Eplasty最新文献

Background: Reduction mammaplasty is one of the most common reconstructive procedures performed in plastic surgery. Multiple comorbidities play a role in postoperative wound healing complications; however, there are insufficient data on the subdermal plexus (SDP) as it relates to these comorbidities. The purpose of this study is to evaluate the relationship between body mass index (BMI) and SDP of the superficial breast tissues and examine the association between SDP and postoperative complications.

Methods: After Institutional Review Board approval, screening, and informed consent, patients undergoing reduction mammaplasty were selected. Tissue to be discarded was sent to pathology for analysis of immunohistochemistry directed against endothelial cells to determine the density of the SDP. Patients with BMI <35 and ≥35 kg/m² were compared. Statistical analysis, including 2-tailed t test and Pearson correlation, was conducted.

Results: A significant difference in SDP density (standard deviation) was identified between patients with a BMI ≥35 versus <35 kg/m² (2.65 capillaries/mm² ± 1.8 vs 1.56 capillaries/mm² ± 1.2; P = .033). Patients with no historical use of tobacco versus those who used tobacco showed a significantly increased SDP (2.11 capillaries/mm² ± 1.6 vs 1.20 capillaries/mm² ± 0.5; P = .009). A significant relationship between postoperative infection (1.00 capillaries/mm² ± 1.1; P = .041) and hematoma/seroma (0.788 capillaries/mm² ± 0.1; P = .003) was identified. No significant relationship was found between SDP and delayed wound healing, nipple-areolar complex complications, fat/flap necrosis, or symptomatic scar occurrence.

Conclusions: There is a statistically significant increase in SDP seen with increasing BMI, which does not explain the higher rate of wound healing complications after reduction mammaplasty typically seen in the higher BMI patient population. The association between BMI and complications after reduction mammaplasty remains unclear.

Background: Branchial fistulas are anomalies of embryonic development of the branchial apparatus, with the most common being second branchial fistulas. However, complete fistulas are infrequent and may relapse. Furthermore, they are difficult to manage without adequate treatment.

Methods: This article presents the case of a complete second branchial fistula in a 1-year-old female patient who had a sinus on the right side of the neck since birth. Excision of the fistula tract was performed without preoperative fistulography. The tract was then ligated and dissected immediately below the mucosa.

Results: The postoperative course was uneventful, and there was no evidence of recurrence.

Conclusions: Previous case reports have also demonstrated good outcomes without excision of the internal opening or tonsillectomy.

Background: The scapholunate interosseous ligament (SLIL) is an important contributor to wrist stability and functionality. SLIL injury is debilitating and therefore many surgical techniques have been proposed, but the optimal treatment modality remains debated.This meta-analysis reviews the available literature comparing surgical techniques used in the treatment of chronic SLIL to determine the best approach.

Methods: An electronic search of the literature was conducted to identify all randomized controlled trials and cohort studies published before January 2019 that evaluated clinical outcomes of capsulodesis reconstruction, the modified Brunelli technique, and the reduction and association of the scaphoid and lunate (RASL) procedure for treatment of chronic SLIL. A chi-square analysis was performed to identify possible differences between each technique for several outcome measures.

Results: A total 20 studies encompassing 409 patients met inclusion criteria. Average age among patients was 36.7 years, and 68.2% of patients were male. Reductions in visual analog scale pain scale; Disabilities of Arm, Shoulder, and Hand (DASH) scores; and increases in grip strength and range of motion were observed for all techniques. Capsulodesis was superior to the modified Brunelli technique regarding preserved range of motion.

Conclusions: No significant differences were observed among any of the techniques for pain, DASH score, and grip strength outcomes. Capsulodesis, modified Brunelli, and RASL surgical techniques for the treatment of chronic SLIL injuries may all be seen as reliable methods of treatment of chronic SLIL injuries. While future trials directly comparing these methods are needed, this study suggests there is no superiority of one technique over another.

Background: Injury to the neurological pathway that enables ankle dorsiflexion is likely to cause foot drop. This pathway includes the motor cortex; lumbosacral plexus; and the sciatic, tibial, and peroneal nerves. Nerve damage typically occurs due to compression, entrapment, traction, or direct trauma to the nerve due to several etiologies. However, there are limited reports on the incidence, etiology, and factors associated with foot drop.

