Journal of Plastic Surgery and Hand Surgery最新文献

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.

Purpose: Contralateral C7 nerve transfer (CC7) surgery has demonstrated success in restoring upper limb motor function after central nervous system injuries. However, deficits in finger extension limit patient independence. This study evaluates a nerve transfer that transfers the motor branch of the flexor carpi radialis (FCR) to the posterior interosseous nerve (PIN) to improve finger extension.

Methods: Two patients with chronic brain injuries, who showed minimal finger extension recovery for over 1 year after CC7 surgery, were enrolled. Both patients then underwent the nerve transfer procedure. Upper extremity motor function was measured using the Fugl-Meyer upper extremity scale (UEFM), and changes in muscle tone were quantified with the Modified Ashworth Scale (MAS). Regular follow-up evaluations were conducted over an 18-month postoperative period to monitor motor recovery and spasticity.

Results: Within the first postoperative month, both patients exhibited significant improvements in spasticity. Although a minor rebound occurred in the second month, spasticity levels stabilized in subsequent evaluations. By 18 months after surgery, one patient regained functional finger extension, underscoring the potential efficacy of the procedure. Importantly, wrist flexion, governed by the flexor carpi radialis, remained unaffected throughout recovery.

Conclusion: FCR-to-PIN nerve transfer alleviates spasticity and partially restores finger extension in patients with limited recovery following contralateral C7 nerve transfer. Although full motor recovery was not achieved, these findings offer promising clinical implications. Overall, the results support the procedure's value in clinical practice. Further studies with larger cohorts are needed to confirm these results and elucidate underlying mechanisms.

Background: Immediate lymphatic reconstruction (ILR) has emerged as an effective intervention to reduce breast cancer-related lymphedema, which affects 2-30% of patients who undergo axillary lymph node dissection (ALND). Our previous research validated ILR's effectiveness over 14 months, but the duration was short and warranted further study. This study provides long-term evidence of its benefits in a well-defined patient cohort.

Method: This retrospective cohort study included unilateral breast cancer patients who underwent ALND between November 2019 and February 2021 with ≥ 24 months of follow-up. Patients were grouped by whether ILR was attempted intraoperatively. Exclusion criteria were recurrence, prophylactic mastectomy, and pre-existing lymphedema. The primary outcome was lymphedema incidence at ≥ 24 months; the secondary was lymphedema-free survival. Outcomes were evaluated using Cox regression models.

Results: Among 73 patients, we analyzed ALND patients divided into a control group (n = 57, defined as no-try or failure) and an ILR group (n = 16). The pooled median follow-up was 37 months. (range, 26~47 months). Among the ILR group, 13 underwent end-to-end anastomosis and 3 end-to-side. Postoperative lymphedema was higher in the control group (24.6%) compared to the ILR group (6.3%). Multivariate Cox regression analysis showed a significantly lower hazard ratio for the ILR group (HR: 0.117, 95% CI: 0.014-0.965), emphasizing ILR's effectiveness in reducing lymphedema risk post-ALND. Additionally, survival plots illustrating lymphedema-free survival showed a significant difference.

Conclusion: Our study emphasizes ILR's efficacy over extended follow-up. The ILR group exhibited a lower rate of postoperative lymphedema, supporting ILR as an effective preventive measure against Breast Cancer-Related Lymphedema (BCRL) following ALND.

Background: This is the first exploratory investigation of the Essen Transidentity Quality of Life Inventory (ETLI) questionnaire administered to transgender men before and after mastectomy.

Methods: Eighty-two transgender men were enrolled in a cross-sectional study. Depending on whether a mastectomy had been performed, 42 patients were assigned to the preoperative and 40 to the postoperative group. Data collection included epidemiologic data, screening questions for comorbidities or mental disorders and three questionnaires (Short-Form Health Survey [SF-36], BODY-Q Chest Module and ETLI). The trial was registered at the German Clinical Trial Register under the number: DRKS00035156. Qualitative data were compared using the chi-squared test, and quantitative scores were analysed using the t-test. Effect sizes were determined using ANOVA. A p-value < 0.05 was considered significant.

Results: The average age of the participants was 26.9 years, with an average duration of hormone intake of 31.4 months and a BMI of 23.8 kg/m². The subscales mental quality of life (QoL) (p < 0.001), physical QoL (p < 0.001), social QoL (p < 0.001) and the global sum score (p < 0.001) of the ETLI showed significantly different scores in the postoperative group compared to the preoperative group. Similarly, the mental component scale of the SF-36 (<0.001) and the Body-Q Chest Module 'chest' (< 0.001) and 'nipples' (< 0.001) were significantly increased in the group after mastectomy.

