Eplasty最新文献

What is the etiology based on the history and physical examination?Describe the embryology associated with orofacial clefts.What kind of treatment team is needed for orofacial clefts, and how do the team members work together?Describe the surgical treatment timeline and goals for orofacial clefts.

Background: The current practice of assessing wounds is highly dependent on visual examination and clinical judgment; these methods are highly subjective and leave great room for error. Objective measures of wound severity and healing are necessary tools that have been lacking in clinical practice. Long-wave infrared thermography (LWIT) has diverse applications that can be optimized to help detect and monitor wounds.

Methods: This work is a retrospective case series of pertinent patients encountered by the authors in clinical practice.

Results: Nine cases were ultimately selected to best represent the multitude of benefits that can be seen with the utilization of LWIT devices.

Conclusions: Through this case series, we show the many advantages of LWIT devices. This technology is safe, noninvasive, and user friendly and, most importantly, gives objective, instant, and repeatable measurements.

Background: Intraneural ganglia are a rare cause of common peroneal nerve palsy. Although several treatment modalities exist, surgical intervention is recommended, especially in the setting of neurological dysfunction. We present a case series and systematic review on the clinical outcomes following surgical excision of common peroneal nerve intraneural ganglia.

Methods: We performed a retrospective chart review of all patients who had undergone surgery for common peroneal nerve intraneural ganglia at Queen Elizabeth Hospital in Birmingham, UK, from 2012 to 2022. Demographic and pre- and postoperative findings were collected. A comprehensive literature search of MEDLINE and EMBASE databases was also performed to identify similar studies. Data were subsequently extracted from included studies and qualitatively analyzed.

Results: Five patients at our center underwent procedures to excise intraneural ganglia. There was a male preponderance. Pain, foot drop, and local swelling were the common presenting features. Postoperatively, all patients who completed follow-up demonstrated improved motor function with no documented cyst recurrence. The systematic review identified 6 studies involving 128 patients with intraneural ganglia treated with surgery. Similar findings were reported, with objective and subjective measures of foot and ankle function and symptoms improving after surgical intervention. The recurrence rate varied from 0% to 25%, although most recurrences were extraneural.

Conclusions: Excision of intraneural ganglia is associated with symptomatic relief and functional improvement. Recurrence rates are relatively low and are rarely intraneural.

Background: Across surgical specialties, tranexamic acid (TXA) is applied to reduce intraoperative and postoperative bleeding. Within plastic surgery, both topical and intravenous routes are used. The application of TXA has yet to be examined in vaginoplasties.

Methods: The authors performed a retrospective chart review of Mayo Clinic patients receiving penile inversion vaginoplasty from January 2017 through July 2021. Incidence of hematoma formation was assessed as the primary outcome. Secondary outcomes included perioperative hemoglobin, vaginoplasty complications, and possible TXA complications. These outcomes were compared across topical only (t-TXA), any intravenous (IV- TXA), and no TXA groups.

Results: Of the 124 vaginoplasties, 21 patients received t-TXA only and 43 received any IV-TXA. Only 4 patients developed a hematoma; 2 were from the no TXA group and 2 were from the any IV-TXA group. There was no significant change in perioperative hemoglobin across groups. Analysis showed lower incidence of divergent urine stream (odds ratio [OR], 0.499 [95% confidence interval (CI)], 0.316-0.789], P = .003) and neovaginal stenosis (OR, 0.435 [95% CI, 0.259-0.731], P = .002) within the any IV-TXA group and no increased incidence of other complications.

Conclusions: The use of either t-TXA or IV-TXA in vaginoplasty cases did not result in an increased rate of complications. There was no significant reduction in hematoma formation or postoperative hemoglobin decrease across groups.

Background: Dorsal augmentation is one of the more complication-prone procedures in rhinoplasty, demanding ample skill and experience to produce an aesthetic and functional result. Numerous autologous grafts, allografts, xenografts, and alloplastic materials have been attempted for augmentation with varying success. Each graft material has its own unique properties that require varying surgical intricacies. The relative risks and benefits of these strategies and materials are also variable and must be weighed. Alloplastic implants are commonly used in eastern countries, but, due to different patient populations and complication profiles, have found less acceptance among western surgeons.

Methods: A PubMed search was done using the terms "dorsal augmentation rhinoplasty," "liquid rhinoplasty," and "grafts used for rhinoplasty." Publication dates ranging from 1957-2022 were included. Abstracts were screened for relevance, and references from each article were reviewed to identify further articles. Chapters on dorsal augmentation from two key rhinoplasty textbooks were also reviewed.

Results: A total of 79 articles and 2 textbooks were formally screened; of these, 65 resources were included. Findings were grouped under the headings "facial analysis," "ethnic factors in graft selection," "graft characteristics," "septal cartilage," "auricular cartilage," "costal cartilage," "diced cartilage grafts," "bone grafts," "soft tissue grafts," "nonsurgical/liquid rhinoplasty," and "alloplastic implants."

