Plastic and reconstructive surgery最新文献

Background: Frontal hairline correction with hair transplantation is a widely performed aesthetic procedure; however, patient satisfaction remains variable. Despite this, limited studies have investigated the factors influencing satisfaction. Therefore, this study aimed to identify key predictors of satisfaction in frontal hairline correction to provide clinicians with insights to optimize patient outcomes.

Methods: This retrospective study analyzed patient data from 4 clinical institutions, focusing on patients who underwent frontal hairline correction with hair transplantation between June of 2021 and July of 2023. Of the 780 individuals initially considered, 736 met the inclusion criteria after the application of exclusion parameters. Key variables, including sex, age, hair characteristics in the recipient area, interest in selfies, educational level, and surgical cost-to-annual income ratio, were analyzed separately for men and women. Correlation analysis and linear regression models were used to identify factors influencing patient satisfaction.

Results: Single-factor analysis identified age, hair characteristics in the recipient area, interest in selfies, educational level, surgical cost-to-annual income ratio, and androgenetic alopecia as predictors of satisfaction. Pearson analysis yielded results consistent with those of the single-factor analysis. Multifactor analysis revealed that age, hair direction, interest in selfies, and surgical cost-to-annual income ratio significantly influenced satisfaction. Interest in selfies, educational level, surgical cost-to-annual income ratio, and androgenetic alopecia were significant predictors of satisfaction for men, whereas hair direction, interest in selfies, and surgical cost-to-annual income ratio were significant predictors for women.

Conclusion: Satisfaction with frontal hairline correction with hair transplantation varies by sex, emphasizing the importance of considering individual factors during surgical planning.

Background: Skin regeneration by means of mechanical stretching is used in reconstructive surgery, but it is often limited by the skin's inherent growth capacity. This multicenter randomized controlled trial evaluated the efficacy of autologous stromal vascular fraction (SVF) transplantation and fat grafting in enhancing skin regeneration during tissue expansion.

Methods: Patients aged 18 to 60 years undergoing skin expansion were randomized to receive SVF transplantation or fat grafting or serve as controls. Participants were also categorized into well-regenerated and poorly regenerated subgroups based on skin texture assessments. Assessments occurred every 4 weeks over 12 weeks, with safety follow-up up to 2 years. The primary outcome was skin thickness change at 12 weeks; secondary outcomes included intermediate skin thickness and the expansion index.

Results: Seventy-two patients were enrolled; after 6 were lost to follow-up, 66 remained (23 in the control group, 21 in the adipose group, and 22 in the SVF group). At 12 weeks, the adipose and SVF groups showed significant increases in skin thickness compared with the control group ( P < 0.05). In well-regenerated skin, treatments maintained thickness; in poorly regenerated skin, treatments increased and maintained thickness through 12 weeks. Both treatment groups had greater increases in expansion index at 12 weeks compared with controls ( P < 0.001). No severe adverse events were observed during the 2-year follow-up.

Conclusions: Autologous SVF transplantation and fat grafting effectively promote skin regeneration during tissue expansion, maintaining skin thickness in well-regenerated skin and counteracting thinning in poorly regenerated skin. Adipose-derived treatments offer an effective strategy for enhancing skin regeneration in tissue expansion.

Background: Lower extremity free flap reconstruction (LE-FFR) is essential for significant soft-tissue defects, but prolonged hospital stays can negatively impact patients and health care systems. This study aimed to identify factors associated with post-flap-surgery length of stay (pfsLOS) in LE-FFR patients to optimize health care delivery and outcomes.

Methods: This retrospective cohort study included 405 patients who underwent 415 microvascular LE-FFRs at 2 level I trauma centers. The primary outcome was pfsLOS, which was then described in the context of total LOS (tLOS). Statistical analyses involved multivariable linear and Cox regression models, analyzing outcomes as relative percentage changes in pfsLOS.

Results: Across all defect causes, median pfsLOS was 10 days (interquartile range, 8 to 14 days), with prolonged pfsLOS (>14 days) in 81 patients (20%). Combined initial plastic and orthopedic surgery treatment (primary multidisciplinary orthoplastic treatment) was associated with a significant decrease in pfsLOS (-13.58%; P = 0.047) in multivariable regression analysis, with the greatest benefit observed in high-severity cases. Other factors significantly affecting pfsLOS included the number of plastic surgery operations (14.47% increase per operation; P < 0.001), blood transfusion (13.03% increase; P = 0.023), and flap surgery duration (0.06% increase per minute; P = 0.041). The time between the first surgery and flap surgery was associated with a significant decrease in pfsLOS (-0.90% per day; P = 0.046). Subanalysis showed that discharge to destinations other than home significantly increased pfsLOS (16.45%; P = 0.001), particularly in socially deprived areas.

