Plastic and reconstructive surgery最新文献

Background: Autologous fat transfer remains a staple in aesthetic and reconstructive surgery because of its regenerative capacity and tissue integration. However, limitations such as donor-site morbidity and unpredictable volume retention persist. Allograft adipose matrix (AAM), a product made from human fat tissue that serves as a natural scaffold to promote adipogenesis, offers a promising alternative, serving as a scaffold for adipogenesis and delivering key extracellular matrix components. This review examines clinical applications and outcomes in soft-tissue augmentation.

Methods: A systematic review was conducted by means of PubMed/MEDLINE/Cochrane/Embase using "allograft adipose matrix," "decellularized adipose matrix," "Renuva," and "Leneva." Studies published up to May 30, 2024, involving human or animal AAM treatment, were included. Data on demographics, clinical use, injection protocols, outcomes, volume retention, and complications were extracted and analyzed.

Results: From 352 studies, 10 involving humans and 9 involving animals were included. Human studies included 93 patients. Indications for AAM included foot and dorsal hand rejuvenation, abdominal and buttocks contouring, temple atrophy, breast and genitalia augmentation, pressure ulcers, and facial rejuvenation. AAM injection volumes varied, with retention rates ranging from 21.5% to 100%. The most common complications were erythema, swelling, injection-site pain, and burning, all resolving easily. Patient satisfaction scores ranged from 72.9% to 100%.

Conclusions: AAM provides a promising biomaterial for soft-tissue augmentation. Histologic analysis supports its role in adipogenesis and neovascularization. Animal studies suggest enhancements through combination therapies, including AAM with autologous fat, platelet-rich plasma, or synthetic scaffolds. Further research is needed to optimize decellularization protocols and improve bioactivity and tissue incorporation.

Despite increasing national rhinoplasty rates, plastic surgeons' share of these procedures may be changing, and rhinoplasty remains one of the most difficult procedures to teach residents. In part, among many factors, any lower adoption trends may be attributable to the multiple available challenging approaches and emerging philosophies in the field. For example, although preservation rhinoplasty has reemerged over the past decade in the rhinoplasty community, whether structural or preservation techniques achieve superior long-term cosmetic and functional outcomes remains operator dependent. During the American Society of Plastic Surgeons Spring Meeting in 2025, 4 senior rhinoplasty surgeons representing 115 practice years discussed their philosophies and approaches to rhinoplasty, focusing on the selective use of structural rhinoplasty versus preservation techniques, techniques, and graft choices to optimize nasal anatomy in three-dimensional planes; aligning surgeon and patient goals in the preoperative setting; and optimizing teachability of rhinoplasty to trainees. Their collective experience offers a framework for the selective introduction of certain preservation principles into a modern approach to rhinoplasty, with a focus on maintenance of functional nasal anatomy and teachability to the next generation of rhinoplasty surgeons.

Background: Treatment selection for postparalysis facial synkinesis (PPFS) is a multifaceted decision for patients. This study aimed to identify patient factors influencing treatment choice between chemodenervation with onabotulinumtoxinA alone and synkinesis surgery.

Methods: PPFS patients presenting between 2009 and 2024 were grouped into those choosing only chemodenervation and those choosing synkinesis surgery. Excluded were untreated patients and those without qualifying photographs at least 16 months after paralysis onset. Electronic Facial Paralysis Assessment was used to quantify synkinesis severity. The primary outcome was choice of treatment type, and the secondary outcome was time from synkinesis diagnosis to surgery. Each outcome was analyzed for associations with patient characteristics using univariable and multivariable analysis.

Results: Of 549 PPFS patients, 231 patients met inclusion criteria. Factors independently associated with selecting surgical treatment included living more than 100 miles from the authors' institution ( P < 0.001) and moderate or severe synkinesis ( P = 0.010). Time from synkinesis diagnosis to surgery was significantly longer for female patients compared with male patients (adjusted mean difference, 441 days; P = 0.025) and for non-White patients compared with White patients (adjusted mean difference, 355 days; P = 0.042). Other variables, including socioeconomic vulnerability, were not found to be independently associated with selection or timing of treatment.

Conclusions: Patients living farther from the authors' institution and those with more severe synkinesis were more likely to choose surgical synkinesis treatment over chemodenervation alone. The time from synkinesis diagnosis to surgery was significantly longer for female compared with male patients and for non-White compared with White patients.

