Plastic and reconstructive surgery最新文献

Background: Pain is a prominent symptom following prosthetic breast augmentation by means of axillary incision, and persists throughout hospitalization. However, routine analgesia is not always effective for all patients. Duration of regional block with ropivacaine is also limited. The objective of this study was to evaluate whether the combination of methylene blue and ropivacaine by means of serratus anterior plane block provides superior long-lasting analgesia compared with ropivacaine alone in prosthetic breast augmentation.

Methods: This double-blind, single-center, randomized controlled trial enrolled 72 female patients, who were randomly and equally assigned to the control group, the ropivacaine group, and the ropivacaine plus methylene blue group during surgery. A standard postoperative analgesic regimen was administered to all patients. The visual analog scale was used to assess pain scores, which were observed and recorded at 6, 24, 48, and 72 hours postoperatively by 2 well-trained, independent investigators.

Results: No statistically significant differences were observed in age ( P = 0.200), body mass index ( P = 0.200), prosthesis brand ( P = 0.764), size ( P = 0.580), or type ( P = 0.260) among the 3 groups. The study demonstrated that serratus anterior plane block significantly improved postoperative pain management within 24 hours. Furthermore, the ropivacaine plus methylene blue group showed no advantages over the ropivacaine group at 6 hours postoperatively, whereas it had a better visual analog scale score than the ropivacaine group 24, 48, and 72 hours postoperatively, which were statistically significant differences ( P < 0.05).

Conclusion: The analgesic effect of methylene blue and ropivacaine in serratus anterior plane block has a longer duration than ropivacaine alone in prosthetic breast augmentation.

Summary: The authors present a technique for neovaginal reconstruction in gender-affirming vaginoplasty using an anteriorly based peritoneal turnover flap to create a full-length lining throughout the depth of the neovaginal canal. Between 2024 and 2025, 10 patients successfully underwent the procedure without major complications. At the 3-month follow-up, 80% of patients maintained neovaginal depth comparable to the immediate postoperative measurement. Internal neovaginal examination demonstrated that the neovaginal lining exhibited a mucosal surface, high elasticity, and self-lubrication. The potential impact of peritoneal flap harvesting on the urinary bladder was evaluated using the Incontinence Questionnaire-Male Lower Urinary Tract Symptoms. This technique may represent a feasible approach for achieving hairless neovaginal reconstruction in gender-affirming surgery, particularly for patients with scrotal skin deficiency or extensive genital hair.

Summary: Refinements in autologous breast reconstruction (ABR) enable personalized approaches to align with patient preferences. The deep inferior epigastric perforator (DIEP) flap remains the primary choice due to its volume adequacy, but alternative techniques are necessary when volume discrepancies arise. The lateral intercostal artery perforator (LICAP) flap has gained traction in oncoplastic breast reconstruction and has been adapted for autologous augmentation in ABR. This study presents a series of patients in whom the LICAP flap was used to augment the reconstructed or contralateral breast for symmetry. The procedure involves preoperative perforator mapping, dissection of a prepectoral pocket, and inset of the LICAP flap to achieve the desired breast volume and contour. Upon completion of the inset, perfusion is confirmed using Doppler ultrasound or laser angiography. Over a 4-year period, 16 LICAP flaps were performed in 11 patients. The mean LICAP flap volume was 201 cc, demonstrating its capacity to provide an increase of 1 to 2 cup sizes. Indications included bilateral augmentation after DIEP flap reconstruction, correction of asymmetry due to partial flap loss or fat necrosis after DIEP flap reconstruction, and contralateral augmentation for symmetry. No flap failures or fat necrosis cases were reported. Minor complications included cellulitis and donor site seroma. The LICAP flap provides a durable and predictable solution for volume enhancement in ABR, offering an alternative to implants or fat grafting. Limitations in sample size and patient-reported outcomes exist, but this technique expands the reconstructive toolkit, allowing for a more tailored approach to breast reconstruction.

