Journal of Plastic Surgery and Hand Surgery最新文献

Surgical intervention for metopic synostosis has been much debated but aims to correct trigonocephaly and hypotelorism while ensuring enough space for undisturbed brain growth. The aim of this study was to evaluate changes in partial intracranial volumes and the interfrontal angle following fronto-orbital advancement. Twenty-six non-syndromic metopic synostosis patients treated with fronto-orbital advancement at Uppsala University Hospital between 2012 and 2022 who had undergone computed tomography preoperatively and at age three were included, as well as 40 age- and sex-matched controls who had undergone computed tomography for post-traumatic evaluation. Demographic information, imaging, pre-, peri-, and postoperative data were collected. The frontal-, middle-, and posterior intracranial volume and their relative distribution were calculated in the softwares Craniosyn and ITK-SNAP 3.8.0. Preoperatively, patients had smaller interfrontal angles (p < 0.001), total intracranial volumes (p = 0.03), and frontal volumes (p = 0.02), compared with controls. At age three, the total intracranial volume (p = 0.96) and frontal volume (p = 0.51) did not differ significantly between patients and controls, whereas the interfrontal angle remained smaller in the synostosis group (p < 0.001). The relative intracranial volume distribution between frontal-, middle-, and posterior volumes did not match the distribution in healthy controls pre- or postoperatively, where the middle volume ratio was notably greater, and both the frontal- and posterior volume ratios were smaller in patients. Fronto-orbital advancement and subsequent growth improve the total- and partial intracranial volume in metopic synostosis to match the volumes of healthy controls at age three but does not restore the relative intracranial volume distribution.

Introduction: Preiser's disease refers to a rare idiopathic avascular necrosis of the scaphoid that often leads to pole collapse and poor clinical outcomes when managed conservatively. Vascularized bone grafting (VBG) using the 1,2 intercompartmental supraretinacular artery (ICSRA) flap has been used to restore perfusion, but its treatment efficacy across different disease stages remains unclear.

Methods: We retrospectively reviewed eight women (mean age 60.6 years) who were treated using 1,2 ICSRA VBG between 2006 and 2022. Disease stage was determined using the Herbert radiographic classification (one stage 1, four stage 2, and three stage 3 cases). Clinical parameters [grip strength, range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Mayo Wrist Scores] and radiographic progression were assessed after a mean follow-up of 3.6 years. Contralateral scaphoid morphology was evaluated to explore any potential anatomical predisposition.

Results: On average, there were improvements in grip strength (9.5 to 16.6 kg), dorsal flexion (49° to 65°), DASH score (49.5 to 10.6), and Mayo score in all cases. Radiographically, the stage 1 case did not exhibit any progression, one stage 2 case progressed, and all stage 3 cases progressed despite symptomatic improvement. Three patients exhibited type 2 scaphoid morphology, but no correlation with outcomes was observed.

Conclusion: VBG using the 1,2 ICSRA flap results in favorable clinical/radiographic outcomes in early Preiser's disease (stages 1-2), effectively preserving function and stability. In stage 3 disease, VBG may provide symptomatic relief but does not prevent progression. This warrants careful patient selection and consideration of alternative reconstructive options.

Objective: This study aimed to investigate the effects of the Enhanced Recovery After Surgery (ERAS) protocol on treatment compliance, psychological distress, and patient satisfaction in individuals undergoing radical surgery for axillary bromhidrosis.

Methods: In this randomized controlled trial, 150 patients scheduled for axillary bromhidrosis surgery were allocated to an ERAS group (n = 75) or a conventional care group (n = 75) using a computer-generated randomization sequence. The ERAS protocol included preoperative counseling, optimized fasting, intraoperative anxiety management, and structured postoperative rehabilitation. Outcomes were assessed via treatment compliance rates (defined as the sum of partial compliance [cooperation after prompting] and full compliance [voluntary cooperation]; non-compliance was resistance to treatment), Self-Rating Anxiety/Depression Scales (SAS/SDS), and a validated satisfaction survey. Statistical analysis was performed using SPSS 22.0.

Results: The ERAS group exhibited significantly higher total compliance (93.34% vs. 75.00%, P < 0.001) and satisfaction rates (89.33% vs. 79.00%, P = 0.012) compared to the control group. Both groups showed reduced SAS and SDS scores post-intervention (P < 0.05), with greater reductions in the ERAS group (SAS: 51.23 ± 5.26 vs. 58.45 ± 4.28; SDS: 53.44 ± 4.06 vs. 60.37 ± 4.72; P < 0.01).

Conclusion: Implementing the ERAS protocol improves patient compliance, alleviates perioperative psychological distress, and enhances satisfaction in axillary bromhidrosis surgery, supporting its integration into clinical practice.