Background: Radiotherapy is a well-established cancer treatment, but its detrimental effects on normal tissue have been underestimated. Late radiation-induced tissue damage leads to dysfunction, such as loss of elasticity and delayed wound healing, which negatively affect the prognosis and quality of life of cancer survivors. The authors' previous research demonstrated that local prophylactic administration of adipose-derived stem cells (ASCs) immediately after irradiation could prevent late radiation-related disorders. This study explored the effects of systemic administration of ASCs for future clinical applications.

Methods: Nude mice were irradiated on their dorsal skin (40 Gy total: 2 Gy × 20, simulating clinical radiotherapy). Human ASCs were administered systemically (through intravenous or intraperitoneal injection, once or twice). Control groups included a nonirradiated group and a vehicle-treated radiotherapy group. After 6 months, full-thickness skin wounds were created on the mice's dorsal skin and observed for 28 days. The wound-healing process was assessed, and tissue samples were analyzed using immunohistochemistry.

Results: Radiotherapy caused subcutaneous fat atrophy and fibrosis at 6 months, which was effectively prevented in the ASC-treated groups. Wound healing was faster in the ASC-treated groups than in the vehicle-treated groups, although not as fast as in the no-radiotherapy group. ASC-treated groups exhibited less fat layer atrophy and fibrosis than vehicle-treated groups. Engraftment of ASCs was confirmed in the fatty layer of the irradiated skin.

Conclusion: Prophylactic systemic administration of ASCs immediately after radiotherapy can prevent tissue damage and dysfunction associated with radiation therapy.

Clinical relevance statement: A combination of radiotherapy and stem cell therapy can be the optimal treatment strategy to maximize the effects for cancer and minimize radiation damage in the future.

Background: To enhance nasal symmetry, septal cartilage can be used as an alar rim graft on the cleft side during primary rhinoplasty. Short-term results have been favorable, but the long-term results are unclear. The authors compare nasal shape and septal deviation in patients with and without the graft at 10-year follow-up.

Methods: This study included 60 patients with unilateral complete cleft lip and palate; 23 patients received a septal cartilage rim graft, and 37 patients did not. Various bilateral measurements were taken, including nostril height, nostril width, the height of the medial one-fourth of the nostril, the nostril area, the nasal dome height, and the nostril axis. Ratios of these measurements were calculated and compared between patients with and without the graft. Asymmetry was categorized based on deviations from symmetry. Nasolabial angle and tip projection ratio assessed nasal growth, while septal deviation was measured using cephalometry.

Results: The one-fourth medial part of nostril height was higher in the graft group ( P = 0.031) than in the nongraft group. The consistency of the surgical results between the 2 groups was not statistically significant. The nasolabial angle and tip projection ratio were not significantly different between the groups. The graft group had a smaller deviated septal angle and length than the nongraft group ( P < 0.001).

Conclusion: Using a septal cartilage graft during primary rhinoplasty was suggested by the study results to provide better support at the medial side of the alar rim and to result in a straighter nasal septum, improving long-term outcomes.

Learning objectives: After studying this article, the participant should be able to: 1. Understand operative techniques for harvesting several different types of free flaps with sensory innervation. 2. Describe options for donor nerves for common recipient locations. 3. Discuss the clinical outcomes, advantages, and special considerations for free flap neurotization.

Summary: As techniques have advanced in autologous free tissue transfer, increasing focus has been placed on functional reconstruction that not only achieves soft-tissue coverage but also maximizes overall function. One recent trend is the increasing use of neurotized free flaps to improve the sensibility of free flap reconstruction. Restoration of sensation to a reconstruction not only provides critically protective sensation but can also help to restore a sense of self and incorporation of the reconstructed tissues. In this article, the authors discuss recent trends and techniques in free flap neurotization.

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are increasingly used for treatment of patients with type 2 diabetes and obesity because of their metabolic benefits and potential wound-healing properties. However, their perioperative safety in acute surgical settings remains unclear. GLP-1 RAs may alter tissue quality and intensify GLP-1 RA-related side effects. This study was performed to examine postoperative complications and GLP-1 RA-associated adverse effects in nonbariatric patients undergoing panniculectomy.

Methods: The authors conducted a retrospective review of 373 patients who underwent panniculectomy from January of 2013 through January of 2023, including 81 GLP-1 RA users and 292 nonusers. Patients with previous bariatric surgery or concomitant hernia repair were excluded due to the added complexity of mesh placement and altered tissue planes, which could confound wound-healing outcomes. 1 All participants had at least 1 year of follow-up. Baseline demographics, nutritional markers, and GLP-1 RA therapy duration were recorded. Logistic regression was performed to adjust for confounders when comparing complications and adverse effects.