Conclusions: Initial combined orthoplastic intervention reduced pfsLOS by 9.10% to 13.58% and overall total LOS by 50.00% for LE-FFR patients. Early coordination between services reduces LOS, optimizes resource use, and likely improves cost-effectiveness and patient outcomes in LE-FFR.

Background: Health disparities persist within plastic and reconstructive surgery (PRS), disproportionately affecting patient populations based on social determinants of health. These disparities contribute to delayed treatment, higher complication rates, and worse aesthetic and functional outcomes, ultimately affecting quality of life and patient well-being. Progress has been made in identifying these inequities, but there remains a need for targeted research to design, implement, and assess interventions that directly address these disparities.

Methods: The authors conducted a scoping review of recent PRS literature to evaluate the proportion of studies focused on identifying, understanding, and addressing disparities. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, a systematic search identified national studies published since 2019 that addressed health care disparities specific to PRS.

Results: Of the 173 studies included, 81.5% focused on identifying disparities, 10.4% aimed to understand causative factors, and an additional 8.10% implemented interventions to reduce disparities. Disparities were most frequently reported in breast surgery, followed by general reconstruction and nonbreast microsurgery. People from underrepresented racial or ethnic groups, patients with lower socioeconomic status, and women experienced the greatest burden of inequity. Most studies evaluated barriers, such as treatment access, offers of care, and postsurgical complications; few studies progressed to implementing solutions to address these challenges.

Conclusions: To achieve meaningful progress, PRS disparities research must move beyond identifying inequities to actively reducing them through evidence-based interventions, policy initiatives, and patient-centered care. Addressing these inequities can improve access to treatment, surgical outcomes, and quality of life for underserved populations. By prioritizing actionable solutions, the field of PRS can achieve more equitable health care delivery.

Background: External hemipelvectomy (EH) is a complex amputation that removes the hemipelvis and leg, most commonly performed to resect a locally advanced pelvic malignancy. This destabilizes the spinopelvic anatomy and may result in a compensatory scoliosis (CS) to maintain an upright posture. The authors hypothesized that pelvic ring reconstruction with vascularized bone (VB) will reduce CS and improve functional outcomes.

Methods: The authors conducted a retrospective cohort study of patients who underwent an EH between May of 2023 and January of 2004. Patients were categorized by use of VB or not (NVB). The primary outcome was CS (Cobb angle >10 degrees on imaging >10 months postprocedure). Secondary outcomes included surgical complications and functional outcomes.

Results: The authors identified 58 reconstructions (VB, 29; NVB, 29). Median follow-up (months) for VB was 25.9 months (interquartile range, 34.6 months) and for NVB was 16.1 months (interquartile range, 114.9 months). For VB, fibula (41.4%) and tibia (37.9%) flaps were most common, including 15 pedicled and 14 free fillet flaps. Median time to full union was 8.8 months (range, 3.4 to 11 months). CS was diagnosed in 22.2% and 78.6% of VB and NVB patients, respectively ( P = 0.004). Median Cobb angle for VB was 8 degrees (range, 2 to 21 degrees) and 15.1 degrees (range, 3 to 30 degrees) for NVB ( P = 0.02). The overall complication rate was not different between the 2 groups. Similar proportions of VB and NVB patients tolerated prostheses (34.5% versus 32.1%) and were reliant on a wheelchair (65.5% versus 60.7%).

Conclusion: Pelvic ring reconstruction with VB after EH appears to reduce the incidence and severity of CS, without increasing complication rates.

Background: The purpose of this study was to investigate key factors related to velopharyngeal insufficiency (VPI) by evaluating velopharyngeal morphology, soft palate mobility, and surgical recovery in cleft palate patients with different types of velopharyngeal function.

Methods: Computed tomographic data were used to compare morphology in 49 postoperative velopharyngeal competence (VPC), 39 VPI, and 49 noncleft individuals. Ultrasound was used to assess surgical recovery in 87 VPC, 77 VPI, and 75 noncleft individuals. Soft palate mobility was evaluated in 20 VPC and 17 VPI patients through cephalometric radiographs.

Results: In terms of velopharyngeal morphology, both VPC and VPI groups exhibited shorter velar and hard palate ratios, longer pharyngeal ratio, and lower velopharyngeal ratio compared with the noncleft group ( P < 0.05), but there were no significant differences between VPC and VPI ( P > 0.05). Both groups exhibited significantly lower echo intensity, higher intensity dispersion index, and lower logarithm unit color velocity values compared with the noncleft group ( P < 0.05). However, the differences in echo intensity, intensity dispersion index, and logarithm unit color velocity between the VPC and VPI groups were not statistically significant ( P > 0.05). In contrast, the VPC group showed significantly better soft palate mobility compared with VPI, with greater elevation angle ( P = 0.042) and higher closure rate ( P = 0.001) during speech.

