Eplasty最新文献

Background: Intraoperative contamination of the surgical field during aesthetic breast augmentation may lead to implant infection with devastating consequences. This study covers a period of 30 years and is divided into 2 phases: a retrospective phase from 1992-2004 when a standard approach was used and a prospective phase from 2004-2022 when a no-touch approach was implemented to avoid contamination.

Methods: Patients in the standard and no-touch groups underwent aesthetic breast augmentation by the same senior surgeon (FDP) in the same outpatient surgical facility during the 30-year period of the study. Patients are divided into 2 groups: from 1992-2004 and from the implementation of the no-touch protocol in 2004-2022.

Results: Patients who underwent breast augmentation using the no-touch approach developed no infections, whereas the standard group had an infection rate of 3.54% (P = .017). The validity of this finding is discussed.

Conclusions: The no-touch approach as described in this article was effective in reducing implant infection rate when performing aesthetic breast augmentation by 1 surgeon at 1 surgical center during an 18-year observation period. Multicenter prospective cooperative studies are necessary to validate perioperative iatrogenic contamination as the cause of implant infection and to explore optimal approaches that could eliminate implant contamination.

Background: Sternoclavicular joint infections (SCJI) are increasing with the opioid crisis and increased intravenous drug abuse (IVDA). Proximal clavicle resection with subsequent pectoralis muscle transposition is part of the treatment of such infections, but the long-term effects on shoulder function are not clear.

Methods: This report presents a consecutive series of 15 cases of SCJI treated with proximal clavicle resection and pectoralis muscle flap coverage. Patient-reported outcomes were recorded using the Shoulder Disability Questionnaire (SDQ) developed by van der Heijden et al.

Results: The average age of patients was 50 years (range, 23-73 years), with nearly half being male (7/15). Of these patients, 3 were lost to follow-up, 1 was excluded due to subsequent shoulder surgery for an unrelated problem, and another was excluded due to subsequent medical issues that precluded a reliable history. Recurrence was noted in 1 patient with ongoing IVDA. Average length of follow-up was 12 months (range, 8-19 months). The long-term shoulder disability was minimal (mean score of 6 ± 9). Among patients with IVDA, however, the long-term shoulder disability was significantly higher (mean score of 33 ± 16, P < .05).

Conclusions: In cases where the SCJI was attributed to IVDA, the long-term shoulder disability score was significantly higher, despite resolution of infection. Possible explanations include the self-reporting nature of the SDQ and the well-documented issues with chronic pain in patients with opioid dependency.  Of the patients lost to follow-up, 2 of 3 had infections attributed to IVDA, highlighting the difficulty of meaningful follow-up in this vulnerable patient population.

What is the purse-string suture (PSS) technique?When should this technique be used?What are the benefits and risks of the PSS technique?What are other clinical applications of the PSS technique in plastic reconstructive surgery?

What are the zones of the eyelid and the characteristics of this defect?What are the eyelid defect reconstruction options?What are the major potential complications of the eyelid defect reconstruction?How can the complications be avoided?

How common are penile amputations, and how are they treated?What key anatomic structures are involved?What are some technical pearls for a successful replantation?What are common complications, and how can they be prevented/treated?

What is an apocrine hidrocystoma?How does an apocrine hidrocystoma present?What are the histological features of an apocrinehidrocystoma?What is the treatment and prognosis?

Background. The combination of first webspace and dorsal hand contracture is a challenging reconstructive problem. Complete soft tissue release results in a large wraparound defect that spans the radial side of the palm, first webspace, and the transverse dimension of the entire dorsal hand. In these situations local tissue is often compromised, and free flap reconstruction is commonly indicated. However, in cases where patients are unwilling or unable to undergo microsurgical reconstruction, regional tissue transfer provides an alternative reconstructive strategy. This case report describes a series of 3 patients with severe combined contractures of the first webspace and dorsal hand. Each patient was relatively contraindicated for local or free tissue transfer and was treated with 2-stage selective contracture release with progressive dorsal then volar defect creation and coverage using a pedicled groin flap. This operation requires thoughtful planning during soft tissue release to coordinate staged, dorsal then volar, defect creation with the progressive liberation of the groin flap at its distal and then proximal ends.

