Plastic and reconstructive surgery最新文献

Background: Poorly managed breast cancer-related lymphedema may lead to recurrent cellulitis. Advances in the management of lymphedema have evolved beyond conservative decongestive therapy to include vascularized lymph node transfer (VLNT). In this article, the authors analyze the impact of VLNT in the reduction of upper extremity cellulitis in breast cancer survivors.

Methods: The authors reviewed all patients at their institution who had breast cancer, underwent mastectomy, experienced upper extremity lymphedema, and proceeded with VLNT from 2017 to 2021. Patients were included if they had 1 or more episodes of cellulitis within the year before VLNT and were followed up for at least 12 months.

Results: The authors included 66 patients who fulfilled their strict inclusion criteria, with a median age of 57 years (interquartile range, 23 to 76 years). All patients were female, and most were White (88%), with a mean ± SD body mass index of 29.4 ± 6.7 kg/m 2 . Many presented with invasive ductal carcinoma (82%), had axillary lymph node dissection (98%), and received chemotherapy (94%) and radiation therapy (86%). VLNT was performed at a median of 92 months after mastectomy (interquartile range, 32 to 156 months). Overall, 58 (88%) patients remained infection-free with an infection rate decrease from an average of 2.27 before the index VLNT to 0.17 ( P < 0.0001) after VLNT.

Conclusions: VLNT is associated with significantly decreased cellulitis rates. It should be considered as part of the treatment for infectious diseases of recurrent upper extremity cellulitis caused by breast cancer-related lymphedema with no adequate clinical improvement from conservative management alone.

Background: Previous studies have primarily evaluated postoperative middle-ear outcomes following palatoplasty and ventilation tube insertion (VTI), with a focus on patient age and cleft severity. However, few have investigated the influence of cleft sidedness and variations in Furlow-based palatoplasty techniques. This study aimed to assess the presence of otitis media with effusion (OME) before and after palatoplasty, with or without VTI, and to identify factors associated with OME, including baseline patient characteristics, cleft sidedness, and surgical approach.

Methods: The authors retrospectively analyzed 86 children with cleft palate or cleft lip and palate who underwent palatoplasty at their hospital from October of 2017 to December of 2021, with at least 2 years of follow-up evaluating middle-ear outcomes.

Results: Age at palatoplasty date, sex, congenital anomalies, and cleft severity were not significantly associated with preoperative OME. Complete clefts showed a higher OME incidence than incomplete cleft palate in univariable analysis, but not in multivariable analysis. The use rate of Furlow palatoplasty combined with hard palate repair increased with increasing cleft severity. Neither the choice of palatoplasty technique nor cleft sidedness was significantly associated with the presence of OME before palatoplasty or with the development of OME after palatoplasty. Postoperative OME rates were similar between children with OME undergoing VTI and those without OME treated by palatoplasty alone.

Conclusions: Cleft sidedness and surgical technique did not influence OME before or after palatoplasty. Ventilation tube insertion is beneficial for patients with OME but may be unnecessary in those without prior effusion.

Several techniques for performing mastopexy and reduction mammaplasty have been reported; however, none has effectively maintained breast and upper pole projection. Silicone implants address these limitations but are associated with higher risks than nonimplant surgical procedures. Growing concerns include the risk of anaplastic large cell lymphoma and adjuvant-induced autoimmune syndrome. In addition, some women desire volume enhancement without implants. Autologous fat grafting is increasingly used for aesthetic breast augmentation and reconstruction. However, few studies have explored its combined use in muscle and breast planes during reduction mammaplasty and mastopexy. No study has yet standardized fat grafting across submuscular, intramuscular, and subcutaneous planes. This study is innovative in systematizing the fat grafting technique and standardizing its simultaneous application to the submuscular, intramuscular, and subcutaneous planes during mastopexy and reduction mammaplasty. It also identifies specific grafting zones for upper pole projection.

Background: Spinal degeneration and deformities affect more than 27% of US adults, and $14.1 billion is spent annually on spinal fusion to address these pathologies. Wound closure using local muscle flaps has been associated with reduced complication rates, including infection and reoperation. The high prevalence of degenerative deformities and health care expenditures highlight the need for resource utilization studies to inform decision-makers on best operative practices.