Background: Post-traumatic headache (PTH) affects up to 80% of patients with mild-to-moderate traumatic brain injury (TBI), contributing to significant morbidity and healthcare burden. While early diagnosis and treatment can help prevent persistent headaches, neurology referral rates remain low. This study aims to (1) identify risk factors for PTH >1 year and (2) assess the frequency of neurology referrals in patients with craniofacial trauma.

Methods: We retrospectively reviewed adult trauma patients who presented with frontal sinus, orbital, and mandibular fractures between (2018-2019). Our primary outcome was the frequency of persistent and new-onset PTH assessed >1 year of injury. Multivariable logistic regression was performed to identify risk factors for long-term PTH.

Results: Among 622 patients with craniofacial fractures, 166 (27%) presented with PTH, and 310 (50%) exhibited signs or symptoms related to TBI. Despite this, 248 (80%) of these patients were not referred to neurology/neurosurgery. Among 81 patients who were not referred and had follow-up >1 year, 10 (12%) reported persistent or new-onset PTH. Among 229 patients with follow-up >1 year, 9 (3.9%) developed new-onset migraines, and 34 (14.8%) experienced persistent or new-onset PTH. Significant risk factors for persistent or new-onset PTH >1 year included a history of pre-trauma headaches (aOR [95% CI] 5 [2-15], P=0.004) and abnormal head CT findings on presentation (aOR [95% CI] 4 [1-14], P=0.03).

Conclusion: Patients with craniofacial fractures, particularly those with pre-trauma headaches and abnormal head CT findings on presentation, should be vigilantly monitored for PTH, and referred early to neurology to prevent long-term morbidity.

Background: Perforator-based propeller flaps (PPF) have emerged as an important reconstructive option for distal lower-extremity defects. While previous studies have reported outcomes, the optimal design parameters and their impact on complications remain unclear. This study aimed to establish evidence-based guidelines for PPF design through a systematic review and meta-analysis of individual patient data.

Methods: PubMed, Embase, and Cochrane Library were searched for studies published through March 2025. A total of 402 propeller flaps from 27 studies were included in the meta-analysis. Primary outcomes included target site complications (TSC), vascular complications, and flap necrosis. Design parameters, including perforator location, flap width, flap dimension, and rotational arc, were evaluated for their impact on outcomes.

Results: Among 402 flaps, TSC occurred in 22% (95% CI: 17%-27%), including venous congestion (4%) and flap necrosis (12%). Lower complication rates were associated with flap width >4.5 cm (22%; P = 0.02), flap dimension 40-80 cm² (18%; P = 0.04), and flap-to-defect ratio <2.5 (16%; P = 0.15).

Conclusion: PPF show a low total flap necrosis rate (2%), with most partial losses closed by skin grafting. Keeping flap dimension within 40-80 cm², width > 4.5 cm, and flap-to-defect ratio < 2.5 preserves optimal outcomes, confirming PPF as dependable single-stage alternatives to free flaps for distal lower-extremity defects.Clinical Question/Level of Evidence: Therapeutic, Level III.

Introduction: Visual aids that simulate personalized postoperative outcomes following breast reconstruction may facilitate shared decision-making and help manage expectations. This study aimed to develop and validate an AI-based surgical simulator trained on real patient photographs to predict breast reconstruction outcomes.

Methods: A cohort of women who underwent bilateral two-stage implant reconstruction or abdominal-based autologous breast reconstruction between January 2010 and June 2024 at Memorial Sloan Kettering Cancer Center was retrospectively identified. Standardized frontal preoperative and postoperative photographs were collected and preprocessed. An AI-based simulator was developed using a generative adversarial network (GAN) and trained on photographs over 250 epochs using a 75:25 training/testing split. AI-generated postoperative predictions were evaluated against real postoperative results both qualitatively and quantitatively using standard metrics including structural similarity index (SSIM) and Fréchet Inception Distance (FID).

