Plastic and reconstructive surgery最新文献

Background: Synkinetic dysfunction of the Depressor Anguli Oris (DAO) and Mentalis muscle (MM) in conjunction with a weak Depressor Labii Inferiors (DLI) produces a characteristic deformity in the perioral region. Chemodenervation, myectomy and facial nerve neurectomy have been utilized to treat this imbalance with varying degrees of success. This study explores the value of highly selective Mentalis denervation combined with transfer of the hypertonic DAO to the hypotonic DLI for improving facial symmetry.

Methods: A retrospective review of ten patients treated with a DAO-DLI transfer and mentalis denervation was undertaken. Still preoperative and postoperative photographs were evaluated utilizing a facial landmark detection system (Emotrics) and direct photographic measurement utilizing an iris calibrated technique.

Results: An average improvement of 3.7 mm of lower lip depression was identified (p value 0.001). Additionally, a statistically significant improvement in smile angle and dental show (p value < 0.05) was also encountered along with a positive trend in commissure height deviation.

Conclusion: This early experience suggests that DAO-DLI muscle transfer in conjunction with highly selective denervation of the mentalis muscle can have a positive effect in the treatment of labio-mental synkinesis.

Background: The superficial circumflex iliac artery perforator (SCIP) flap has gained popularity in microsurgical reconstruction, yet anatomical variations of the pedicle poses challenges in flap elevation. The primary aim of this study is to clarify whether the superficial branch of the SCIA exhibits a consistent axial course with reproducible, optimal setting of real-time ultrasonographic mapping. By focusing on this pedicle axiality with ultrasound, the study aims to improve the safety and precision of SCIP flap harvest.

Methods: A stepwise ultrasound mapping protocol was performed in a prospective series of patients undergoing SCIP flap reconstruction. High-frequency linear ultrasound probes were used to identify the SCIA origin, its course, and cutaneous perforators relative to the anterior superior iliac spine (ASIS) and inguinal ligament.

Results: Ultrasound successfully identified the SCIA origin and mapped its course in all cases. Most branches followed a consistent intra-adiposal, longitudinal path between the deep and superficial fascia. The majority of SCIP pedicles (91.9%) demonstrated an axial pattern extending cephalically beyond the ASIS, and the most distal part could be mapped with ultrasound. Preoperative mapping closely correlated with intraoperative anatomy, facilitating safe flap elevation with minimal dissection time and improved flap design.

Conclusion: This article presents concise guidelines for ultrasonographic mapping of the SCIP flap. Our findings demonstrate that the superficial branch of the SCIA shows a consistent axial flap pattern. These insights redefine the anatomical understanding of the SCIP flap and offer comprehensive guidance for its safe and reliable application in reconstructive surgery.LEVEL OF EVIDENCE: IV.

Background: In body contouring surgery, high-definition liposuction appears to be an evolution of traditional liposuction. This study aimed to determine if broad liposuction of the deep layer (lamellar) and the preservation of the superficial layer (areolar) result in a naturally defined abdomen, has no stigma of liposuctioned skin, and low rates of early and late complications.

Methods: This cross-sectional, retrospective study was conducted between May 2015 and April 2022. A total of 962 patients underwent trunk liposuction surgery, including: 864 (89.8%) females and 98 (10.2%) males. Surgical strategies were standardized and described in stages: surgical marking, infiltration plan, liposuction plan, and postoperative care. All patients underwent vibroliposuction (PAL) on the back and Suction Assisted Liposuction (SAL) on the abdomen. Early and late complications and patient satisfaction rates were also analyzed.

Results: The mean patient age was 26 years. Early complications included pulmonary embolism (0.3 percent), infection (0.5 percent), epidermolysis (0.6 percent), deep vein thrombosis (0.8 percent), anemia (13.1 percent), and seroma (14.9 percent). Late complications included contour irregularities (1.2 percent), localized fat accumulation (1.5 percent), cutis marmorata (1.7 percent), hyperpigmentation (2.6 percent), and transient fibrosis (3.2 percent). No cases of mortality, fat embolism, intraabdominal injury, or skin necrosis were reported. The majority of patients were satisfied (96 percent).

Conclusions: Liposuction exclusive to the deep layer (lamellar) was associated with a reduction in early and late complications, except for anemia, and resulted in natural abdominal definition and high patient satisfaction. These findings support the safety and aesthetic benefit of this technique.

Introduction: Surgeon preferences in implant-based reconstruction have increasingly favored firmer gel implants for their superior stability, reduced gel bleed, and lower capsular contracture rates. However, this has paralleled an increase in 180° anterior-posterior implant flipping. Herein, we aim to identify the patient and implant factors contributing to this complication.

Methods: This is a 5-year retrospective cohort study of 343 patients (502 breasts) who underwent expander-to-implant exchange. For each breast, Delta (expander fill minus implant volume) and delta-to-expander percentage (relative under- or overfilling) were calculated and analyzed by tertiles. Categorical and continuous variables were compared using chi-squared or Fisher's exact and Wilcoxon rank-sum tests, respectively. Multivariable logistic regression identified predictors of implant flipping.

Results: Implant flipping occurred in 21 breasts (4.2%) and was associated with higher BMI (median, 29.6 vs. 25.4 kg/m², p=0.014), greater expander fill volumes (575 vs. 425 mL, p=0.006), use of highly-firm implants (86% vs. 51%, p=0.006), and smaller implant-to-expander volume ratios (median, -20 vs. -65 mL, p = 0.013). On multivariable analysis, independent predictors were BMI (aOR 1.1, p=0.047), highly-firm implants (aOR 4.41, p=0.023), and the highest delta-to-expander tertile (aOR 5.09, p=0.041).

Conclusion: Implant flipping was linked to higher BMI, firmer implants, and greater implant-to-expander volume mismatch, reflecting a looser pocket. While firmer implants reduce capsular contracture and gel bleed, flipping emerges as a potential trade-off. This risk may be reduced through surgical refinements that optimize implant-pocket dynamics. These findings emphasize the importance of individualized planning during expander-to-implant exchange, especially in patients at elevated risk for malposition.

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.