Eplasty最新文献

Background: The umbilicus has historical significance regarding health and beauty principles. The visually pleasing aesthetic of the umbilicus has become a vital standard for the perceived success of an abdominoplasty procedure. While the ideal position and shape of the umbilicus have been studied extensively in literature, less is known about the optimal size. Herein, the authors provide a comprehensive literature review to help determine the ideal umbilical size.

Methods: A computerized search in the PubMed database was performed to identify articles that discussed ideal umbilical size.

Results: The review was performed in July 2022. A total of 21 articles were initially identified, only 6 of which discussed umbilical size. References from the included articles were also evaluated for relevance and resulted in 10 additional articles in the final review. Most of the articles indicated that a smaller umbilicus was found to be aesthetically pleasing, but a numerical range of values were not specified.

Conclusions: Although the literature on the ideal umbilical size is sparse, the consensus is toward a smaller, vertically oriented umbilicus.

Background: The pectoralis major musculocutaneous (PMMC) flap is a versatile and commonly used technique for reconstruction of the head and neck in patients at high risk in free tissue transfer procedures. In this report, a "supercharged" PMMC flap, in which the lateral thoracic artery was cut, preserved, and anastomosed to the cervical vessels, was developed to stabilize blood flow.

Methods: The supercharged PMMC flap was introduced in a patient who was at high risk for partial necrosis of the flap and underwent surgery for reconstruction of the tongue. Intraoperative perfusion monitoring using laser-assisted indocyanine green angiography (ICGA) was also performed to verify the status of blood flow in the flap.

Results: ICGA monitoring of blood flow in the flap revealed instability. Subsequently, a supercharged PMMC flap was applied, which prevented partial necrosis of the flap.

Conclusions: Combined with ICGA, a supercharged PMMC flap contributed to successful reconstruction in a patient at high risk for necrosis of the flap region.

Background: Soft tissue reconstruction of the leg should be relatively easy to perform, utilize viable tissues similar in skin texture and thickness to those lost, leave the most inconspicuous donor-site defect possible, and be performed without compromising other body parts. Evolution in flap surgery has enabled fasciocutaneous, adipofascial, and super-thin flaps to be harvested for the purpose of reconstruction, thereby minimizing morbidity from muscle inclusion into the flap. The authors present their experience with propeller flaps for reconstruction of soft tissue defects in the lower third of the leg.

Methods: This study included 30 patients (20 male, 10 female; aged 16-63 years) with moderate-sized leg defects. There were 18 posterior tibial artery perforator flaps, and 12 flaps were based on perforators of the peroneal artery.

Results: Soft tissue defect dimensions ranged from 9 cm² to 150 cm². Six patients developed complications, including infection, wound dehiscence, and partial flap necrosis. One patient had more than one-third flap loss, which was managed by regular dressing and later by split-thickness skin graft. Mean surgery duration was 2 hours.

Conclusions: The propeller flap is a useful, versatile option for coverage of compound lower limb defects for which there are limited alternative means of coverage.

Congenital upper extremity anomalies are common, with an incidence of 27.2 per 10,000 births.¹ This case series highlights patients with delayed presentation of congenital hand anomalies due to breakdowns in referral to pediatric hand surgery. A retrospective review of patients with congenital hand anomalies with delayed presentation to the University of Mississippi Medical Center Congenital Hand Center was performed, and 3 patients were included. Delays in care result from a variety of missteps for patients and parents navigating the health system. In our case series, we observed fear of surgical correction, lack of expected impact to quality of life, and paucity of knowledge of available surgical options by the patient's pediatrician. While all patients underwent successful reconstruction of their congenital hand anomalies, these delays in care resulted in more demanding surgeries and prolonged return to normal hand use. Early referral to pediatric hand surgery for congenital hand anomalies is critical to avoid delays in care and unfavorable post-operative outcomes. Educating primary care physicians of regional surgeon availability, surgical options, ideal reconstruction timelines, and methods to encourage parents to pursue surgical options early for correctable deformities can improve patient outcomes and lessen resultant social consequences in patients with congenital hand anomalies.

Background: Poly-4-hydroxybutyrate (P4HB) (Phasix) biosynthetic mesh was recently introduced as an alternative to synthetic and biologic meshes for ventral hernia repair (VHR). However, outcomes data are limited. This study aims to analyze outcomes of VHR with P4HB mesh and identify predictors of postoperative outcomes.

Methods: We performed a retrospective study of adults who underwent open VHR with P4HB by the senior author from 2014 to 2020 with >12 months' follow-up. Subgroup comparisons and multivariate logistic regression were performed.

Results: Inclusion criteria were met by 169 patients with a median of 15 months of follow-up. Overall, 21.9% had surgical site occurrences, 17.8% required reoperation, and 4.7% had recurrences. Patients with prior VHR (47.9%) experienced similar outcomes to those without. Patients with prior mesh infection (18.3%) had higher rates of postoperative mesh infection (6.5% vs 0.7%; P = .029) but did not have higher rates of reoperation. Retrorectus repairs (45.5%) had similar outcomes to onlay repairs (54.5%). Recurrence risk was increased by hypertension (odds ratio [OR] = 13.64; P = .046), immunosuppression (OR = 42.57; P = .004), and history of prior VHR (OR = 20.20; P = .014).

