Journal of Plastic Surgery and Hand Surgery最新文献

Surgical treatment of craniosynostosis includes a wide range of techniques. Although a variety of more extensive cranioplasties have been employed to enhance outcomes, efforts to identify less invasive surgical approaches with better results continue. Since the introduction of springs as a tool for craniosynostosis surgery in 1997 at Sahlgrenska University Hospital in Gothenburg, Sweden, several studies have established their utility as an efficient surgical method. Because springs are currently used in the majority of our surgeries addressing craniosynostosis in children, this review summarizes our extensive experience with this method in more than 750 surgeries.

Introduction: Free flap reconstruction procedures are renowned for their duration and the requirement for many staff and large quantities of equipment. This single-centre cross-sectional study aimed to quantify the total emissions related to two such procedures carried out at a district general hospital.

Methods: One deep inferior epigastric perforator (DIEP) free flap procedure and one anterolateral thigh (ALT) free flap procedure, both carried out in February 2024, were analysed. Data related to staff transport, anaesthetic duration, mass of disposable equipment, quantity of reusable surgical equipment and consumption of electricity and heating for the relevant theatre areas were collected. Emissions were calculated using UK government conversion factors and classified by scope and contributory element as per the Greenhouse Gas Protocol.

Results: Total emissions were estimated at 385.5 kgCO2eq for the DIEP and 369.6 kgCO2eq for the ALT. Scope 1 emissions related to heating, atmospheric release of general anaesthetic and incineration of waste accounted for 33.7% of DIEP emissions and 35.6% of ALT emissions. Scope 2 emissions related to the use of grid electricity accounted for 44.8% of DIEP emissions and 46.7% of ALT emissions. Scope 3 emissions related to staff transport, cleaning of reusable equipment and the supply chain for disposable equipment accounted for 21.5% of DIEP emissions and 17.7% of ALT emissions.

Conclusion: Significant reductions in emissions may be achievable without significant infrastructural changes through initiatives to reduce staff transport by single-occupancy car, improving the energy efficiency of the theatre areas and reducing the use of single-use surgical equipment.

Background: The quest for eternal youth has been a common theme in many cultures for centuries. While we have yet to discover a way to preserve youth eternally, we have made significant progress in understanding the aging process and in developing pharmaceuticals, surgical techniques, and technologies. In addition to rhinoplasty's facial beautification effect, we investigated whether it had a facial anti-aging effect using an artificial intelligence (AI)-based program. We also examined the correlation between patient satisfaction and the anti-aging effect of rhinoplasty.

Methods: This study included 244 patients who underwent functional septorhinoplasty (FSRP) between January 2018 and August 2020 at Inonu University, Department of Otorhinolaryngology. Preoperative and postoperative photographs in our archive were evaluated using an AI-based age analysis program. In addition, the participants evaluated preoperative and postoperative nose satisfaction with the FACE-Q survey in the postoperative period.

Results: One hundred two males (41.8%) and 142 females (58.2%) were included in the study. The mean preoperative age determined by the program was 25.9 ± 6.1, and the mean postoperative age was 25.7 ± 5.8. Despite the mean follow-up period of the patients was 25.3 ± 8.7 months, our study showed no significant difference between the mean preoperative and postoperative ages. The mean general satisfaction of the patients increased postoperatively.  Conclusion: Despite the average follow-up period, the absence of a significant difference between preoperative and postoperative perceived mean age may be interpreted as a possible anti-aging effect of rhinoplasty. This effect was more prominent in older patients and in women.

Longitudinal trends in breast reconstruction after modified radical mastectomy remain under described. This study aims to assess procedural trends in autologous reconstruction (AR) and implant-based reconstruction (IBR), to analyse demographic shifts in these patients, and to examine differences in oncologic management. This retrospective study utilizes the Surveillance, Epidemiology, and End Results (SEER) database to investigate trends in immediate breast reconstruction from 2000 to 2020 following unilateral modified radical and radical mastectomy. Demographic and oncologic variables were collected, and reconstruction types were categorised as IBR, AR, or a combination. Subgroup analyses compared IBR and AR patients, and demographic changes between the 2000-2010 and 2010-2020 cohorts were examined. Chi-square tests in R studio were used for statistical analysis. Of the 25,649 patients, 51.8% underwent IBR and 48.2% AR. AR patients were typically younger, more frequently Black, had higher incomes, and were less likely to live in rural areas compared to IBR patients. A shift from AR to IBR was observed, with AR decreasing from 41.8% in 2000 to 24.5% in 2020. Significant demographic changes in AR patients included increased age, higher proportions of Black and Asian patients, reduced income, and increased non-marital status. Oncologic management differed, as AR patients were less likely to have received chemotherapy and radiation prior to their reconstruction, and experienced longer reconstruction times compared to IBR patients. This study highlights a decline in AR and rising IBR popularity, and reveals evolving patient characteristics. Understanding these trends is crucial for equitable access and informed decision-making in breast cancer reconstructive care.