The birth prevalence of cleft lip and/or palate (CL/P) varies globally, and regional differences have previously been observed within Sweden. Updated data on CL/P birth prevalence is needed and has been requested nationally and internationally. This study investigated regional differences and temporal trends in the birth prevalences of CL/P and specific cleft subtypes across Sweden's six health care regions (HC regions) from 2000 to 2020. Using data from the Swedish Medical Birth Register and the National Register of Congenital Anomalies (coverage 97-99%), the study included 2,230,771 children. Variables included were year and region of birth, and cleft diagnoses: cleft lip and/or palate (CL/P), cleft palate without cleft lip (CP), cleft lip with/without cleft palate (CL ± P), bilateral cleft lip with/without cleft palate (BCL ± P), and unilateral/bilateral cleft lip and palate (UCLP, BCLP). Poisson regression models were used to assess regional differences and trends. The Stockholm HC region had the lowest prevalence for all cleft types except CP. The Northern HC region had a higher CP prevalence, while clefts involving the lip (CL ± P, BCL ± P) were more common in the Southeastern and Southern HC regions. Declining trends were observed in at least two regions for all cleft types except CP. CL/P, CL ± P, and BCL ± P showed decreasing prevalence in three regions. The findings confirm some previously reported regional patterns, including a higher CP birth prevalence in northern Sweden. Potential explanations for the regional differences include genetic variation, differences in attitude towards pregnancy termination, socioeconomic factors, and exposure to other risk factors, but need further examination.

Background: The aim of study was to investigate the risk factors for free flap failure in the reconstruction of diabetic foot ulcers.

Methods: We retrospectively analyzed patient records collected from three teaching hospitals in Japan from April 2007 to March 2019. The exclusion criteria were potentially fatal severe systemic diseases and being unable to ambulate. We evaluated the risk factors associated with free flap failure in the reconstruction of diabetic foot ulcers. Univariate analysis and a multivariate logistic regression were used to identify the independent risk factors for free flap failure.

Results: A total of 86 patients were enrolled. Among all the records reviewed, 13 patients (15.1%) experienced free flap failure. According to the univariate analysis, 84.6% of patients in the failure group and 49.3% of patients in the success group had peripheral artery disease (PAD), and the difference was statistically significant (p = 0.031). The wound location and tissue donor site were not related to the result of surgery. The p values for sex (p = 0.134), white blood cell count (p = 0.183), serum calcium concentration (p = 0.066), and HbA1c level (p = 0.078) were lower than 0.2. Multivariate logistic regression analysis revealed that PAD was the major independent risk factor for free flap failure (OR = 6.076, 95%CI: 1.031-35.821).

Discussion: This study revealed that PAD was a major risk factor for free flap failure in the reconstruction of diabetic foot ulcers.

Introduction: An accurate preoperative estimation of deep inferior epigastric perforator (DIEP) flaps in breast reconstruction facilitates planning. Different methods have been proposed, but few methods have been validated for the degree of agreement with harvested volume, and none have been validated in a more significant cohort. This article aimed to validate the triangular prism method using computed tomography (CT) to estimate DIEP weight in routine clinical practice.

Methods: The triangular prism method, previously described by Nanidis, Ridha, and Jallali, uses CT to estimate DIEP flap weight, used in clinical practice in the department, was evaluated. The study included 1 year of consecutive patients, and data were extracted from the department's free flap audit registry. Bland Altman plots with mean bias and limits of agreement (LOA) with confidence intervals were drawn to estimate agreement between the estimated and actual flap weight.

Results and conclusions: A total of 164 DIEPs were recorded, and complete data were available for 119 DIEPs (73%). The mean estimated flap weight was 979 g (range: 251-2,125, SD [standard deviation] 448), and the actual flap weight was 937 g (range: 303-2,792, SD 461). The Bland-Altman plot showed that the estimated weight overestimated the actual weight by an average of 41 grams. However, the LOAs of -530 and 614 grams far exceed the a priori set limits of maximum acceptable difference (100 grams) between the estimated and the actual flap weight. Further studies are needed regarding how the triangular prism method can be combined with clinical measurements to become an easily used and reliable tool.

Background: The aim of our study is to investigate the preoperativeerative risk factors of the necessity of ulnar slip recection (USSR) in addition to A1 pulley release in patients with proximal interphalangael (PIP) joint flexion contracture.

Methods: Patients were divided into two groups. The patients who underwent A1 pulley release in group 1, and patients who underwent USSR in addition to A1 pulley release in group 2. Demographic characteristics, preoperativeerative Visual Analog Scale (VAS), Quick Disabilities Of The Arm, Shoulder, and Hand (qDASH), contracture degree, symptom duration, comorbidities, PIP joint tenderness, comorbidities, postoperative VAS and qDASH score information at the 6th month were obtained from the patient files.