Methods: The authors reviewed their clinic's data from 1022 patients with foot drop from 2004 to present to determine the incidence, causes, and risk factors of foot drop. Microsoft Excel was used for descriptive statistical data analysis and graphing.

Results: A total of 21 causes of foot drop were found. Of 1022 patients, 142 (13.9%) had foot drop after lumbosacral (LS) spine surgery, while 131 patients (12.8%) with LS spine complications who had not undergone surgery also reported foot drop. The LS spine complications and surgeries were influenced by age (median age, 63 and 55 years, respectively) and were marginally higher in male patients (54%). A total of 79 patients (7.8%) with foot drop had previously undergone hip replacement surgery. Older age (median age, 60 years) and female sex (85%) were risk factors for hip replacement surgery resulting in foot drop. In contrast, younger age and male sex were the risk factors for gunshot and stab wounds, injection drug use, drug or medication overdoses, and motor vehicle accidents resulting in foot drop.

Conclusions: Failed back surgery syndrome is the leading cause of foot drop after lumbosacral spine and hip replacement surgeries in both male and female older (median age, 60 years) patients. However, most (85%) of the foot drop patients in the present study who underwent hip replacement surgery were female patients. Sports and recreational activities, motor vehicle accidents, drug use, and violence are common causes of foot drop in younger male adults.

Background: The diagnosis and treatment of breast cancer can significantly affect a woman's health and well-being. Several studies have identified factors contributing to disparities in breast reconstruction among ethnic groups, but few have examined the experience of Hispanic women.

Methods: Hispanic women who had undergone breast reconstruction were interviewed in retrospective focus groups. Data were collected to identify themes that affected decision-making regarding the type and timing of reconstruction.

Results: Most participants chose to undergo reconstruction to regain normalcy and maintain their previous "feminine" appearance. Most (75%) received silicone breast implants, and 25% received autologous reconstruction. Safety was the most important consideration when choosing the type of reconstruction. All but 1 participant relied on a spouse or other family member for support during recovery. Although most found the experience overwhelming, they felt their community was supportive and encouraging throughout the process.

Conclusions: Several themes underlying the decision to undergo reconstruction were identified, including maintaining femininity and choosing the safest procedure. Overall, participants described the experience as overwhelming but found support from community and family. These findings, which could be applied broadly to women regardless of ethnicity, can be used to improve communication between surgeon and patient throughout the reconstruction process.

Background: Late-effect radiation-induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia, and wound chronicity all work to impair healing, and this becomes more pronounced when defects are large or when avascular structures such as bone are exposed. Effective treatment options for this type of wound are limited. Thorough excision of irradiated tissue followed by distal pedicled or free flap closure is the most successful; however, this often requires multiple-stage surgeries and prolonged hospitalization and is associated with significant donor site morbidity. This is complicated further when wounds are large or in difficult locations, when surgery is not appropriate, or when there is limited access to surgeons with the appropriate experience/skill to perform such procedures.

Methods: This case series describes the use of an autologous heterogenous skin construct (AHSC) made from a small full-thickness sample of the patient's healthy skin. Three patients with intractable late-effect radiation wounds were treated with AHSC. Case 1 describes an abdominal wound with tunneling of 7.5 cm to the pubic symphysis, which had been treated for known osteomyelitis, and a shallower full-thickness groin wound. Case 2 describes a right scapular wound with exposed bone, which had failed flap closure. Case 3 describes a right thigh wound in a patient who had been treated for sarcoma with extensive radiation therapy. This eventually resulted in an above-the-knee amputation, which failed to heal, and full exposure of the distal end of the resected femur. All wounds had been present for greater than 10 months.

Results: Mean percent volume reduction was 83% (±2.7) at 3 weeks and 92.9% (±4.7) at 4 weeks. The tunneled abdominal wound decreased in depth from 7.5 cm to 1.2 cm in 3 weeks. Complete closure was achieved at 11 weeks for the abdominal and groin wounds (patient 1) and at 16 weeks for the thigh wound (patient 3). The scapular wound volume of patient 2 had decreased by 91.8% at week 4 but was not fully restored until week 21. Mean time to closure was 16.1 (±4.7) weeks.

