Plastic and reconstructive surgery最新文献

Background: Tranexamic acid (TXA) is widely used in surgery to reduce perioperative bleeding, but concerns persist regarding its potential thromboembolic risks. This study evaluates the association between intraoperative intravenous (IV) TXA use and 90-day postoperative venous thromboembolism (VTE) risk in patients undergoing plastic and reconstructive surgery of the head and neck.

Methods: We conducted a retrospective cohort study using the Fortuna database, a national administrative claims dataset with over 200 million patients. Adult patients undergoing plastic and reconstructive surgery between 2010 and 2024 were identified using CPT codes, and whether they received IV TXA on the index day of procedure was determined. The primary outcome was VTE diagnosis within 90 days postoperatively. Use of enoxaparin or heparin was also documented. High-dimensional propensity score matching with inverse probability of treatment weighting (IPTW) was used to adjust for baseline demographics, comorbidities, medication exposures, and healthcare utilization. Logistic regression was used to evaluate the association between treatment and the binary outcome.

Results: A total of 1,011 patients received IV TXA and 157,959 did not. After propensity score matching, the two groups were well-balanced. The incidence of VTE was 0.2% in the TXA group, and 0.28% in the non-TXA group. Weighted logistic regression demonstrated no statistically significant difference in VTE risk (OR 0.62, 95% CI: 0.13-3.04, p = 0.55).

Conclusions: IV TXA use was not associated with increased postoperative VTE risk in plastic and reconstructive surgery of the head and neck, supporting its continued use as a safe hemostatic adjunct in this patient population.

Introduction: Mandibular distraction osteogenesis (MDO) is a critical intervention for addressing severe upper airway obstruction in infants with Robin Sequence (RS). Nonetheless, this procedure carries a risk of facial nerve dysfunction (FND), particularly affecting the marginal mandibular nerve (MMN). Since 2019, our group has prospectively monitored real-time facial nerve conduction using electroneurography (ENoG) during MDO procedures. This pilot study evaluates nerve conduction changes and their potential association with postoperative clinically visible FND.

Methods: Nine infants with RS undergoing MDO from 2019-2024 were randomly selected from a prospectively enrolled cohort. ENoG recorded motor responses from the orbicularis oculi and mentalis muscles. Significant changes were defined as a peak latency increase of ≥10% or an amplitude decrease of ≥60% from baseline.

Results: Twenty-five unilateral procedures [osteotomy/placement of hardware (18); hardware removal (6); revision (1)] were analyzed by a certified ENoG technician. Median age at surgery was 11.4 months (IQR 2.4-42.7). Retraction during osteotomy was the surgical step most associated with a significant amplitude decrease in 83.3% of cases, while device activation caused the most frequent peak latency increase in 44.4% of cases. Temporary MMN dysfunction was observed after four procedures (16.0%). Sensitivity/specificity were 17.6%/87.5% while NPV was 84.8%.

Conclusion: This prospective pilot study suggests intraoperative risk of MMN injury during MDO is greatest during retraction for osteotomy and device activation. With an NPV of 84.8%, ENoG predicted the absence of postoperative FND when there were no significant conduction changes. Further research is necessary to confirm its diagnostic utility and establish standardized pediatric intraoperative ENoG thresholds.

Background: Autologous breast reconstruction improves quality of life after mastectomy but carries a significant risk of postoperative complications. Body Mass Index is commonly used for risk stratification, despite limitations in reflecting body composition and fitness. This prospective study aimed to identify more optimal predictors for complication risk, including cardiopulmonary condition, smoking history, and body fat composition.

Methods: In this prospective study, patients undergoing DIEP-flap reconstruction were assessed preoperatively with cardiopulmonary exercise testing and abdominal CT angiography. Subcutaneous adipose tissue, visceral adipose tissue, and intramuscular adipose tissue were measured from CT images. Complications were classified using the Clavien-Dindo system. Predictors of postoperative complications were identified using logistic regression and validated in an independent cohort.

Results: Postoperative complications occurred in 46% of the 39 enrolled patients, with 33% requiring medical intervention (CD grade ≥ II). Physical fitness, measured using CPET, was not associated with CD≥ II complications. In multivariable analysis, only SAT and smoking history were independent predictors of complications, explaining 56% of the variance. A SAT threshold of 451 cm² for non-smokers and 204 cm² for patients with smoking history was identified, achieving 100% sensitivity and 77% specificity. Validation in an independent cohort confirmed the predictive value of SAT (AUC 0.715).

Conclusion: Physical fitness and BMI were not independent predictors of postoperative complications. SAT and smoking history were stronger predictors and can be easily accessed through routine CT imaging. These findings support the use of SAT as a practical, more accurate risk stratification tool for autologous breast reconstruction candidates.