Methods: A retrospective review was performed on adult patients who underwent posterior spinal fusion for degenerative or deformity indications at the authors' institution between 2019 and 2022. Patients were stratified by the prophylactic use of muscle flap closure, and outcomes were compared between groups. Costs were applied to consumed resources, and univariate and multivariable regression analyses were performed to measure the impact of muscle flaps on overall costs.

Results: Of 520 included patients, 240 received muscle flap closures. These patients had significantly fewer readmissions (odds ratio [OR], 0.49 [95% CI, 0.29, 0.84]), reoperations (OR, 0.49 [95% CI, 0.26, 0.89]), and hardware failures (OR, 0.09 [95% CI, 0.00, 0.45]), but greater odds of seroma (OR, 5.22 [95% CI, 2.12, 15.7]). They also had shorter hospital stays (5.4 versus 6.5 days [ P = 0.033]), but operative time did not vary by closure type. Multivariable regression revealed that muscle flap closure was associated with a $7152 reduction in overall costs per patient ( P < 0.03).

Conclusions: Muscle flap closure correlates with reduced complication rates and decreased overall costs per patient. These findings support the use of prophylactic muscle flap closure from safety and health economics perspectives.

Background: Facial aging is a multifactorial process that results from deflation and descent of facial soft tissue. Modern deep layer face-lift techniques aim to restore a youthful facial shape by using the superficial musculoaponeurotic system (SMAS) to reposition descended facial fat into areas of deflation within the lateral cheek and malar eminence. Although there are many advocates of various SMAS techniques and numerous descriptions of methods to manipulate and fixate repositioned facial fat, there is no consensus in the literature as to a "best" SMAS technique. The authors' investigation aimed to determine whether there should be a consensus on the preferred method of SMAS manipulation in terms of improving contour in the aging face.

Methods: A systematic review was performed to investigate the current body of literature on SMAS face-lift techniques. Careful review of operative technique was performed, and techniques were classified as medially or laterally based, depending on the extent of sub-SMAS dissection. Analysis of aesthetic outcomes and complications was performed to determine the superiority of one technique over another in achieving a youthful facial contour.

Results: A total of 17 articles were selected for review that clearly described operative technique and reported aesthetic outcomes. Patient satisfaction and improvement in overall facial contour was noted across studies.

Conclusions: Various SMAS techniques can provide excellent aesthetic outcomes; however, medially based "deep plane" techniques, which carry dissection medial to the stout retaining ligaments, have not been shown to provide significant improvement in the appearance of the midface or improved longevity of results.

Background: Thigh-lift surgery is considered a complication-prone operation, with publications reporting complication rates between 35% and 74%. These studies have not specifically evaluated the effects of each technique on the complication rates. This study presents complication rates for the 3 most common surgical techniques (T, L, and I thigh lifts) and evaluates possible causes in the largest reported cohort of patients with massive weight loss.

Methods: A retrospective cohort study of 750 thigh lifts in 375 patients from 2008 through 2023 was performed. The data collected were collated into the 3 thigh-lift techniques and analyzed according to preoperative risk factors and postoperative complications.

Results: The overall complication rate was the lowest for I thigh lifts (40.3%), followed by T thigh lifts (66.6%) and then L thigh lifts (73.9%). An analysis of major complications revealed rates of 9.5%, 33%, and 39.1%, respectively. Smoking, a body mass index of 30 or above, higher temperatures, and prolonged operative duration were found to increase the risk of complications.

Conclusion: The I incision technique for thigh-lift surgery after massive weight loss has fewer complications, reduces scarring and operating times, and has a low revision rate.

The use of pragmatic clinical trials (PCTs) has been increasing within medical and surgical research departments, but has not yet been widely implemented in plastic surgery. PCTs are similar to randomized controlled trials (RCTs) in that they both randomize patients to treatments and follow them prospectively after treatment. However, PCTs are less strict than RCTs in many ways: PCTs have fewer inclusion and exclusion criteria, to facilitate the recruitment of representative samples; use data collected during routine clinical care; and commonly rely on subjective patient-reported outcomes. PCTs offer many advantages over the standard RCT, including greater cost efficiency, larger sample sizes, and faster completion times. Because of these advantages, PCTs offer potential benefits to plastic surgery research efforts, but researchers must make intentional design choices when planning a PCT. Researchers should consider the ethics of their study question and treatment identification, appropriate randomization techniques, reliable plans to mitigate possible bias, and minimal but sufficient follow-up plans.