Background. Lower extremity injuries in the pediatric population that are associated with Gustillo 3B/3C fractures require special consideration. Limb salvage should be attempted in the pediatric patient if at all possible, and oftentimes the soft tissue defect that is present over the bony fracture is substantial. The traditional algorithm used in the management of Gustillo 3B/3C fractures in plastic surgery, referred to as the reconstructive ladder, would recommend flap reconstruction with free tissue transfer in most cases because regional options are often unavailable or do not provide adequate coverage. Free tissue transfer procedures are extensive and necessitate a donor site; they often require multiple procedures and subsequent revisions. Furthermore, when concomitant injuries or medical conditions are present, a patient may not be an appropriate candidate for a free flap. Another option, however, does exist for the pediatric patient with a significant lower extremity injury that is often overlooked by the plastic surgeon. Several articles in the orthopedic literature describe the utility of temporary limb deformation to allow for soft tissue closure, with gradual correction of the bony deformity over time. Although the healing process for these procedures take several months, there is no need for extensive soft tissue reconstruction and the ultimate result is a leg that is functional with adequate coverage. This article reports a case where this type of bone and soft tissue reconstruction was performed in a patient with an excellent overall outcome. This technique could be useful in select cases as an option in pediatric lower extremity reconstruction.

Background: Head and neck reconstruction is challenging because of the functional requirements of movement, sensation, and cosmesis of this highly visible region. This study is the first to compare Novosorb biodegradable temporizing matrix (BTM) and Integra collagen-chondroitin silicone (CCS) skin substitutes for reconstruction of soft tissue head and neck wounds.

Methods: This retrospective review included adults who underwent wound reconstruction of the head/neck with either BTM or CCS between 2015 and 2020. Patient-level data, complications, and closure rates were compared.

Results: The review identified 15 patients: 5 who received BTM and 10 who received CCS. Mean age at dermal template placement was 55 (range, 28-79) years. Race, sex, smoking status, medical comorbidities, defect size, radiation history, prior surgeries, and follow-up time were not significantly different between groups. Wound etiologies for BTM and CCS included burn (40% vs 60%), trauma (20% vs 20%), surgical wounds (20% vs 20%), and skin cancer (20% vs 0%), respectively (P = .026). Skin grafts were placed in 8 (80%) wounds after CCS placement, compared with 3 (60%) after BTM (P = .670). Template reapplication was required in 2 (40%) BTM wounds and 3 (30%) CCS wounds (P = 1.0). Infection, hematoma, and seroma were comparable between groups, although skin graft failure was higher in the CCS group at 3 (37.5%) compared with 0 for BTM (P = .506). More secondary procedures were required after CCS placement (CCS, 1.9 ± 2.2; BTM, 0.9 ± 0.8; P = .090). Definitive closure in patients not lost to follow-up occurred in 4 (100%) BTM and 6 (75%) CCS cases (P = 1.0).

Conclusions: Head and neck wounds treated with BTM had comparable closure and complication rates as CCS bilayer and required fewer secondary procedures and skin grafts. These findings suggest that BTM is safe and efficacious for application in head and neck wounds and may be considered as an economical alternative.

Background. Cerebrospinal fluid leaks are the most common complication of endoscopic endonasal skull base tumor resection. The workhorse nasoseptal flap or other vascularized intranasal flaps may not be a viable option in patients who have previously undergone surgery or local radiation; in these cases, pericranial flaps may also be unavailable. Free flap reconstruction in patients undergoing endoscopic resection is challenging because of limited exposure. The transmaxillary approach has recently been reported for free flap reconstruction of these defects. This report describes a patient with a pituitary tumor who underwent craniotomy and resection of a pituitary mass via an endoscopic endonasal approach. Postoperatively, the patient developed a high flow cerebrospinal fluid leak that did not resolve with lumbar drain and attempts at endoscopic revision of nasoseptal flap. An adipofascial anterolateral thigh free flap was harvested, based on the descending branch of the lateral circumflex femoral vessels. An upper gingivobuccal sulcus incision was used to access the maxilla. Openings were created in the anterior and medial maxillary sinus to create a passage to the sphenoid sinus. The flap was inset into the defect via this transmaxillary channel. The pedicle was tunneled subcutaneously through the cheek to recipient facial vessels. The procedure resulted in complete resolution of cerebrospinal fluid rhinorrhea and pneumocephalus. Imaging at 18 months showed the flap in good position. This report describes the technique in detail along with a review of the current literature.