Conclusions: The VPC group showed significantly improved soft palate mobility compared with the VPI group; however, it was interesting to note the lack of significant differences in velopharyngeal morphology and surgical recovery in postoperative cleft palate patients with VPC and VPI.

Background: Breast augmentation with implants is commonly performed among East Asian patients, but few studies have analyzed how breast morphology changes postoperatively. This study evaluated these changes in this population.

Methods: This was a single-surgeon retrospective review of East Asian women who underwent primary endoscopic transaxillary breast augmentation from 2019 through 2024 using the same profiled silicone implants. Patients with massive weight loss or breast ptosis were excluded. Measurements included suprasternal notch to nipple, nipple to inframammary fold, base diameter (BD), areola height, and areola width, measured manually preoperatively and 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Paired t test was used to compare average measurements and changes.

Results: In total, 184 breasts (92 patients) were analyzed. The average increase in absolute measurement and percentage change (regardless of implant size) between preoperative measurement and 1 year was 1.4 cm (7.7%) for suprasternal notch to nipple, 2.3 cm (42.6%) for nipple to inframammary fold, 0.4 cm (3.2%) for BD, 0.7 cm (26.6%) for areola height, and 0.7 cm (21.4%) for areola width. At 1 year, all measurements except BD showed significant changes from preoperative values.

Conclusions: The findings of this study suggest that in primary transaxillary breast augmentation in East Asian patients, placing implants of any volume that match the native base diameter results in outward anterior expansion, with preferential lower-pole distension over time and minimal change in breast footprint. The upper pole stretches less than the lower pole, and the nipple remains stable to the chest wall within the first year. These data offer insights into the breast's natural morphology and postoperative course, aiding future augmentation consultations.

Background: Malar region treatment is crucial for facial feminization in individuals assigned male at birth (AMAB). The main therapeutic options are malar implants and lipofilling, sometimes combined with injectable fillers. However, no consensus exists in the literature on the superiority of one technique over the other. This is the first report to compare and evaluate the effectiveness of malar implants and lipofilling for feminizing the midface in AMAB patients, and to assess patient satisfaction.

Methods: Between November of 2018 and November of 2022, the authors conducted a prospective comparative bicentric study on 40 patients who voluntarily underwent midface feminization using either fat grafting or malar implants. Patient satisfaction and the efficacy of each technique for cheek feminization were evaluated using the FACE-Q scales, the Satisfaction With Life Scale, the Subjective Happiness Scale, and the Face and Neck Lift Objective Photo-Numerical Assessment Scale, administered preoperatively and 1 year after surgery.

Results: A significant improvement ( P < 0.05) was observed in both groups between preoperative and postoperative scores, indicating high satisfaction and efficacy, independent of the chosen method. Neither technique proved to be superior to the other in terms of patient satisfaction.

Conclusions: Malar enhancement using implants or lipofilling is effective for malar feminization in AMAB patients. Malar remodeling techniques should be tailored to each patient's expectations and preoperative clinical evaluation. Further studies with a longer follow-up period and a larger patient cohort are needed to determine whether one technique may prove superior to the other.

Background: Tendon reconstruction is a difficult procedure with unpredictable results, and evaluating and selecting the appropriate muscle tendon is crucial. To improve the results of tendon reconstruction, the authors investigated active muscle contraction during wide-awake local anesthesia no tourniquet (WALANT) surgery, in which the patient can perform active movements.

Methods: Among 213 WALANT tendon reconstructions, 148 muscle tendons were evaluated for active contraction distance and passive stretch distance of the muscle tendons, time elapsed before reconstruction, and characteristics and changes in muscle active contraction patterns after verbal instructions.

Results: Active contraction and passive stretch distances showed significant positive correlations and flexor muscles displayed larger distances than extensor muscles. Time elapsed before reconstruction did not correlate with either distance. In the flexor digitorum superficialis muscle, active contraction distance was greater in the grip-related ulnar digits, but the late-phase pattern was more frequent. In the extensor indicis proprius muscle, contraction distance on instruction to extend the thumb was smaller than that when instructed to extend the index finger.

Conclusion: WALANT surgery is the only procedure in which active contraction distance and characteristics of muscle tendons can be observed intraoperatively, and it appears useful for tendon transfer.