Results: GLP-1 RA users had higher rates of type 2 diabetes (55.6% versus 29.5% [ P = 0.01]), hypertension (69.1% versus 52.7% [ P = 0.04]), and chronic obstructive pulmonary disease (17.3% versus 6.5% [ P = 0.02]), along with elevated prealbumin levels (22.8 ± 6.6 versus 20.4 ± 7.7 mg/dL [ P = 0.030]). Analyses showed a greater incidence of delayed wound healing (18.5% versus 7.5% [ P = 0.0066]) but lower seroma rates (4.9% versus 14.0% [ P = 0.032]) in GLP-1 RA users. These differences persisted on multivariable regression. No significant differences were noted in infection, fat necrosis, hematoma, or GLP-1 RA-related gastrointestinal side effects.

Conclusions: GLP-1 RAs demonstrate promise in chronic wound care. Their use was correlated with increased incidence of delayed wound healing but fewer seromas in acute surgical settings. Overall, these findings support their perioperative safety, but vigilant monitoring for potential wound-healing delays is advised.

Background: Tongue reduction surgery can improve symptomatic macroglossia in Beckwith-Wiedemann syndrome (BWS), but there is no consensus on the optimal tongue reduction surgical technique. This study assessed trends and outcomes of several tongue reduction techniques for treating macroglossia in BWS. Using perioperative and polysomnographic data, the authors present their institutions' rationale for increasingly adopting the peripheral resection technique.

Methods: Medical records of patients with BWS seen between December of 2004 and June of 2024 were reviewed for molecular diagnosis, surgical history, polysomnographic findings, and perioperative complications.

Results: A total of 103 patients underwent 114 tongue reductions at a median age of 1.3 years (interquartile range [IQR], 0.4 to 2.8 years). Use of the peripheral resection technique increased from 10% of all tongue reductions before 2019 to 76% after 2019 ( P < 0.05). Compared with the W-plasty with keyhole approach, the peripheral resection had shorter operative times (29.0 [IQR, 24.0 to 34.0 minutes] versus 35.0 minutes [IQR, 28.0 to 39.0 minutes]; P < 0.05), a higher incidence of immediate extubation (51.7% versus 25.0%), shorter intubation periods (0 [IQR, 0 to 2.02 days] versus 5.0 days [IQR, 0 to 6.0 days]; P < 0.01), shorter pediatric intensive care unit admissions (3.0 [IQR, 1.0 to 10.0 days] versus 7.0 days [IQR, 3.0 to 20.0 days]; P = 0.042), and shorter hospital stays (4.0 [IQR, 2.0 to 10.0 days] versus 11.0 days [IQR, 5.0 to 19.0 days]; P = 0.005). Improvements in polysomnography and volume of resected tissue were similar between the two approaches ( P > 0.05). The anterior wedge (22.2%) and W-plasty (15.6%) techniques had more complications compared with peripheral resection (6.6%; P = 0.351).

Conclusions: Peripheral resection appears noninferior to the W-plasty and anterior wedge approaches in treating symptomatic macroglossia in BWS. The authors document their institutional transition toward increasingly adopting this technique.

Background: Capsular contracture is a common complication following breast augmentation and reconstruction with implants. Implant rupture is suspected to cause capsular contracture, but the evidence remains limited.

Methods: This intrapatient study included consecutive patients with 1 ruptured and 1 intact implant who underwent bilateral implant exchange following breast augmentation. The primary outcome was the association between capsular contracture (Baker III and IV) and implant rupture. Secondary outcomes included comparisons of silicone content and histopathologic characteristics of the breast implant capsule in the breast with a ruptured implant and the contralateral intact implant.

Results: Among 105 patients with unilateral implant rupture, capsular contracture was observed in 53 of 105 breasts (50%) with ruptured implants, versus 25 of 105 breasts (24%) with intact implants (OR, 4.5; P < 0.001). This association was entirely driven by low-cohesive implants (OR, 7.5; P < 0.001 and OR, 23.0; P < 0.001 in the sensitivity analysis), whereas no association was observed among the 13 patients with highly cohesive implants. Capsules surrounding ruptured implants contained significantly more silicone (median, 1.97 mL versus 0.11 mL; P < 0.001), were thicker (median, 926 µm versus 526 µm; P < 0.001), and showed increased lymphocyte ( P = 0.002) and multinucleated giant cell infiltration ( P < 0.001) compared with capsules around intact implants.

Conclusions: The study shows that implant rupture is an important risk factor for capsular contracture, likely mediated by silicone leakage, causing inflammation and fibrosis. These findings emphasize the importance of preventing implant rupture, which can be achieved by using implants with a lower rupture rate, or by proactively exchanging implants before the risk of rupture increases.