Plastic and reconstructive surgery最新文献

Background: Patients with macromastia or ptosis undergoing mastectomy often require a Wise-pattern incision, yet this design carries increased risk of ischemic complications. The use of an inferior dermal flap ("autoderm") in the prepectoral plane has emerged as a strategy to provide vascularized implant coverage without acellular dermal matrix (ADM).

Methods: A systematic search of PubMed, Embase, and Cochrane Library was performed through August 2025 in accordance with PRISMA guidelines. Eligible studies reported outcomes of Wise-pattern skin-sparing or skin-reducing mastectomy with dermal flap reconstruction in the prepectoral plane. Data on demographics, technique, and complications were extracted. Pooled proportions for major outcomes were estimated using random-effects meta-analysis.

Results: Ten studies comprising 287 patients and 464 breasts met inclusion. Most were single-institution case series; three were comparative cohorts. The pooled breast-level rate of implant loss was 4.8% (95% CI 3.8-6.0%; I² = 0%). Infection occurred in 7.5% (95% CI 4.8-11.4%; I² = 12%), and major mastectomy skin flap necrosis in 8.6% (95% CI 5.1-14.2; I 2 = 47.6%). Comparative studies found outcomes comparable to ADM-assisted reconstruction, though necrosis was higher with Wise-pattern mastectomies compared to mastectomies with elliptical incisions.

Conclusions: Wise-pattern prepectoral reconstruction with a dermal flap demonstrates low rates of implant loss and infection. Ischemic complications were the most frequent adverse events reported. This approach may safely expand reconstructive options for obese or ptotic patients, though higher-quality prospective data are needed.

Objective: To review our experience of tracheal reconstruction for various defects and provide an algorithm for reconstruction.

Methods: All tracheal reconstruction cases from May 2002 to December 2024 were identified. Patient characteristics, types of defects, methods of reconstruction, postoperative complications, and outcomes were analyzed.

Results: Defects less than 4cm long were typically repaired in an end-to-end fashion (Type I, n = 72) and covered with a pedicled muscle flap, omentum, or local tissue. Longer defects (Type II) were reconstructed with a free radial forearm flap for lining with rigid prosthetic support (n=10). Type III defects (n=33) were those without a larynx. These were further classified into concurrent tracheal defects as part of a total laryngopharyngectomy (IIIa), tracheostoma recurrence after a previous total laryngectomy (IIIb), or a combined total laryngopharyngectomy, total esophagectomy and tracheal resection (IIIc). They were reconstructed with either a free anterolateral thigh (ALT) flap, radial forearm flap, or pedicled internal mammary artery perforator (IMAP) flaps. Only Type II and III defects were included for analysis in this study. Two patients died from innominate artery bleeds 3 and 6 weeks after surgery. Two patients died from multiple organ failure 2 months after surgery. Twenty-four patients ultimately succumbed to disease progression with a median survival of 22 months (range: 3 - 125 months). The remaining 15 patients were alive at their last follow-up (median: 27 months; range: 2 - 216 months).

Conclusion: Tracheal reconstruction, while technically challenging, may provide a reasonable quality of life and survival in otherwise non-resectable patients.

Background: Black race is associated with worse outcomes following implant and autologous breast reconstruction. Although oncoplastic surgery is increasingly used to optimize aesthetic and oncologic outcomes, it remains unclear whether similar racial disparities exist in this setting. This study evaluates the impact of race on surgical and patient-reported outcomes following oncoplastic breast surgery.

Methods: We conducted a retrospective review of patients who underwent oncoplastic procedures using reduction mammoplasty or mastopexy techniques between January 2017 and December 2024. Primary outcomes included postoperative complications. Secondary outcomes included patient-reported outcomes measured by the BREAST-Q. Demographic and clinical variables were compared between Black and White patients. Multivariable logistic regression was used to identify factors independently associated with complications.

