lu Wang, Hao Huang, Grant G Black, Angela Ellison, David M Otterburn","doi":"10.1097/SAP.0000000000004257","DOIUrl":"10.1097/SAP.0000000000004257","url":null,"abstract":"<p><strong>Background: </strong>The deep inferior epigastric perforator (DIEP) flap can be reliably neurotized for autologous breast reconstruction. In standard fashion, a sensory branch of intercostal nerve T11 or T12 of the DIEP flap is coapted to the anterior cutaneous branch of T3 at the recipient site. In this study, we compare objective sensation recovery and patient-reported sensation, for DIEP flaps innervated by T11 versus T12.</p><p><strong>Methods: </strong>Patients undergoing neurotized DIEP flap reconstruction after mastectomy were prospectively identified. All nerve coaptation was performed with an allograft between T11 or T12 to T3; the donor nerve was selected by the surgeon based on intraoperative viability and appearance. Sensation testing was performed with a pressure-specified sensory device in the superior, medial, inferior, and lateral quadrants of the breast and at the nipple-areolar complex at specified time points. Patients were additionally invited to complete the Sensation Module of the BREAST-Q postoperatively.</p><p><strong>Results: </strong>Sixty-five neurotized DIEP flaps in 42 patients were included; 35 flaps innervated with T11, and 30 flaps innervated with T12. Preoperative breast sensitivity measurements were comparable between the two groups. In the first 6 months after reconstruction, breasts innervated by T12 were more sensitive in the medial quadrant (P = 0.019). Six to 12 months after reconstruction, the T12 cohort had greater sensitivity in most breast regions (P < 0.05). After 12 months, T12 sensation was superior in the inferior and lateral quadrants (P < 0.05). Postoperative patient-reported breast sensation and breast symptoms were similar, but patients with T12-innervated reconstruction had higher quality-of-life impact BREAST-Q scores, trending toward significance (72 [62-100] vs 62 [48.5-70.25], P = 0.309).</p><p><strong>Conclusions: </strong>DIEP flaps innervated with T12 have superior sensation recovery compared to flaps innervated with T11. Moreover, patients receiving flaps innervated with T12 report higher quality-of-life relating to breast sensation. When multiple viable donor nerves are available for coaptation, T12 may be the preferred choice due to its superior sensory outcomes.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":"94 4S Suppl 2","pages":"S271-S275"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750854","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":"Use of Intraoperative Manual Drainage for the Detection of Lymphatic Ducts for Lymphaticovenous Anastomosis.","authors":"Hideki Tokumoto, Shinsuke Akita, Rikiya Nakamura, Shouko Hayama, Mana Wada, Kentaro Kosaka, Yoshitaka Kubota, Nobuyuki Mitsukawa","doi":"10.1097/SAP.0000000000004324","DOIUrl":"10.1097/SAP.0000000000004324","url":null,"abstract":"<p><strong>Background: </strong>Manual lymphatic drainage (MLD) is a widely accepted conservative treatment for lymphedema. Lymphaticovenous anastomosis (LVA) is a minimally invasive bypass surgery that improves lymphedema. However, identifying the lymphatic duct can be challenging during LVA. Transient dilation of the lymphatic ducts can be accomplished with intraoperative MLD, which can definitively identify and isolate the lymphatic ducts. This study describes the use of this intraoperative MLD procedure.</p><p><strong>Methods: </strong>LVA procedures that used intraoperative MLD were compared with those that did not. The lymphatic diameter, LVA site, rate of cellulitis episodes, and indocyanine green (ICG) lymphography pattern characteristics between the 2 groups were compared. The surgeon performed MLD distal to the incision.</p><p><strong>Results: </strong>The intraoperative MLD drainage (+) and drainage (-) groups consisted of 269 and 189 anastomoses, respectively. The median lymphatic duct diameter in the drainage (+) group was significantly larger (0.6 vs 0.5 mm; P < 0.001). The drainage (+) group had significantly higher linear pattern rates preoperatively (76.2% vs 37.6%; P < 0.001), lower extremity (68.4% vs 51.9%; P < 0.001), distal site (81.8% vs 63.5%; P < 0.001), and postoperative improvement by local ICG lymphography pattern (22.7% vs 14.3%; P = 0.03). The rate of cellulitis episodes was significantly lower in the drainage (+) group.</p><p><strong>Conclusions: </strong>The successful detection rate of the lymphatic duct based on the intraoperative MLD was high on the distal side of the extremity and the lymphatic duct without sclerosis. This method was also effective for early-stage lymphedema.</p>","PeriodicalId":8060,"journal":{"name":"Annals of Plastic Surgery","volume":" ","pages":"447-451"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623311","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}