Plastic and reconstructive surgery最新文献

Summary: A clear understanding of the various dimensions and applications of available screws used in hand surgery is critical for the effective management of fractures, osteotomies, and arthrodeses. In 2015, an invaluable review of commonly used screws in hand and upper extremity surgery was published, codifying dimensions and nomenclature into an easily referenceable chart. There have since been significant advancements and innovations in screw materials and design. This updated review aims to provide a comprehensive and current reference for commonly used screws, reflecting the latest innovations and trends in the field, as well as their utilization in various procedures. This article incorporates the latest developments in headless, headed, hand plate, biologic screws, and intramedullary nails. This review focuses on the most relevant and widely used options to serve as a readily accessible and valuable resource for practicing hand surgeons.

Summary: Central platysmal banding is a common reason that patients seek surgical rejuvenation of the lower face and neck. Numerous surgical methods have been described to address banding, however all have high rates of platysmal band recurrence. Many theories have been proposed to explain the cause of both primary and recurrent platysmal banding, however recently persistent innervation by the cervical branch of the facial nerve has been implicated as the primary cause. This article serves to summarize the available evidence on platysmal banding as well as suggest surgical and non-surgical methods to address primary and recurrent banding.

Background: Plastic surgery is among the most diverse surgical specialties, contributing to reconstructive, aesthetic, and functional care. However, little is known about its long-term workforce adequacy in the United States. As demand rises, concerns have emerged regarding maldistribution, training bottlenecks, and the specialty's ability to meet future needs.

Methods: Workforce projections from 2022 to 2037 were obtained from the Health Resources and Services Administration's Health Workforce Simulation Model, which estimates physician supply and demand by specialty and region. Supply was measured in full-time equivalents, accounting for new trainees, retirements, and attrition. Demand was modeled under two scenarios: status quo and reduced barriers (expanded access for underserved populations). Workforce adequacy (supply-to-demand ratio) was assessed nationally, regionally, and by state using descriptive statistics and heat maps generated in Python and Excel.

Results: Plastic surgery supply is projected to decline by 22.1% by 2037, while demand will increase by 6%. National adequacy will fall from 100% to 74% under the status quo scenario and to 52% under reduced barriers. Non-metro areas are projected to remain critically underserved, with adequacy declining from 20% to 15%. By 2037, 46 states are expected to face workforce deficits. Plastic surgery is projected to have the lowest adequacy of all 37 specialties analyzed under the reduced barriers model.

Conclusion: A substantial mismatch between supply and demand is anticipated in the U.S. plastic surgery workforce over the next decade. Addressing this will require expanded training pathways, targeted distribution, and policies that reduce access barriers to ensure equitable surgical care.

Objective: This study aims to evaluate the safety and therapeutic efficacy of a novel Bioengineered Exosomal Hair Growth Factors Complex (BEHC™) for hair growth that amalgamates bioengineered exosomes with biomimetic polypeptides QR678 Nexo™ targeting androgenetic alopecia (AGA). The formulation's effectiveness was rigorously evaluated through both in vitro and in vivo experimental paradigms.

Methodology: In vitro, human follicle dermal papilla cells (HFDPCs) were cultured and treated with the novel formulation under study. Cell viability and proliferative responses were quantified using MTT assays, while anti-inflammatory efficacy was assessed by measuring mRNA expression levels of interleukin-6 (IL-6) and interleukin-1 beta (IL-1β). In vivo, an open-label prospective clinical study involved 85 human participants (Indian men and women aged 20-60 years), with efficacy metrics including hair pull tests, photographic evaluations, videomicroscopic assessments, and patient-reported outcomes across eight treatment sessions. Safety profiles were monitored through physical examinations and participant-reported adverse events.

Results: In vitro findings showed a statistically significant enhancement in human follicle dermal papilla cells (HFDPC) proliferation (172.4% relative to control) and down-regulation of IL-6 and IL-1β mRNA levels. In vivo, the hair pull test revealed a reduction in hair shedding from an average of 7.8 to 1.4 hairs. Videomicroscopic analyses indicated elevations in terminal hair counts and shaft diameters, with sustained enhancements in hair density two months post-treatment.

Conclusion: The Bioengineered Exosomal Hair Growth Factors Complex (BEHC™) is a promising minimally invasive intervention for managing hair loss, demonstrating enhanced therapeutic efficacy while minimizing adverse effects, marking a significant advancement in regenerative dermatology.

Summary: This study presents a modified latissimus dorsi detrusor myoplasty (LDDM) technique using the hemi-obturator nerve for neurogenic underactive bladder (NUAB) reconstruction. Anatomical studies (n=22 hemipelves) revealed that the diameters of the anterior (mean: 0.209 cm) and posterior branches (mean: 0.199 cm) matched the thoracodorsal nerve's diameter (one-way ANOVA, p = 0.557), confirming their ideal donor potential. LDDM by using posterior branch of intrapelvic obturator nerve as the donor nerve was performed in five patients with NUAB. 4/5 (80%) patients restored voluntary voiding postoperatively, with post-void residual volume (PVR) decreasing significantly from 308.5(187.5) mL to 62.0 (58.8) mL (P=0.042) and bladder contractility index (BCI) improving significantly from 12.8(5.7) to 151.9(46.5) (P=0.007). These results demonstrate that LDDM using the hemi-obturator nerve is an effective surgical approach for functional detrusor reconstruction in NUAB patients.

Background: Laser resurfacing and chemical peeling represent two widely practiced skin rejuvenation techniques, each with distinct mechanisms and risk profiles. Despite their widespread use, comparative efficacy and safety across various dermatologic conditions remains incompletely synthesized. This systematic review and meta-analysis compared these modalities to guide evidence-based decision-making.