Conclusion: The ETLI questionnaire is a viable tool to measure effects on the QoL and satisfaction with body image in transgender men, correlating with well-established scores.

Background: Research on the psychological development of infants with craniosynostosis would benefit from further properly validated tailored measures.

Aim: Our study aimed to translate and evaluate the Infant Characteristics Questionnaire (ICQ; Bates et al., 1979) for use with parents of infants with craniosynostosis in Sweden.

Methods: Participants included parents of 83 infants (67.5% boys) with isolated craniosynostosis (sagittal: n = 51, metopic: n = 32), and an average age of 184.7 days (SD = 67.1). Parents completed the ICQ and interviews were conducted with 22 of the families. The interviews were analyzed using conventional qualitative content analysis.

Results: Reliability in terms of internal consistencies were sufficient for the overall scale (α = .85), the Fussy/Difficult (α = .80) and Unadaptable (α = .76) subscales, close to acceptable for the Unpredictable subscale (α = .66), and low for the Sociable subscale (α = .45). Parents found the ICQ relevant for capturing important aspects of their infants' temperament, and the instructions and questions easy to understand. However, many parents noted that the question regarding their child's first reaction to solid food was not applicable and some suggested adding more questions about sleeping difficulties.

Conclusion: Overall, the ICQ seems to be acceptable to parents of children with craniosynostosis in Sweden - a prerequisite for continued use and development. Future studies should investigate additional psychometric properties, including factorial validity, to further establish its usefulness in Swedish populations, both with and without craniosynostosis.

This study investigated the birth prevalence of cleft lip and/or palate (CL/P) in Sweden between 2000 and 2020 using data from the Swedish National Medical Birth Register, which includes over 97% of children born in the country, and its subregister the National Register of Congenital Anomalies. The dataset included 2,230,771 anonymized children, with the variables year of birth, sex and diagnoses according to ICD-10. Computed variables were any CL/P diagnosis, cleft palate without cleft lip (CP), cleft lip with or without cleft palate (CL ± P), bilateral cleft lip with or without cleft palate (BCL ± P), unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and maternal smoking. Overall cleft birth prevalence was 1.52 / 1,000 births, with a yearly risk ratio of 0.989. Trends in the birth prevalences of different cleft types showed a decrease in CL ± P, BCL ± P, UCLP, and BCLP, while CP birth prevalence remained stable. CL/P, CL ± P, BCL ± P, UCLP, and BCLP were significantly more common in boys than girls, but the opposite was shown for CP. The overall birth prevalence was relatively coherent with previous findings, and the decreasing trend seemed to be attributable to the decreasing occurrence of visible clefts (CL ± P, BCL ± P, UCLP, and BCLP). Possible explanations for this are yet to be examined but could include better management of risk factors, demographic changes, or shifts in attitudes toward cleft pregnancy termination. The study provides reliable epidemiological data on CL/P, suggesting a decreasing birth prevalence and changing distribution of cleft types that may require future adjustments of cleft care protocols.

Introduction: Medial gastrocnemius flaps are commonly employed in conjunction with endoprosthesis implantations for the management of malignant tumors affecting the proximal segment of the tibia. This study aimed to evaluate the effect of the routine transfer of the muscle on the incidence of infections within the surgical field.

Methods: Forty-three patients presenting with a suspected malignant tumor in the proximal segment of the cruris underwent evaluation at our hospital. The enrolled patients were stratified into two cohorts. Patients in Group 1 (n = 16) underwent a combined procedure involving a medial gastrocnemius flap and a megaprosthesis, whereas patients in Group 2 (n = 17) did not undergo flap surgery.

Results: In Group 1, osteosarcoma (OS) was diagnosed in seven patients (43%). Subsequently, oncologic resection with a wide margin was performed on the affected bone region, resulting in an average defect length of mean 12.81 ± 5.05 cm. The patients in this group were followed-up for an average duration of 34.06 ± 13.21 months. Similarly, in Group 2, OS was present in seven patients (41.17%), and they underwent identical oncologic resection procedures. The mean defect length in Group 2 was measured at mean 14.12 ± 4.54 cm. The average follow-up period for patients in Group 2 was 30.41 ± 12.06 months.

Conclusion: Within Group 1, four patients (25%) experienced infections within the surgical site, while within Group 2, five patients (29.4%) exhibited such infections (p > 0.05). The utilization of megaprostheses in osseous defect repair, either alone or in combination with gastrocnemius flaps, did not yield statistically significant differences in infection rates.