Plastic and reconstructive surgery最新文献

Background: Rhinoplasty and particularly tip refinement, is complex and prone to revision, especially in thin-skinned patients. To address these issues, the senior author developed a fascia-cartilage hybrid tip graft (FCHTG) combining crushed lower lateral cartilage with superficial mastoid fascia. This autologous, moldable, and pliable graft provides both support and contour refinement with minimal donor-site morbidity. This study evaluates the surgical outcomes of FCHTGs for nasal tip contouring in primary and revision rhinoplasty.

Methods: A retrospective review was conducted of all open rhinoplasty cases performed by a single surgeon from May 2021 to May 2024. Patients who underwent rhinoplasty with use of the FCHTG with a minimum 12-month follow-up were included in the study. Outcomes assessed included rate of post-operative infection and revision surgery.

Results: A total of 1,418 patients (90.9% female; mean age 31.4 years) met inclusion criteria with a mean follow-up period of 20.4 months. The overall infection rate was 1.8% (n = 17), with 2 patients requiring operative intervention related to infection. The revision surgery rate was 1.2% (n = 15), with the most common reason for revision being over-projected tip (n = 11).

Conclusions: The FCHTG is a safe, autologous grafting option for nasal tip contouring, providing structural support and improved aesthetics with minimal donor site morbidity. It demonstrates low complication and revision rates, making it particularly advantageous in complex or revision rhinoplasty cases, especially in patients with thin or scarred skin.

Summary: At the 2025 annual meeting of the American Association of Plastic Surgeons (AAPS), the Innovation, Dignity, Excellence, & Access (IDEA) Committee hosted a panel titled "Non-Traditional Leaders in U.S. Plastic Surgery: Challenges and Triumphs." The discussion featured Drs. Carolyn De La Cruz, Richard Baynosa, Harvey Chim, and Paris Butler, and was moderated by Dr. Milton Armstrong. Each panelist shared their distinctive professional journey, highlighting how integrity, diligence, and excellence transcend barriers of gender, race, and ethnicity. Their stories of perseverance, mentorship, and resilience in the face of marginalization serve as powerful inspiration for the next generation of surgeons.

Background: Peripheral nerve block (PNB) usage in breast reconstruction (BR) improves post-operative pain with minimal risks. This study examined outcomes of patients receiving PNB for post-operative analgesia in BR.

Methods: A retrospective analysis using the ACS-NSQIP database identified women that underwent BR from 2012-2021. Patients who received regional anesthesia in addition to general anesthesia were included. Patients that received other forms of anesthesia were excluded. Post-operative complications were compared between PNB and non-PNB groups, as well as among BR timing, modality, operative time and ASA class. Group differences assessed via t-tests and Fisher's Exact tests. Multivariate logistic regression assessed whether complications were independently associated with receiving PNBs.

Results: Out of 25,188 patients, 9,429 patients (37.4%) received PNB for perioperative BR analgesia. Patients that received PNBs had longer operative times, more wound complications, reoperations and readmissions. PNB usage was associated with increased likelihood of SSI even when BR modality, timing, operative time and ASA classification were isolated (p<0.05). Further, sub-group analysis revealed PNB use was associated with SSI for all BR modalities and timing.

Conclusions: The decision to use PNBs in BR should be made with awareness of the associated risk of increased wound complications. Despite that, benefits of PNBs may still very well outweigh these risks for all our patients. However, based on our findings we still suggest increased surveillance and more comprehensive consultation. Further research into the association of PNB usage and wound complications should be performed such that our patients can obtain maximal benefit and minimize unwanted side-effects.

Background: Tranexamic acid (TXA) is widely used in surgery to reduce perioperative bleeding, but concerns persist regarding its potential thromboembolic risks. This study evaluates the association between intraoperative intravenous (IV) TXA use and 90-day postoperative venous thromboembolism (VTE) risk in patients undergoing plastic and reconstructive surgery of the head and neck.

Methods: We conducted a retrospective cohort study using the Fortuna database, a national administrative claims dataset with over 200 million patients. Adult patients undergoing plastic and reconstructive surgery between 2010 and 2024 were identified using CPT codes, and whether they received IV TXA on the index day of procedure was determined. The primary outcome was VTE diagnosis within 90 days postoperatively. Use of enoxaparin or heparin was also documented. High-dimensional propensity score matching with inverse probability of treatment weighting (IPTW) was used to adjust for baseline demographics, comorbidities, medication exposures, and healthcare utilization. Logistic regression was used to evaluate the association between treatment and the binary outcome.