Results: There were 13 male and 31 female patients in group 1 and 7 male and 24 female patients in group 2. The mean age was 61.67 years in group 1 (p = 0.506). PIP joint tenderness was present in 27 patients in group 1 and 37 patients in group 2 (p = 0.717). The average time from symptom onset to operation was 2.65 months in group 1 and 3.87 months in group 2 (p = 0.002). The mean preoperativeerative VAS was 3.34 in group 1 and 4.34 in group 2 (p = 0.001). The mean preoperativeerative qDASH score was 21.89 in group 1 and 25.14 in group 2 (p = 0.926). Preoperativeerative mean contracture degree was 17.02 degrees in group 1 and 22.18 degrees in group 2 (p = 0).  Conclusion: Higher preoperative VAS score, preoperativeerative symptom duration, PIP joint contracture and lower qDASH score lead to the need for USSR. Patients should be informed accordingly and surgery plans should be made accordingly.

Introduction: Patients undergoing curative treatment for soft-tissue sarcomas (STS) of the thigh bear the risk of developing lymphatic fistula and lymphedema. Innovative microsurgical concepts such as primary preventive lymphatic reconstruction show promising results. To discuss the likelihood of lymphatic complications after limb-preserving treatment of STS in the era before lymphatic reconstructive surgery and depending on the sarcoma location in the thigh became paramount in treating these patients.  Methods: We reviewed clinical data of 471 patients who underwent curative lower limb sarcoma treatment at our institution during the period from 2005 to 2019. We allocated patients into cohorts depending on the tumor location in the thigh respecting anatomical compartments as medial, posterior and the anterior compartment. We primarily analyzed incidences of postoperative lymphatic fistula and lymphedema.

Results: We included 69 patients into this study. Mean follow-up period was 36 months. The overall incidence of lymphatic complications was 69.6% (48 of 69 patients). Lymphatic fistulas in general (symptomatic and asymptomatic, ±lymphedema) were observed in 55% of all patients (38 of 69), whereas lymphedema occurred in 47.8% of all our patients (33 of 69). Lymphatic fistula alone occurred in 15 patients (21.7%) and lymphedema alone occurred in 10 patients (14.5%).

Conclusions: Incidences of lymphatic complications after limb-preserving curative treatment of STS of the thigh are high and vary depending on the exact tumor location. Medial and anterior thigh sarcomas are at high risks for lymphatic complications. Our results might facilitate selecting high-risk patients and aid in justifying preventive microsurgical strategies.

Introduction: Ganglion cysts are tumor-like formations that develop as a result of herniation of synovium around muscles, tendons, and joints. Sometimes recurrence develops after primary treatment and secondary treatment is planned as a result.  Objective: The aim of this study was to perform a retrospective analysis of plastic surgery treatment approaches and patient outcomes in 1,784 patients with ganglion cysts.  Method: The study type was descriptive and longitudinal. Patients were followed up from at least 6 months to 5 years after the primary ganglion cyst was treated. Data collection was retrospectively extracted from the patient records of the clinic where the study was conducted. Descriptive tests, chi-square test, and post hoc analysis were used for data analysis.  Results: The mean age of patients with ganglion cysts in this study was 34.49 ± 8.21 years, 61% were female. 83.4% had ganglion cysts in the upper extremity and 58.9% of them were localized in the dorsal wrist. For treatment, 36.3% underwent cyst excision and 23.6% underwent cyst resection. Recurrence occurred in 27.2% of the total number of patients. None of the patients with recurrence underwent a second cyst aspiration, 33.8% underwent cyst excision.  Conclusion: Ganglion cysts were mostly localized to the hand and wrist and needle aspiration may be preferred for diagnosis as it provides a definitive result as to whether the mass is benign or not. Recurrences after surgical excision, resection or joint arthrodesis were found in the literature.

Background: This study aimed to compare the repairing effects of reverse digital artery island flap and dorsal branch digital artery island flap on fingertip defects.

Methods: From January 2023 to January 2024, analyzed retrospectively clinical data of 41 patients with fingertip defects who underwent two kinds of surgery. There were 24 patients in the reverse digital artery island flap group and 17 patients in the dorsal branch digital artery island flap group. The size of the defect area of the affected finger, the range of motion (ROM) of the interphalangeal joint, the operation time, the hospital stay and the cold tolerance were evaluated and compared.

Results: There was a significant difference between the reverse group and the dorsal branch group in the ROM of the proximal interphalangeal joint of the affected finger. The appearance of the affected finger was significantly better in the reverse group than in the dorsal branch group. There was no significant difference between the two groups in the area of defect of affected finger, ROM of distal interphalangeal joint, operation time, hospital stays, function of affected finger and cold tolerance of skin flap.

Conclusions: Compared with the dorsal branch digital artery island flap, the reverse digital artery island flap can provide better hand appearance. However, in terms of proximal interphalangeal joint ROM , the effect of dorsal branch digital artery island flap is better than that of reverse digital artery island flap.