Dupuytren's contracture (DC) is often treated with limited fasciectomy (LF), while percutaneous treatment options are gaining popularity. The recent trends in the incidence rates of LF are not well known. Our study aimed to investigate the incidence rates of LF over time, and we collected nationwide data on all LF performed between January 1, 1997 and December 31, 2018. The main outcome variables were the incidence rates of first and subsequent LF for each patient per 100,000 person-years, calculated for each study year, gender, and age group. Data were obtained from the Finnish National Hospital Discharge Registry, which covers the entire population of Finland. Reporting to the registry is mandatory for all public and private hospitals, and the validity has been found to be excellent. All adult patients with a diagnosis code of M72.0 for DC and a surgical procedure code of NDM10 for LF were included in this study. The incidence rate of the first LF declined from 36.5 to 11.7, while the rate of subsequent LF increased from 2.3 to 14.0 from 1997 to 2011 and then declined to 9.3 in 2018. LF was performed significantly more often in men than in women (ratio 4:1). Additionally, it was performed significantly more often in patients between 60 and 79 years than in other age groups. Despite the estimated increase in the prevalence of DC, our data show that the incidence rate of first LF has declined, and there was no discernible consistent trend in the incidence of subsequent LF during the same period.

Background: Muscle sparing-transverse rectus abdominis flap has been widely used for breast reconstruction and the abdominal hernia or bulging at the donor site is relatively common complication. Previous studies have emphasized the fascial defects and the defect of muscle has been neglected. This study aims to investigate the relationship between the size of the rectus abdominis muscle defect and its impact on hernia or bulge formation after muscle sparing-transverse rectus abdominis flap.

Materials and methods: A retrospective study of patients undergoing unilateral or bilateral breast reconstruction with muscle sparing-transverse rectus abdominis myocutaneous flap was performed. We compared the patient group with postoperative abdominal hernia or bulging requiring surgery with the patient group without hernia. The surgical specific data of the size of rectus abdominis muscle defect, muscle sparing type and flap weight are analyzed.  Results: We conducted a survey on a total of 160 patients, of which six patients experienced abdominal hernia or bulging requiring surgery. Comparing patient group requiring surgical treatment for hernia or bulging with patient group without hernia, there was a significant difference of the width of rectus abdominis muscle defect. The cut-off value of the width was 4.5 cm.  Conclusion: When performing MS-TRAM, minimizing the resection of rectus abdominis muscle remains crucial, especially the horizontal width.

This qualitative systematic review aims to get a better understanding of what it means to live with a rare congenital craniofacial condition according to patients and their parents. Eight patient representatives provided input to this study. After a systematic search, 1,291 studies were screened and 32 qualitative and mixed methods articles (> 691 participants) were included. ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ), Cochrane, and COnsolidated criteria for REporting Qualitative research (COREQ) checklists were used for reporting qualitative evidence synthesis and assessment of reporting of included studies. Studies predominantly included parents' perspectives and used mixed samples of diagnosis and sometimes combined the parent and patient perspectives. The results sections of the articles were analyzed inductively using Thematic Synthesis (i.e. line-by-line coding, generating descriptive and analytical themes). Five analytical themes were identified that describe experiences and perspectives: (1) Healthcare experiences, (2) Raising and Growing up, (3) Development of character, (4) Physical impact of the condition, and (5) Social experiences. Underlying themes illustrate that the different aspects throughout life are intertwined, that relationships in all different domains play an important role in shaping perspectives, and that experiences may change over time. Furthermore, it demonstrates that living with a craniofacial condition and undergoing treatment is multifaceted and that the perspectives of patients and parents may differ. In conclusion, well-being and quality of life of patients and their parents are dependent on many different aspects, and surgeons and other healthcare professionals should tailor their skills, expertise, and support to individual-specific needs besides medical indications and move beyond surgical excellence.