Results: A total of 1,011 patients received IV TXA and 157,959 did not. After propensity score matching, the two groups were well-balanced. The incidence of VTE was 0.2% in the TXA group, and 0.28% in the non-TXA group. Weighted logistic regression demonstrated no statistically significant difference in VTE risk (OR 0.62, 95% CI: 0.13-3.04, p = 0.55).

Conclusions: IV TXA use was not associated with increased postoperative VTE risk in plastic and reconstructive surgery of the head and neck, supporting its continued use as a safe hemostatic adjunct in this patient population.

Introduction: Mandibular distraction osteogenesis (MDO) is a critical intervention for addressing severe upper airway obstruction in infants with Robin Sequence (RS). Nonetheless, this procedure carries a risk of facial nerve dysfunction (FND), particularly affecting the marginal mandibular nerve (MMN). Since 2019, our group has prospectively monitored real-time facial nerve conduction using electroneurography (ENoG) during MDO procedures. This pilot study evaluates nerve conduction changes and their potential association with postoperative clinically visible FND.

Methods: Nine infants with RS undergoing MDO from 2019-2024 were randomly selected from a prospectively enrolled cohort. ENoG recorded motor responses from the orbicularis oculi and mentalis muscles. Significant changes were defined as a peak latency increase of ≥10% or an amplitude decrease of ≥60% from baseline.

Results: Twenty-five unilateral procedures [osteotomy/placement of hardware (18); hardware removal (6); revision (1)] were analyzed by a certified ENoG technician. Median age at surgery was 11.4 months (IQR 2.4-42.7). Retraction during osteotomy was the surgical step most associated with a significant amplitude decrease in 83.3% of cases, while device activation caused the most frequent peak latency increase in 44.4% of cases. Temporary MMN dysfunction was observed after four procedures (16.0%). Sensitivity/specificity were 17.6%/87.5% while NPV was 84.8%.

Conclusion: This prospective pilot study suggests intraoperative risk of MMN injury during MDO is greatest during retraction for osteotomy and device activation. With an NPV of 84.8%, ENoG predicted the absence of postoperative FND when there were no significant conduction changes. Further research is necessary to confirm its diagnostic utility and establish standardized pediatric intraoperative ENoG thresholds.

Background: Autologous breast reconstruction improves quality of life after mastectomy but carries a significant risk of postoperative complications. Body Mass Index is commonly used for risk stratification, despite limitations in reflecting body composition and fitness. This prospective study aimed to identify more optimal predictors for complication risk, including cardiopulmonary condition, smoking history, and body fat composition.

Methods: In this prospective study, patients undergoing DIEP-flap reconstruction were assessed preoperatively with cardiopulmonary exercise testing and abdominal CT angiography. Subcutaneous adipose tissue, visceral adipose tissue, and intramuscular adipose tissue were measured from CT images. Complications were classified using the Clavien-Dindo system. Predictors of postoperative complications were identified using logistic regression and validated in an independent cohort.

Results: Postoperative complications occurred in 46% of the 39 enrolled patients, with 33% requiring medical intervention (CD grade ≥ II). Physical fitness, measured using CPET, was not associated with CD≥ II complications. In multivariable analysis, only SAT and smoking history were independent predictors of complications, explaining 56% of the variance. A SAT threshold of 451 cm² for non-smokers and 204 cm² for patients with smoking history was identified, achieving 100% sensitivity and 77% specificity. Validation in an independent cohort confirmed the predictive value of SAT (AUC 0.715).

Conclusion: Physical fitness and BMI were not independent predictors of postoperative complications. SAT and smoking history were stronger predictors and can be easily accessed through routine CT imaging. These findings support the use of SAT as a practical, more accurate risk stratification tool for autologous breast reconstruction candidates.

Background: Gummy smile (GS), defined as excessive gingival display, compromises facial harmony and self-confidence. Traditional treatments, including orthognathic surgery, botulinum toxin (BTX-A), and lip repositioning, carry limitations in invasiveness, durability, or adaptability. Micro-Autologous Fat Transplantation (MAFT) presents a minimally invasive alternative by volumizing the upper lip and modulating perioral biomechanics.