Background: Capsular contracture remains a significant complication of nipple-sparing mastectomy(NSM) with immediate direct-to-implant(DTI) reconstruction. Although local inflammation is known to contribute to its development, the role of systemic inflammatory markers remains unclear. This study aimed to evaluate whether preoperative systemic inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), are associated with the increased risk of developing capsular contracture.

Methods: The medical records of 376 patients who underwent NSM with DTI reconstruction were retrospectively reviewed. The patients were divided into the non-contracture group (grades 1 and 2) and the contracture group (grades 3 and 4) based on Baker's classification. Clinicopathological variables, including the preoperative NLR and PLR, were analyzed.

Results: Among the 376 patients, 43 (11.4%) developed grade 3 or 4 capsular contractures. The contracture group showed significantly higher proportions of patients who underwent radiotherapy or chemotherapy and those with elevated preoperative NLR and PLR levels. Multivariate analysis identified radiation therapy and elevated NLR and PLR as independent risk factors of capsular contracture. Subgroup analysis revealed that NLR and PLR were not predictive of contracture among patients who did not undergo radiotherapy, but remained significant predictors among those who did.

Conclusion: Elevated preoperative NLR and PLR are associated with an increased risk of capsular contracture, particularly in patients receiving radiotherapy. These findings suggest that systemic inflammation, which is potentially exacerbated by radiation-induced fibrosis, may play a synergistic role in the development of capsular contracture. These markers may aid in preoperative risk stratification and support more personalized surgical planning.

Background: Gummy smile (GS), defined as excessive gingival display, compromises facial harmony and self-confidence. Traditional treatments, including orthognathic surgery, botulinum toxin (BTX-A), and lip repositioning, carry limitations in invasiveness, durability, or adaptability. Micro-Autologous Fat Transplantation (MAFT) presents a minimally invasive alternative by volumizing the upper lip and modulating perioral biomechanics.

Methods: A retrospective study was conducted on 52 patients (mean age: 43.4 years; 92.3% female) who underwent MAFT for GS correction between 2014 and 2023. Fat was harvested, purified, and micro-injected using the MAFT-GUN® into the nasolabial groove, ergotrid, and upper lip. Gingival exposure was measured at four maxillary incisor regions pre- and postoperatively. Patient satisfaction was assessed via a 5-point Likert scale; mean follow-up was 56.4 months.

Results: Mean preoperative gingival exposure (3.31 mm) significantly decreased to -0.82 mm postoperatively (p < 0.00001), with a mean reduction of 4.13 mm. The right central incisor showed the greatest improvement. Satisfaction scores increased from 1.40 to 4.90. Mean injected fat volume was 16.1 mL (SD: 3.4 mL), with a calculated graft weight of 14.8 g. No significant correlation was found between volume and outcome (p > 0.40), suggesting anatomical responsiveness. Only two patients (4%) required minor touch-ups; no major complications occurred.

Conclusions: MAFT is a safe, effective, and durable treatment for GS. By harmonizing perioral musculature and preserving dynamic lip movement, it bridges the gap between temporary neuromodulators and invasive surgeries, offering a reproducible, minimally invasive solution with long-term aesthetic and functional benefits.

Background: Artificial intelligence (AI) has been integrated into diagnostic modalities like nerve conduction studies (NCS) and ultrasound (US) to improve their performance in detecting idiopathic median neuropathy at the carpal tunnel (IMNCT), and its signs and symptoms referred to as carpal tunnel syndrome (CTS). AI could be a useful tool for streamlining diagnosis to improve accessibility and efficiency of CTS diagnosis. This systematic review evaluated AI diagnostic accuracy for CTS.

Methods: This review was registered with PROSPERO (CRD42024606291) and adhered to PRISMA guidelines. Searches were performed across Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL. Studies were included if they involved AI models (index test) in CTS diagnosis, where the reference standard was established by US, NCS, and/or clinical diagnosis. Results were synthesized via bivariate analysis to calculate pooled sensitivity, specificity, area under the curve (AUC), and positive and negative likelihood ratios (LRs).

Results: Twenty studies were included, with 17 assessing AI's diagnostic accuracy and four evaluating its ability to classify CTS severity. Half of the studies utilized US as the reference standard, followed by NCS (30%). The AI models demonstrated a sensitivity of 0.884 (95% CI, 0.862-0.903), specificity of 0.892 (95% CI, 0.859-0.918), AUC of 0.936, LR+ of 8.260 (95% CI, 6.220-10.800), and LR- of 0.131 (95% CI, 0.108-0.150) in diagnosing CTS. The overall certainty of the evidence was rated as moderate.

Conclusion: AI models show promise in reliably diagnosing CTS, which can serve as a useful adjunct in the clinic to promote efficiency and workflow while standardizing diagnostic practices.