Conclusions: This study aimed to analyze outcomes of VHR augmented with P4HB mesh through retrospective review. VHR with P4HB mesh produces acceptable recurrence rates with favorable complication risks compared with biologic and synthetic meshes. Predictors of recurrence include a history of prior hernia repair, hypertension, and immunosuppression. A history of prior mesh infection seems to place patients at risk for developing subsequent infection but did not increase need for reoperation.

Background: Previous studies have shown that patients suffering from endocrine orbitopathy (EO) seem to present with profound asymmetry in proptosis. As asymmetry might pose a major problem in planning decompression surgery, information on the amount of variation between sides and a concise evaluation method should be available. Therefore, a study based on a concise 3D cephalometric analysis was conceived to evaluate globe position.

Methods: A 3D-cephalometric analysis was performed on computed tomography (CT) data from 52 orbitopathy and 54 control data sets. Using 36 anatomic landmarks, 33 distances were evaluated to measure sagittal, vertical, and horizontal globe position.

Results: EO patients presented with marked exophthalmos and statistically significant asymmetry. Depending on the 2 measured distances, 38% and 42%, respectively, presented sagittal asymmetry of >2 mm, and 12% and 13%, respectively, presented with sagittal asymmetry >4mm. No such asymmetry was seen in the control group. Furthermore, EO patients showed a larger interglobe distance due to lateral globe position. Marked asymmetry correlated with male sex. Proptosis measured to the deep bony orbit correlated with values measured to the orbital aperture or with constructed Hertel values.

Conclusions: Use of 3D cephalometry and CT-based analysis confirmed findings from previous clinical studies on profound sagittal asymmetry in EO. Endocrine orbitopathy leads to a sagittal-lateral globe displacement that is even more pronounced in the current study than in earlier investigations. Concerning surgical therapy, presurgical asymmetry, especially if profound, has to be considered to achieve an esthetic symmetrical outcome. Use of 3D orbital analysis is an appropriate method to describe globe position beyond clinical measurements.

Introduction: Soft tissue loss following total knee arthroplasty can result in catastrophic complications. Defects can be covered using various flaps and grafts, including fasciocutaneous flaps. Here, we discuss one case of double bipedicled "bucket-handle" local advancement flaps used for a nonhealing midline knee dehiscence wound following total knee arthroplasty.

Methods: Flaps were planned using perforators identified with forward-looking infrared (FLIR) thermal imaging. Two bucket-handle bipedicled flaps were used for repair. Autologous split-thickness skin grafts were used for the donor sites.

Results: FLIR imaging was used for flap monitoring. Apart from one site of superficial epidermolysis that healed with local wound care, there were no postoperative complications.

Discussion: This case demonstrates the successful use of double bipedicled local advancement flaps to reconstruct a defect following a total knee arthroplasty. These flaps minimize donor site morbidity, provide adequate coverage, allow for tension-free closures, and have reliable vascular supplies. FLIR thermal imaging is an accessible and useful tool in designing and monitoring flaps.

Background: Wide palatal defects remain a challenge to the plastic surgeon. The authors present a new method for closure of a wide Veau class II cleft palate in which anterior palatal closure was achieved by use of a bipedicled mucoperiosteal anterior palatal flap.

Methods: Two patients with wide Veau class II cleft palatal defects underwent palatoplasty with difficulty in closing the anterior palate. A novel technique was employed for tension-free closure.

Results: A tension-free closure in the midline was achieved with a bipedicled mucoperiosteal anterior palatal flap.

Conclusions: This novel technique can assist with closure of the anterior-most portion of hard palatal defects.

Background: Surgical site complications (SSCs) are not uncommon in plastic surgery procedures due to characteristics of the incisions and the patients undergoing such procedures. Closed incision negative pressure therapy (ciNPT) has been used to manage surgical incisions across surgical specialties. This systematic review and meta-analysis examined the impact of ciNPT on risk of SSCs following plastic surgery.

Methods: A systematic review was conducted to identify studies published between January 2005 and July 2021 comparing ciNPT versus traditional standard of care (SOC) dressings for patients undergoing plastic surgery. Meta-analyses were performed using a random effects model. A cost analysis was conducted using inputs from the meta-analysis and cost estimates from a national hospital database.

Results: Sixteen studies met the inclusion criteria. In the 11 studies that evaluated the effect of ciNPT on of SSCs, ciNPT use was associated with a significant reduction in risk of SSC (P < .001). ciNPT use was also associated with reduced risk of dehiscence (P = .001) and skin necrosis (P =.002) and improved scar quality (P = .014). Hospital length of stay was decreased by an average of 0.61 days for patients receiving ciNPT (P < .001). There were no differences in observed risk of SSIs (P = .113) and seromas (P = .143). While not statistically significant, a decrease in rate of reoperations (P = .074), fluid volume removed from the drains (P = .069) and drain days (-1.97 days, P = .093) was observed with ciNPT use. The estimated cost savings attributed to ciNPT use was $904 (USD) per patient.

Conclusions: The findings suggest that ciNPT may reduce the incidence of SSCs and related health care utilization and costs in plastic surgery procedures.