Results: Among 518 patients, 18.5% identified as Black and 81.5% as White. Black patients had a higher burden of preoperative risk factors, including elevated BMI, higher ASA class, diabetes, hypertension, advanced cancer stage, and neoadjuvant chemotherapy. However, overall complication rates did not differ significantly between groups. Elevated BMI was independently associated with increased complication risk, whereas race showed no significant association. BREAST-Q scores were similar between cohorts at all time points except at 1 year; Black patients reported significantly lower scores (p=0.046).

Conclusion: Oncoplastic surgery in Black patients is associated with complication rates and patient-reported outcomes comparable to those observed in White patients. These findings suggest that oncoplastic surgery may be a viable treatment option for Black patients. However, further prospective, multi-center studies with larger, racially diverse cohorts and longer follow-up are needed to validate these results.

Background: Photoaging represents a significant clinical challenge with limited effective therapeutic interventions capable of reversing established UV-induced damage. While conventional laser therapies rely on thermal mechanisms with associated complications, picosecond laser-induced optical breakdown (LIOB) offers a revolutionary photomechanical approach. This study provides the first comprehensive molecular characterization of photoaging reversal mechanisms following consecutive 755 nm Alexandrite picosecond laser treatments.

Methods: Thirty female BALB/c nude mice underwent validated UV irradiation protocols to induce photoaging, followed by randomization into five groups (n=6 each): control, UVA-exposed without laser, UVB-exposed without laser, UVA-exposed with consecutive laser treatments, and UVB-exposed with consecutive laser treatments. Three consecutive picosecond laser sessions (755 nm, 0.71 J/cm², 500 pulses with diffractive lens array) were administered post-induction. Comprehensive assessments included wrinkle scoring, erythema quantification, transepidermal water loss measurement, collagen intensity evaluation, histological analysis, and immunohistochemical molecular characterization.

Results: Consecutive picosecond laser treatments produced remarkable photoaging reversal across multiple biological systems. Wrinkle scores decreased from 2.11±0.78 to 0.78±0.67 in UVB-treated groups. LIOB simultaneously activated TGF-β/Smad pathways, enhanced collagen synthesis, reduced matrix degradation (decreased MMP-9 expression), restored barrier function (increased filaggrin and aquaporin 3 expression), and resolved inflammation (reduced NF-κB signaling). Histological analysis confirmed significant collagen regeneration and normalized epidermal architecture.

Conclusions: This investigation establishes consecutive LIOB as a paradigm-shifting therapeutic approach that reverses photoaging through coordinated activation of repair pathways while avoiding thermal damage. The comprehensive molecular mechanisms elucidated provide robust scientific foundation for clinical translation, positioning consecutive picosecond laser technology as a transformative advancement in photoaging treatment with unprecedented efficacy and safety profiles.

Background: Patients with cleft lip and/or palate have a significantly higher prevalence of sleep-disordered breathing (SDB) due to congenital anatomic differences and the sequelae of surgical management. Of note, the velopharyngeal and oropharyngeal airway size plays a significant role. This single-center retrospective study compares the effect of conventional Furlow palatoplasty and small-Z Furlow palatoplasty on airway morphology.

Methods: Consecutive patients with cleft lip and alveolus (CL/A) and cleft lip and palate (CL/P) presenting for secondary alveolar bone grafting (ABG) between 2017-2019 were enrolled for this study. Exclusion criteria included syndromic patients, previous secondary velopharyngeal surgery, and previous sleep surgery. Patients were divided into the control group (CL/A only), those who received primary conventional Furlow palatoplasty, and those who received primary small-Z palatoplasty. Speech was assessed by 2 experienced speech pathologists and SDB via the OSA-18 questionnaire. Airway and velum morphology was assessed using cone beam CT.