Introduction: Hydrocephalus is more common in patients with craniofacial syndromes (CS) relative to non-syndromic craniosynostosis, and the optimal management is challenging. This study examined the prevalence and treatment outcomes of hydrocephalus among children with CS.

Materials and methods: We performed a retrospective review of medical records for all children with established CS and registered in the Gothenburg Craniofacial Registry between 1975 and 2022. This review included analyses of data regarding patient demographics, radiological imaging, hydrocephalus treatment modalities, and shunt revisions.

Results: Eligible patients (n = 193) included those with CS, including Pfeiffer (n = 13), Crouzon (n = 57), Apert (n = 49), Muenke (n = 25), and Saethre-Chotzen (n = 49) syndromes. A total of 22 patients (11.4%) presented hydrocephalus requiring treatment [Pfeiffer, n = 8 (61.5%); Crouzon, n = 13 (22.8%); and Apert, n = 1 (2.0%)]. Nineteen (9.8%) patients underwent ventricular shunt insertion, and three (1.6%) underwent endoscopic third ventriculostomy as a first procedure. None of the Muenke or Saethre-Chotzen patients required hydrocephalus treatment. Seventeen (85%) patients with shunts required revision mainly due to shunt obstruction. Pfeiffer patients had the highest risk of both developing hydrocephalus requiring treatment and needing shunt revision (p < 0.001 and p = 0.004, respectively). Approximately 40% of patients with Pfeiffer, Crouzon, or Apert presented ventriculomegaly not requiring treatment.

Conclusions: Hydrocephalus requiring treatment is common in Pfeiffer and Crouzon patients but rare in Apert, Muenke, or Saethre-Chotzen syndrome. Shunt treatment is often associated with complications that require revisions, emphasizing the importance of distinguishing non-progressive ventriculomegaly from hydrocephalus requiring treatment.

The peroneal artery perforator flap is widely used to repair deep defects in the distal lower leg and ankle. However, the success of flap transplantation depends on the accurate location of the peroneal artery perforators, which can be a challenge due to potential vascular damage and anatomical variations. This study utilizes digital subtraction angiography and high-frequency ultrasound to clarify the anatomical features of the peroneal artery and its perforators and accurately locate these perforators, thereby improving preoperative design and clinical outcomes. Peroneal artery perforator sequential flaps were employed to repair the wounds and donor sites, with the second donor site sutured directly. A total of 36 peroneal artery perforators were identified in seven patients, with an average of 5.14 perforators per patient. The majority of these perforators (47.22%) were concentrated in the middle segment of the lower leg. All flaps underwent tension-free primary closure and survived successfully, presenting a smooth appearance, a fine texture, and a color similar to that of the surrounding skin. Only a linear scar was left in the secondary donor site, which did not affect the overall appearance of the limb. This technique can accurately localize peroneal artery perforators, optimize the design of peroneal artery perforator sequential flaps, and facilitate the success of the surgery and postoperative esthetic recovery.

Purpose: Targeted muscle reinnervation (TMR) is a new technique for treating symptomatic neuroma, in which a sensory nerve after resection of a painful neuroma is coapted to an expendable motor nerve. There has been little information about optimal motor nerves for TMR of the vulnerable sensory nerves in the upper extremity.

Methods: Fourteen upper extremities of fresh-frozen cadavers were dissected to describe the anatomical course of the vulnerable sensory nerves, which included the superficial radial nerve, the dorsal branch of the ulnar nerve, and the medial and lateral antebrachial cutaneous nerves. The bifurcation, diameter, and entry points in muscles of expendable motor nerves suitable for TMR of the sensory nerves were investigated.

Results: The distal anterior interosseus nerve was available as a donor for TMR of the superficial radial nerve and the dorsal branch of the ulnar nerve in the distal third of the forearm. The motor branch to the pronator teres muscle was suitable for TMR of the medial antebrachial cutaneous nerve. It was possible to transfer the lateral antebrachial cutaneous nerve to the motor branch of the brachioradialis or extensor carpi radialis longus muscles.

Conclusions: The results of this anatomical study provide useful information when TMR is applied for neuromas of the sensory nerves in the upper extremity.