Plastic and reconstructive surgery最新文献

Background: We have developed an innovative integrated approach, combining reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with reverse-sequence endoscopic latissimus dorsi muscle flap (R-E-LDMF) harvest for breast reconstruction (BR), through a discreet axillary incision. While both techniques demonstrate clinical feasibility, a systematic comparison of patient-reported outcomes, complications, and cost-efficacy between endoscopic implant-based BR and R-E-LDMF BR remains unexplored.

Methods: A prospective, two-center cohort study was conducted from July 2021 to March 2024, enrolling breast cancer patients who underwent R-E-NSM followed by either Dual-plane BR or R-E-LDMF BR. The Primary endpoint was patient-reported outcomes assessed using the BREAST-Q reconstruction module (focusing on breast satisfaction and quality of life). Others included clinical outcomes, complications, and oncological outcomes.

Results: Among 191 enrolled patients (41 R-E-LDMF vs. 150 Dual-plane), R-E-LDMF BR required longer operative times but incurred substantially lower hospitalization costs. After controlling for baseline patient characteristics, patients who underwent R-E-LDMF BR had greater satisfaction with their breasts (difference, -9.39; -16.97 to -1.80; P =0.016) at 1 year compared with patients who underwent Dual-plane BR. BREAST-Q scores showed no intergroup differences in quality of life. The R-E-LDMF group had higher rates of any and minor complications, while the major complication rates and oncological outcomes were similar between the two groups.

Conclusions: The R-E-LDMF BR technique achieved comparable aesthetic results and major complication rates to the Dual-plane approach, while significantly reducing overall medical costs, despite higher minor complication rates. This approach represents a cost-effective alternative for patients seeking optimal aesthetic results with reduced financial burden.

Background: Surgical treatment for foot melanoma often requires complex soft tissue reconstruction, increasing the risk of postoperative complications. While the association between postoperative complications and cancer recurrence has been explored in various oncologic fields, evidence in melanoma remains limited. This study aimed to investigate whether postoperative complications influence oncologic outcomes in patients with foot melanoma.

Methods: Patients who underwent wide excision and immediate reconstruction for primary foot melanoma between 2006 and 2021 were reviewed. The cohort was divided into two groups based on the presence or absence of postoperative complications. The cumulative incidence of oncologic events was analyzed, and the association between complications and locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS) was assessed.

Results: A total of 238 patients were included, with a median follow-up of 54 months. The mean Breslow thickness was 3.4 mm. Free flaps were the most commonly used method of reconstruction, followed by skin grafts and local flaps. Postoperative complications occurred in 46 patients, with delayed wound healing related to skin graft loss being the most frequent. Tumor-related characteristics did not differ between patients with and without complications. Overall, 84 patients experienced disease recurrence. Patients with complications showed significantly higher rates of local and regional lymph node recurrence, along with inferior LRRFS and DFS. These associations remained significant after multivariable adjustment and were more pronounced in patients with advanced tumor stage.

Conclusions: Postoperative complications following surgical treatment for foot melanoma may be associated with an increased risk of locoregional tumor recurrence and inferior oncologic outcomes.

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.