Plastic and reconstructive surgery最新文献

Background: The deep plane facelift has the technical advantages of being more effective in mobilization of soft tissues of the anterior face and allowing for more direct fixation of these tissues. These attributes of the deep plane facelift make it advantageous for Asian faces.

Methods: The From Jan 2021 and August 2023, 61 Asian patients with a mean age of 52 years (Range 38-75) underwent the deep plane facelift. Our surgical technique and refinements in performing this procedure were demonstrated in detail. These included specific mobilization end-points, a systemic approach to suture fixation with each fixation suture targeting specific landmarks in the anterior face for tightening and a systematic system of skin flap inset to ensure precise and tension free closure. The mean follow up was 19 months. Patient satisfaction was assessed with a targeted survey covering their appearance and quality of life.

Results: Long-term results were good. Patient satisfaction was high with 98% reported that they were satisfied or highly satisfied with their results. Patients reported improvement of both their appearance and quality of life after the surgery. Complication rates were low and included superficial epidermolysis behind the ears [n = 2 (3%)], hypertrophic scarring [n = 1 (1.6%)] and facial nerve neuropraxia [n = 1 (1.6%)]. There was no hematoma.

Conclusions: The deep plane facelift is a very effective facelift technique for Asian patients. The technical refinements presented in this paper allow the procedure to be performed safely and predictably.

Background: The objective of this study was to provide an overview of the clinical outcomes associated with single-port endoscopic nipple-sparing mastectomy with total prepectoral breast implant reconstruction.

Methods: From April 2021 to April 2024, patients undergoing single-port endoscopic nipple/skin-sparing mastectomy with total pre-pectoral breast implant reconstruction were selected to evaluate the efficacy and safety of this method and to collect information on patient-reported outcomes.

Results: A total of 218 patients were enrolled in this study, of which 207 completed follow-up, yielding a follow-up rate of 95.0%. In terms of surgical safety, the occurrence of flap ischemic problems was 7.8%, while the occurrence of flap necrosis was 3.7%. The occurrence of nipple resection during surgery was 7.4%, and among the 191 patients who had their nipples preserved, the occurrence of nipple ischemia was 7.0%. The occurrence of nipple necrosis was 1.5%, that of infection 10.1%, and that of prosthesis removal 3.9%. Approximately 1.0% of patients experienced metastasis and recurrence during the median 14.3 months follow-up period, as demonstrated by the CUSUM learning curve. A cumulative plot analysis indicated that it would require approximately 21 cases for the surgeon to achieve a meaningful reduction in operating time.

Conclusion: Single-port endoscopic nipple-sparing mastectomy with total prepectoral breast implant reconstruction is a safe, effective, and visually acceptable surgical technique. While it provides good oncological safety, further evidence is required to fully support its use.

Background: This study assesses operative trends over time and outcomes of 5 osteotomy techniques used to treat the midface in Apert syndrome. Using clinical and photogrammetric data, the authors present their institution's selection rationale for correcting specific dysmorphologies of the midface in Apert syndrome based on the individual phenotype.

Methods: The authors retrospectively reviewed patients with Apert syndrome who underwent midface distraction from 2000 through 2023. Patients were temporally divided by 2012 to assess differences in surgical approach. Postoperative facial dimension changes, surgical and perioperative characteristics, and complications data were compared across techniques.

Results: A total of 39 patients with Apert syndrome underwent 41 midface distraction procedures (23 [56%] in the early cohort and 18 [44%] in the late cohort). The use of segmental osteotomies for frontofacial advancement increased from 0% before 2012 to 61% from 2012 onwards ( P < 0.001). Monobloc with bipartition was the only technique associated with decreased intercanthal distance ( P = 0.016), and Le Fort II with zygomatic repositioning achieved the greatest median change in bilateral canthal tilt of 8.7 degrees (interquartile range, 1.3, 8.7 degrees; P = 0.068). Monobloc with Le Fort II achieved the greatest median change in facial convexity of -34.9 degrees (interquartile range, -43.3, -29.2 degrees; P = 0.031). Severity of complications, stratified by Clavien-Dindo grade, was greater in transcranial than subcranial procedures, but similar between segmental and nonsegmental osteotomies ( P = 0.365).

Conclusions: In studying the midface in Apert syndrome and attempting to resolve its varying functional and aesthetic issues, the authors document an evolution toward multipiece osteotomies over time. With an appreciation for differential midface hypoplasia, segmentation is found to be associated with more effective normalization of the face in Apert syndrome.

Clinical question/level of evidence: Therapeutic, III.

Learning objectives: After studying this article, the participant should be able to: 1. Explain the basic concept of functional limb salvage. 2. Understand the complexity of salvaging the limb when consulting the patient, especially regarding how to obtain the best possible functional outcome, whether it be from limb salvage or amputation. 3. Implement orthoplastic thinking to salvage the limb. 4. Understand the latest innovations for limb salvage.

Summary: The goal of limb salvage is to have the patient achieve the best possible function that allows daily activities (eg, walking and running) and the ability to perform tasks that require strength and dexterity. This is a complex process requiring the work of a multidisciplinary team practicing the principles of good wound care, orthoplastic thinking, and strategizing on future function. Understanding the new advances in this field of rapid change and growth will help reconstructive surgeons to make better decisions and incorporate them into daily practice, allowing for the best possible outcome.

Summary: Deep-plane face-lift surgery is not new, having originally been described over 30 years ago; however, the technique has seen a recent surge in popularity. Although proponents emphasize its ability to deliver very natural results, critics often cite the possibility of additional risk of the procedure because of its technically challenging dissection in proximity to branches of the facial nerve and other critical structures. These risks are perhaps greatest when operating in what have historically been described as the "danger zones," particularly when releasing the zygomatic retaining ligaments, when performing the medial deep plane dissection in the midface, and when extending the platysma flap over the angle of the mandible into the neck. The senior author (D.B.R.) has performed deep-plane face-lift surgery for over 20 years, training many novice surgeons to perform this procedure safely and incrementally. In this article, the authors illustrate surgical techniques to optimize safety when performing deep-plane dissections. A novel vertical midline platysmaplasty combined with extended release of the low cervical platysma provides rejuvenation of the neck that extends to the clavicles.

Background: Assessment of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) prevalence is challenged by a lack of population-level data for the prevalence of breast implants in the wider population. Absence of such data obscures the true prevalence of BIA-ALCL and hinders informed consent consultations. The authors performed a systematic review to synthesize data from published studies reporting BIA-ALCL cases in defined patient populations to better inform the evidence base.

Methods: PubMed and Embase were searched to obtain studies reporting the prevalence of BIA-ALCL in defined patient cohorts with breast implants where case prevalence was calculable. Study characteristics, the number of BIA-ALCL cases, and total sample size were extracted and used to calculate the prevalence of BIA-ALCL per 100,000 implanted patients.

Results: Of 1477 publications identified by the search, 38 studies incorporating 28 cohort and 6 registry studies satisfied the inclusion criteria, encompassing a total population sample of 17,038,371 patients and 1170 BIA-ALCL cases. The prevalence of BIA-ALCL was found to be 30.54 per 100,000 implanted patients with textured implants (1 case per 3274 implanted patients) and 6.70 per 100,000 implanted patients with implants of any type (1 case per 14,925 implanted patients).

Conclusions: By synthesizing the published literature, this work provides a determination of BIA-ALCL prevalence using study- and population-level data where the prevalence of breast implants is known. The accurate determination of BIA-ALCL prevalence is of fundamental importance for patients undergoing implant-related surgery to enable the provision of valid informed consent.