Methods: A retrospective study was conducted on 52 patients (mean age: 43.4 years; 92.3% female) who underwent MAFT for GS correction between 2014 and 2023. Fat was harvested, purified, and micro-injected using the MAFT-GUN® into the nasolabial groove, ergotrid, and upper lip. Gingival exposure was measured at four maxillary incisor regions pre- and postoperatively. Patient satisfaction was assessed via a 5-point Likert scale; mean follow-up was 56.4 months.

Results: Mean preoperative gingival exposure (3.31 mm) significantly decreased to -0.82 mm postoperatively (p < 0.00001), with a mean reduction of 4.13 mm. The right central incisor showed the greatest improvement. Satisfaction scores increased from 1.40 to 4.90. Mean injected fat volume was 16.1 mL (SD: 3.4 mL), with a calculated graft weight of 14.8 g. No significant correlation was found between volume and outcome (p > 0.40), suggesting anatomical responsiveness. Only two patients (4%) required minor touch-ups; no major complications occurred.

Conclusions: MAFT is a safe, effective, and durable treatment for GS. By harmonizing perioral musculature and preserving dynamic lip movement, it bridges the gap between temporary neuromodulators and invasive surgeries, offering a reproducible, minimally invasive solution with long-term aesthetic and functional benefits.

Background: Artificial intelligence (AI) has been integrated into diagnostic modalities like nerve conduction studies (NCS) and ultrasound (US) to improve their performance in detecting idiopathic median neuropathy at the carpal tunnel (IMNCT), and its signs and symptoms referred to as carpal tunnel syndrome (CTS). AI could be a useful tool for streamlining diagnosis to improve accessibility and efficiency of CTS diagnosis. This systematic review evaluated AI diagnostic accuracy for CTS.

Methods: This review was registered with PROSPERO (CRD42024606291) and adhered to PRISMA guidelines. Searches were performed across Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL. Studies were included if they involved AI models (index test) in CTS diagnosis, where the reference standard was established by US, NCS, and/or clinical diagnosis. Results were synthesized via bivariate analysis to calculate pooled sensitivity, specificity, area under the curve (AUC), and positive and negative likelihood ratios (LRs).

Results: Twenty studies were included, with 17 assessing AI's diagnostic accuracy and four evaluating its ability to classify CTS severity. Half of the studies utilized US as the reference standard, followed by NCS (30%). The AI models demonstrated a sensitivity of 0.884 (95% CI, 0.862-0.903), specificity of 0.892 (95% CI, 0.859-0.918), AUC of 0.936, LR+ of 8.260 (95% CI, 6.220-10.800), and LR- of 0.131 (95% CI, 0.108-0.150) in diagnosing CTS. The overall certainty of the evidence was rated as moderate.

Conclusion: AI models show promise in reliably diagnosing CTS, which can serve as a useful adjunct in the clinic to promote efficiency and workflow while standardizing diagnostic practices.

Background: The periorbital area is susceptible to aging and structural changes, resulting in sunken eyelid deformities characterized by a hollow upper eyelid and pronounced orbital bone prominence. Conventional treatments, such as dermal fillers and fat grafting, have limitations in providing consistent and lasting results.This retrospective study introduces the endoscopic Retro-Orbicularis Oculi Fat (ROOF) transposition technique as a novel approach to correct sunken eyelid deformities and enhance lateral orbital convexity.

Methods: Twenty-six patients (25 female, 1 male; mean age: 34, range: 24-44) with noticeable supraorbital rim prominence and no excess upper eyelid tissue underwent endoscopic ROOF transposition between January 2021 and January 2024 were included. The procedure was performed through minimal scalp incisions with endoscopic visualization. Twenty-four patients also had concurrent endoscopic midface and temporal lift procedures, while two underwent forehead lift. Preoperative and postoperative images were evaluated at the 12-month follow-up.

Results: Postoperative assessments demonstrated significant improvements in eyelid contour and lateral orbital fullness, with stable results throughout the follow-up period. Early postoperative edema and bruising resolved within one week. No irregularities or complications were reported, and patient satisfaction ranged from good to excellent.

Conclusion: The endoscopic ROOF transposition technique provides a minimally invasive and effective solution for sunken eyelid deformities, offering lasting results without donor site morbidity. This approach can be combined with other endoscopic facial rejuvenation procedures, though the technique requires expertise and does not fully address medial orbital deformities.

Level of evidence: V.