Results: A total of 1,405 patients were included (implant: n=1006 [72%]; autologous: n=399 [28%]). The cohort was predominantly White (83.5%), with smaller representations of Asian (5.5%), Black (5.0%), and Other (6.0%) patients. Quantitative assessment of image fidelity supported accurate model predictions (implant: SSIM 0.61, FID 23.77; autologous: SSIM 0.50, FID 38.21). AI-generated predictions demonstrated visual concordance with real postoperative photographs in terms of breast shape, volume, symmetry, and nipple reconstruction.

Conclusion: This study demonstrates the feasibility of an AI-based model trained on real-world clinical photographs to simulate breast reconstruction outcomes. These findings support further exploration of AI-based models for personalized surgical simulation in breast reconstruction and their integration into clinical care.

Inverted nipples is a common congenital abnormality, with a variety of techniques previously described for correction, with high recurrence rates. We describe a novel technique to address inverted nipples in patients undergoing concurrent breast surgery, which the senior author has performed for correction of inverted nipples, using fascia fat graft, from 2014 to 2024. Eighteen women (26 nipples) have successfully undergone correction in conjunction with other breast procedures with no complications or recurrences, minimal scarring and donor site morbidity.

Background: Capsular Contracture (CC) is a key downstream complication of breast implant surgery captured by breast implant registries worldwide. A number of factors have a been linked to CC development including smooth implants and bacterial contamination. The purpose of this study was to analyze prospectively captured data from the Australian Breast Device Registry to investigate the risk of capsular contracture with respect to patient demographics, the use of contamination minimization measures (CMM), implant characteristics and variations in surgical technique.

Methods: These data were extracted from the Australian Breast Device Registry including 91 537 implants and analyzed against patient demographics, CMMs, implant characteristics and variations in surgical technique to determine which factors were associated with reducing capsular contracture risk.

Results: A variety of factors including use of nipple shields, antiseptic rinse, changing gloves for insertion and anatomic implant shape were associated with significantly reduced rates of capsular contracture.

Conclusions: Our findings show that the change of gloves, the use of antiseptic rinse and the use of nipple shields significantly reduce the risk of CC following cosmetic breast augmentation. These findings further support the importance of minimizing bacterial contamination at the time of implant placement and the need for clinicians to be appropriately trained, vigilant and aim for the highest standards of infection control and sterile technique when using breast implants for any indication.

Background: Esophageal replacement (ER) in pediatric patients is complex, and while gastric or colonic interpositions are common, they carry long-term complications. Supercharged jejunal interposition (JI) offers better function but is technically challenging due to variable vasculature. We describe a protocol using computed tomography angiography (CTA) and 3D reconstruction to optimize surgical planning and vessel selection.

Methods: A retrospective review of patients undergoing supercharged JI for ER was conducted. Preoperative CTA of the chest and neck assessed the internal thoracic arteries/veins (ITA/ITV) and secondary venous options, including cephalic (CV) and external jugular veins (EJV). CTA with 3D segmentation of the superior mesenteric vasculature mapped jejunal branching patterns.

Results: Thirteen patients underwent supercharged JI with CTA-based planning. The median age was 4.9 years (range: 1.5-15.5). Bilateral ITA visualization was achieved in all patients, and all underwent supercharge to the ITA. ITVs were visualized with lower resolution. Ten patients underwent venous anastomosis to the ITV. The CV was used three times due to insufficient ITV size. Of 26 potential vessels, 42% of CVs and 15% of EJVs were insufficient for use. Five patients underwent mesenteric imaging with 3D reconstruction which identified significant vascular variability. Preoperative vessel mapping correlated with intraoperative findings and reduced extensive mesenteric dissection.

Conclusion: Preoperative CTA with 3D vascular modeling facilitates recipient and donor vessel selection, optimizes surgical planning, and may improve operative efficiency and outcomes in pediatric supercharged JI.