Methods: Following PRISMA guidelines, we searched major databases through October 2024 for studies directly comparing laser treatments and chemical peels. Data on clinical improvement, adverse effects, and treatment sessions were pooled using random-effects models.

Results: Thirty-eight studies involving 1,695 patients were included. Both modalities achieved significant improvement over baseline. Overall efficacy was comparable between lasers and peels SMD: 1.53, 95% CI: 0.57 to 2.50). Laser treatment was more effective for melasma (SMD 1.53 [95% CI: 0.57, 2.50]), while chemical peeling was superior in psoriasis SMD -4.30 [95% CI: -6.84, -1.76]). No significant efficacy difference was observed in acne/acne scarring or overall photoaging. Lasers required fewer treatment sessions on average (mean difference: 2.00 sessions, p < 0.001). Transient erythema and procedure pain were more common with lasers (RR: 6.63, 95% CI: 0.39 to 113.14; RR 4.42; 95% CI: 1.72, 11.37, respectively), whereas rates of post-inflammatory hyperpigmentation were similar.

Conclusion: Both modalities are effective for skin rejuvenation. Lasers may offer advantages in melasma and require fewer sessions, but with more short-term redness and discomfort. Chemical peels remain valuable, especially for certain conditions (e.g., psoriasis) and in patients prioritizing minimal downtime. Treatment choice should be individualized to patient skin type, condition, and tolerance for side effects.

Summary: Severely ptotic and flat breasts pose significant reconstructive and aesthetic challenges due to poor skin elasticity and attenuated support structures, which limit the stability of upper pole projection. Augmentation mastopexy using implants may increase the risk of nipple-areola complex vascular compromise, and many patients prefer to maintain or reduce breast volume. Between 2022 and 2024, we performed vertical mastopexy with a double dermoglandular reposition technique in 31 patients (mean age, 38 years) to address severe ptosis without implants. The approach combines an inferior pedicled dermoglandular flap, folded and anchored to the pectoralis fascia to restore central projection, with a superior pedicled dermoglandular flap, rotated into an upper pole pocket to recreate convexity. Each flap maintains an independent vascular pedicle, allowing simultaneous restoration of projection and upper pole fullness with minimal risk of ischemia. Average operative time was 175 minutes, and only minor complications were observed; no flap necrosis occurred. At 12 months, the upper pole contour and projection appeared qualitatively stable. In this single-surgeon series, early outcomes suggest that this implant-free technique may offer a short-term, safe option for challenging ptosis cases with adequate residual tissue, while avoiding prosthetic-related complications. Larger prospective studies with long-term follow-up and objective volumetric assessment will be necessary to confirm durability.Clinical Question/Level of Evidence: Therapeutic, IV.

Background: Beckwith-Wiedemann Syndrome (BWS) is a congenital overgrowth disorder with variable clinical manifestations. Given the phenotypic variability of BWS, patient experiences and quality of life (QoL) can differ significantly. Here, we explore the role of patient-reported outcomes in BWS.

Methods: Patients with BWS (aged 4-18 years) were prospectively administered FACE-Q Craniofacial measures (appearance distress, psychosocial, school, and social). Surveys were converted to a Rasch transformed score (0-100, 100 being best outcome). Patient demographics, clinical characteristics, and BWS Index of Macroglossia score (BIG) were reviewed.

Results: Thirty-six patients completed all surveys (n=18, 50.0% males). Mean age at FACE-Q administration was 8.8±3.5 years. Most patients had a genetic diagnosis of IC2-LOM (n=24, 66.6%). At baseline, 12 patients were classified as BIG 0 (33.3%), 6 patients as BIG 1 (16.7%), 12 patients as BIG 2 (33.3%), and 6 patients as BIG 3 (16.7%). Almost half (n=16, 44.4%) underwent tongue reduction surgery at average age 2.3±2.0 years. Average FACE-Q scores were 91.9±10.9 for appearance distress, 86.3±16.4 for psychological function, 80.7±17.7 for school function, and 82.9±15.5 for social function. There were no differences in any of the measures between patients who underwent tongue reduction surgery, by BIG score, and by blood mosaicism (p>0.05).

Conclusions: Patients with BWS have encouraging QoL scores. Among those with the most severe macroglossia phenotypes, surgical correction can significantly reduce the severity of macroglossia and ensure comparable improvements in QoL to those with milder phenotypes who did not undergo surgical management.

Background: While occipital neuralgia (ON) has been linked to head and neck trauma, the timing and development of symptoms following injury remain unclear This study investigates the onset of ON after trauma and injury mechanisms that may predispose individuals to ON.

Methods: 212 patients with ON were assessed for prior head/neck injury, timing of pain onset, and injury mechanism at Weill Cornell Medicine and Massachusetts General Hospital from 2020-2024. Postoperative outcomes were evaluated for patients who underwent nerve decompression surgery.

Results: A total of 117 patients (55.2%) reported a history of head/neck trauma. Among these, 65 patients (55.6%) reported pain onset following injury. Most patients (41.5%) reported pain starting on the same day, while others reported onset within one week (15.4%), within 6 months (13.8%), or longer (12.3%). Injury mechanisms included whiplash (64.6%), direct strike to head (46.2%), direct strike to head and neck (29.2%), direct neck strike (4.6%), and other (6.2%). Patients with a direct strike to the head and neck had significantly higher odds of experiencing pain following injury (p=0.01). Patients with trauma-related pain who underwent nerve decompression surgery (n=25, 38.5%) experienced significant reductions in pain intensity (8.5 points), frequency (17.9 days/month), and duration (20.4 hours) (p<0.05).

Conclusions: ON most commonly begins on the same day of injury, with whiplash and direct head/neck trauma being the most common mechanisms. Surgical decompression is an effective treatment for pain relief in ON patients with past head/neck trauma.