Conclusions: Current dorsal augmentation literature focuses on retrospective studies and expert experiences. There are limited quantitative and prospective studies present to delineate an ideal graft. With consistently advancing technology and knowledge of facial aesthetics, a surgeon must maintain a thorough understanding of the current graft and implant options to offer a specialized treatment plan for each deformity and patient.

Background: The authors report the rare, but potentially blinding, complication of bilateral endogenous bacterial endophthalmitis observed in a 35-year-old man during his admission to a regional burns center following a burn injury from an electronic cigarette device. This complication has been reported only twice in burn patients following extensive and life-threatening burn injuries. This patient underwent surgical debridement and split-thickness skin grafting of non-major burns as per standard of practice. In the postoperative period, the patient developed bilateral eye pain, redness, and photophobia, and was subsequently diagnosed with bilateral endogenous bacterial endophthalmitis secondary to a Staphylococcus aureus infection of the burn wound. After ophthalmology input and treatment with systemic and intravitreal antibiotics, he made a full recovery from both his burns and endophthalmitis.

Conclusions: This report describes a rare, sight-threatening complication that arose from an infected burn wound in an otherwise healthy patient. It highlights the importance of prompt diagnosis and treatment to preserve vision and the need for burn surgeons to have a high level of awareness of this entity, even in the context of minor burns.

Background: Breast reduction is one of the most common procedures performed by plastic surgeons, and the inferior pedicle is a technique frequently used to maintain vascular supply to the nipple areolar complex (NAC). One of the relative contraindications for its use is the presence of a long nipple-to-inframammary fold (IMF) length; however, in the authors' practice, inferior pedicle mammoplasties have been successfully performed for over 10 years on almost all patients.

Methods: The authors performed a retrospective study including patients who underwent bilateral breast reduction with inferior pedicle technique from October 2009 to April 2021 by 2 different surgeons in New Orleans, Louisiana. Patient baseline characteristics as well as surgical outcomes were recorded.

Results: The study population consisted of 221 patients and 436 breasts. The average age of patients was 38 years, and average body mass index was 32.35 kg/m². Average follow-up time was 135 days. The average nipple-to-IMF distance for the patient population was 16.03 cm, and the average pedicle width of the inferior pedicles used for breast reductions was 10 cm. There was no incidence of total nipple necrosis. The most common complication was a superficial wound at the T junction of the breast reduction incision (23%).

Conclusions: Breast reductions with an inferior pedicle are safe to perform, without the risk of nipple necrosis, for all patients with inferior pedicle length up to 33 cm.

What are the clinical presentation and potential etiologies of giant lipomas?What is the appropriate imaging procedure for a neck lipoma?What are the differential diagnoses of a giant lipoma?What are the surgical approaches for a giant neck lipoma?

Background: Carcinoma cuniculatum is a rare variant of squamous cell carcinoma, mostly affecting the skin but also sparsely reported to occur in the oral cavity. Oral carcinoma cuniculatum (OCC) tends to be misdiagnosed as verrucous carcinoma; this may lead to inadequate treatment and recurrence due to the locally aggressive nature of the tumor. This report presents the case of a 56-year-old man with a progressively enlarging painful OCC at the maxillary right molar region, exhibiting both exophytic (red, soft, nodular mass) and endophytic (superficial ulceration and bone exposure, mimicking nonhealing extraction sockets) growth patterns. Incisional biopsy was consistent with OCC, a diagnosis that was corroborated through histopathologic examination of the resected specimen. The patient underwent en bloc resection (segmental maxillectomy) of the tumor and prosthetic rehabilitation with an obturator and remains disease-free 2.5 years postoperatively.

Conclusions: The aim of this report is to provide a thorough clinical imaging and histopathological presentation of OCC along with a brief literature review to highlight the difficulties of accurate diagnosis and the pitfalls in treating this uncommon entity.

Background: Primary explosion injuries with fireworks can lead to devastating and geometrically complex facial traumas that present a challenge to the reconstructive surgeon. Our patient, a woman in her early thirties, was hit directly in her chin by a large artillery shell firework. This caused complete soft tissue loss of the lower lip and chin beyond the oral commissures, complicated further by a comminuted mandible fracture.

Methods: After external fixation, our patient underwent a 2-stage reconstruction with a novel composite flap arrangement. Soft tissue coverage and lip reconstruction were performed with opposing bilateral radial forearm free flaps. The outer flap constituted the soft tissue of the new chin and outer lower lip, whereas the inner flap composed the intraoral lining. In the second stage, portions of the inner upper lip mucosa and superior orbicularis oris muscle were flipped down as a bipedicle, axial pattern "bucket-handle" type flap to the lower lip to reconstruct the vermilion. A graft of fascia lata was attached to the modioli of the orbicularis oris and interpositioned beneath the vermilion flap and the radial forearms to restore static and some dynamic sphincter control. One month later, the mandibular fractures underwent open reduction and internal fixation.

Results: Two months after soft tissue reconstruction with no complications, our patient had satisfactory aesthetic outcomes, oral competence, and speech.

Conclusions: This case has shown that use of bilateral, fascia lata-reinforced radial forearm flaps may be an effective choice for soft tissue reconstruction and oral competence restoration in cases of severe facial explosion trauma.