Results: Amongst the 95 included patients, 23 were in the control group, 32 had conventional Furlow palatoplasty, and 40 patients had small-Z Furlow palatoplasty. There was no statistically significant difference in speech outcomes or OSA-18 scores between the 3 groups. However, compared to the conventional group, the small-Z group demonstrated increased velopharyngeal airway volume, decreased velar length and increased minimum cross-section area of the velopharyngeal airway.

Conclusion: Conventional and small-Z Furlow palatoplasty provided patients with a similar speech and sleep quality outcome. The small-Z palatoplasty, however, demonstrated an increased velopharyngeal airway volume and minimum cross-section area, as well as decreased velar length.

Background: End-to-side anastomosis (ETS) to major arteries is a valuable technique for limb free flap reconstruction that preserves distal perfusion; however, its effects on distal circulation remain unclear. Few studies have evaluated longitudinal hemodynamic changes at the anastomotic site. This study aimed to identify and characterize postoperative hemodynamic abnormalities using ultrasonography in limb free flap reconstruction with ETS.

Methods: This prospective observational case series included patients who underwent limb reconstruction with ETS between October 2018 and May 2024. Ultrasonography was performed during the early (<3 months) and delayed (≥6 months) postoperative phases. Hemodynamic findings at the anastomotic site were descriptively assessed, and their associations with patient characteristics were explored.

Results: Fifty-nine free flaps in 51 patients were included. All flaps survived with preserved distal perfusion and no soft tissue complications. Indications were trauma in 35 flaps and infection in 24. Reconstructions involved the upper limb in 26 flaps and the lower limb in 33. Delayed-phase abnormal hemodynamic findings were identified in six flaps, all in lower limb reconstructions: three showed flow acceleration due to anastomotic stenosis, one distal flow loss, and two flow interruption at non-anastomotic sites. Advanced age and higher anesthetic risk scores were more frequent in cases with abnormal findings. Five of six cases showed abnormalities in the early postoperative phase.

Conclusions: Subclinical hemodynamic abnormalities may occur after ETS-based limb free flap reconstruction despite favorable clinical outcomes. Early postoperative ultrasonography may help identify patients who may warrant closer vascular surveillance.

Background: Mandibular distraction osteogenesis (MDO) has emerged as the preferred surgical treatment for neonatal tongue-based airway obstruction (TBAO), yet comprehensive outcomes data comparing surgical and non-surgical approaches remain limited.

Methods: We conducted a retrospective cohort study of 579 patients with congenital micrognathia from 2007-2023 at a single tertiary pediatric care institution according to STROBE guidelines, with 344 patients having confirmed TBAO managed in the neonatal period. Patient demographics, treatment modalities, and outcomes were analyzed. A Random Forest machine learning model was developed to predict MDO failure, defined as subsequent tracheostomy or death.

Results: Of 344 patients with TBAO, 267 (77.6%) underwent surgical intervention: 189 (70.8%) MDO, 53 (19.9%) tracheostomy, and 25 (9.4%) tongue-lip adhesion. Seventy-seven patients (22.4%) were managed non-surgically, primarily with continuous positive airway pressure (CPAP) therapy. Following institutional implementation of MDO in 2011, tracheostomy rates decreased significantly from 39.6% to 15.7% (p<0.001). Among non-surgical patients receiving CPAP, obstructive apnea-hypopnea index normalized from 26.3±26.6 to 4.5±4.5 events/hr (p<0.001), though treatment duration averaged 570 days. MDO failure occurred in 21 patients (11.1%), with neurologic disorders (OR 7.61, p=0.001) and lower airway pathology (OR 11.72, p<0.001) as strongest predictors. The Random Forest model predicted MDO success with superior accuracy compared to the GILLS score (90.0% vs 70.0%).

Conclusions: MDO implementation achieved high success rates while reducing tracheostomy rates. Non-surgical management with CPAP achieved airway normalization in selected patients despite prolonged treatment duration. Machine learning models outperformed traditional scoring systems, identifying neurologic disorders and lower airway pathology as key failure predictors to guide surgical decision-making.