Conclusions: AHSC was effective in covering exposed bone, improving wound bed vascularity, filling in significant wound depth, and achieving complete wound closure with one application in patients with intractable late-effect radiation wounds.

Background: Pressure injuries (PIs) are a challenging problem in health care affecting 2.5 million people per year in the US, with 60,000 deaths directly attributed to PIs annually. Surgical closure is the treatment of choice for stage 3 and 4 PIs, but with complication rates of 59% to 73%, less invasive and more effective treatments are needed. Autologous heterogeneous skin construct (AHSC) is a novel autograft made from a small full-thickness harvest of healthy skin. This single-center retrospective cohort study sought to determine the effectiveness of AHSC in the treatment of recalcitrant stage 4 pressure injuries.

Methods: All data were collected retrospectively. The primary efficacy outcome was complete wound closure. Secondary efficacy outcomes included percent area reduction, percent volume reduction, and coverage of exposed structures.

Results: Seventeen patients with 22 wounds were treated with AHSC. Complete closure was achieved in 50% of patients in a mean time of 146 (SD ± 93) days, and the percent area and volume reductions were 69% and 81%, respectively. A 95% volume reduction was achieved in 68.2% of patients at a mean time of 106 (SD ± 83) days, and critical structures were fully covered in 95% of patients in a mean time of 33 (SD ± 19) days. After AHSC treatment, there was a mean decrease of 1.65 hospital admissions (P = .001), 20.92 hospital days (P < .001), and 2.36 operative procedures per year (P < 0.001).

Conclusions: AHSC demonstrated the ability to cover exposed structures, restore wound volume, and achieve durable wound closure in chronic refractory stage 4 PIs with better closure and recurrence rates than current surgical and nonsurgical treatments. AHSC represents a minimally invasive alternative to reconstructive flap surgery that preserves future reconstructive options while minimizing donor-site morbidity and promoting improved patient health.

Background: The objective of this study was to investigate the surgical repair techniques and the outcomes of sciatic nerve injuries in traumatic wounds.

Methods: A literature search was conducted using the following keywords:sciatic, nerve, repair, technique, conduit, graft, reconstruction, outcome, rehabilitation, recovery, function, surgery, and NOT anesthesia.

Results: In total, 715 studies were retrieved. After abstract review, 13 articles fit the criteria. A total of 2627 repairs were carried out, including nerve grafts (n = 953), suture (n = 482), and neurolysis (n = 1192). Six studies reported good motor outcome, and good sensory outcome was reported across 2 studies. The thigh region accounted for 81.5% of lesions. Sciatic, peroneal, and tibial nerves were all equally affected. Gunshot wounds were the most common mechanism of injury (22.6%).

Conclusions: The cumulative evidence demonstrates sciatic nerve injury repair has poor motor and sensory outcomes. This study shows there is a lack of standardized outcome measures, making comparisons very difficult. Graft lengths of <4 cm within the intermediate region yielded more successful outcomes. Further higher quality studies of nerve transfers in the lower limbs are needed to determine the optimal repair to restore sciatic nerve function.

Background: The forehead flap is a local transposition flap based on a pedicled vessel commonly used to reconstruct facial defects. Often patients requiring reconstructions are smokers, yet the effects of smoking on forehead flaps are not well defined. Our study is aimed to examine smoking as a preoperative risk factor for complications following forehead flaps.

Methods: This retrospective cohort study used data collected from the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2019. Multivariate logistic regression models were fitted to evaluate the association between smoking and development of wound complications.

Results: A total of 1030 forehead flaps cases were analyzed and separated into 2 cohorts based on current smoking status: 789 (76.6%) nonsmokers versus 241 (23.4%) smokers. No significant differences in rates of wound complications were found for nonsmokers versus smokers (2.7% vs 4.1%; P = .0807), including when adjusted for comorbidities in a multivariate logistic regression model (adjusted odds ratio, 1.297 [95% confidence interval, 0.55-2.9]; P = .5174).

Conclusions: Smoking has been demonstrated to be a risk factor for plastic surgery procedures. However, in our review of 1030 forehead flaps, smokers did not have worse outcomes compared with nonsmokers. Although it is still advised to recommend smoking cessation given multiple health benefits, smoking status should not preclude candidacy for facial reconstruction with a forehead flap based on complication risk.