Plastic and reconstructive surgery最新文献

Background: The spinal accessory nerve (SAN) is particularly vulnerable to iatrogenic injury during head and neck procedures, especially in the posterior cervical triangle where it courses superficially. Despite its clinical relevance, reliable surface-based strategies for SAN localization remain underdeveloped, particularly in the context of aesthetic and limited-access surgeries.

Methods: A cadaveric study was conducted on 186 hemi-necks from 111 Thiel-embalmed cadavers to identify consistent anatomical relationships between the SAN and four readily palpable skeletal landmarks: the mastoid process, sternoclavicular joint, midclavicular point, and acromioclavicular joint. Linear distances from the SAN's emergence at the posterior border of the sternocleidomastoid muscle to each landmark were measured, and a reproducible "danger zone" was mathematically defined.

Results: The SAN was reliably identified in all dissections. The mean distances from the nerve to the mastoid process, sternoclavicular joint, midclavicular point, and acromioclavicular joint were 5.1 cm, 11.0 cm, 9.1 cm, and 12.8 cm, respectively. A circular danger zone with a mean diameter of 2.96 cm (6.9 cm² area) was calculated based on overlapping standard deviations. When focusing solely on the mastoid process as the most consistent reference, a refined zone of 1.98 cm diameter (3.1 cm²) was delineated.

Conclusion: This study defines a clinically relevant and reproducible surface-based danger zone for SAN localization in the posterior cervical triangle. Anchored to palpable skeletal landmarks and validated on a large anatomical dataset, the proposed model enhances surgical safety during oncologic and aesthetic neck procedures by facilitating preemptive nerve identification.

This national projection study evaluates the future supply and demand of plastic surgeons in the United States through 2037 using the Health Workforce Simulation Model from the Health Resources and Services Administration. Workforce supply was modeled in full-time equivalents (FTEs), accounting for residency graduation rates, attrition, and retirement patterns through scenario-based sensitivity analysis across alternative workforce assumptions. Demand projections incorporated demographic trends, service utilization, and physician-to-population ratios. Under status quo assumptions, the national supply of plastic surgeons is projected to decline by approximately 22%, from 10,960 FTEs in 2022 to 8,540 by 2037. In contrast, demand is expected to increase by nearly 6% under baseline conditions and by more than 40% if access barriers are eliminated. This imbalance translates into a national adequacy decline from 100% in 2022 to 73% by 2037, with the most pronounced disparities in nonmetropolitan regions and in states such as Arkansas, Maine, and New Mexico, which are projected to have the lowest adequacy levels. This projected shortage represents a multifactorial challenge shaped by demographic aging, geographic maldistribution, constrained rural infrastructure, and reimbursement pressures. Addressing these trends will require coordinated, data-driven interventions supported by sound policy planning. Policy initiatives should emphasize equitable surgeon distribution, targeted financial incentives in underserved regions, protection of procedural scope, and the adoption of technological innovations to enhance equitable and sustainable access to plastic surgery care across the United States.

Background: In autologous breast reconstruction, the internal mammary artery is the preferred recipient vessel. Although rib-resecting is usually performed, the rib-preserving technique has gained increasing attention in recent years without being scientifically evaluated.

Methods: In our retrospective study, we analyzed 234 autologous breast reconstructions performed between 2018 and 2023 at a single hospital, comparing 163 patients who underwent rib resection with 71 patients who received the rib-preserving technique. Intraoperative data, postoperative pain medication usage, and follow-up interventions over a minimum of one year were screened.

Results: Ischemia time was significantly shorter in the rib-resecting group (45:00 min, IQR 37:44-60:00) compared with the rib-sparing group (50:59 min, IQR 43:59-71:00; p = 0.006). However, the rib-sparing group had longer pedicle lengths (11, IQR 10-12 vs. 10, IQR 9.5-11 cm; p = 0.074) and larger arterial diameters (p = 0.084). Postoperatively, rib-resecting patients required longer opioid treatment (3, IQR 2-4.25 vs. 2.5, IQR 1.63-3 days; p = 0.019), reported greater pain on the first postoperative day (p = 0.049), and exhibited more blood loss and drainage volume (p = 0.033, p = <0.001). Follow-up procedures were more frequent in the rib-resecting group (1, IQR 1-3) than in the rib-sparing group (1, IQR 0-1; p = 0.001), including lipofilling (35% vs. 20.3%, p = 0.029).

Conclusion: The rib-sparing approach shows significant advantages over rib-resection, particularly in terms of reduced postoperative morbidity and more aesthetically pleasing result with fewer secondary interventions. When technically feasible, it should be considered the preferred method in autologous breast reconstruction.Clinical Question/Level of Evidence.

Lymphatics System Transfer (LYST) is a recently described technique that combines the benefits of the established Vascularized Lymph Node Transfer (VLNT) with the advantages of Vascularized Lymph Vessel Transfer (VLVT). This procedure involves harvesting vascularized tissue that includes superficial lymphatic vessels and their corresponding draining nodes and transferring the tissue flap to the upper or lower extremity by microsurgical anastomosis. We present a novel pedicled LYST technique utilizing a Superficial Circumflex Iliac Perforator (SCIP) flap to treat patients with lower extremity lymphedema and concomitant chronic venous disease. Six patients underwent pedicled SCIP LYST, five of whom also received lymphovenous bypass distally in the lower extremity. Average follow-up period was 31 weeks (range: 10-55 weeks). Postoperative outcomes included a mean 15-point reduction in Lymphedema Life Impact Scale (LLIS) score (0.5 point per week) and a mean 30-unit decrease in bioimpedance spectroscopy (L-dex) measurements (0.9 units per week). No immediate complications were reported. The inclusion of long afferent lymphatic vessels with their draining lymph nodes may reduce the amount of lymphangiogenesis required to achieve physiological function, potentially leading to earlier functional recovery, though continued follow-up is necessary. The pedicled nature of this technique eliminates the need for microsurgical anastomosis, simplifying and shortening the procedure. Additionally, the proximal location of the pedicled flap may specifically offer advantages for patients with concomitant chronic venous disease, as flap lymphatics and lymph nodes drain efferent to the site of venous obstruction.

Background: Plastic Surgery The Meeting (PSTM) is a leading platform for presenting advancements in surgical techniques, research, and innovation. While research output has grown substantially over the past decade, systematic analyses of evolving academic themes in plastic surgery remain limited. We sought to determine which research themes have dominated PSTM abstracts over the past decade and how these themes have evolved over time.

Methods: We applied BERTopic, a transformer-based topic modeling algorithm, to the last decade of publicly available PSTM abstracts. Abstracts were extracted, preprocessed, and embedded using the all-mpnet-base-v2 model. Dimensionality reduction (UMAP), clustering (HDBSCAN), and topic representation (TF-IDF) with maximal marginal relevance) were used to generate and refine topics.

Results: Analysis of 4,867 PSTM abstracts (2014-2023) identified 11 coherent research topics and one outlier group. The most prevalent themes were "Breast Reconstruction & Implants" (26.1%) and "Cleft Lip, Palate & Craniofacial Surgery" (17.4%). Several areas demonstrated substantial growth, most notably "Transgender & Gender-Affirming Surgery" (36.3% CAGR) and "Carpal Tunnel & Wrist Surgery" (31.2% CAGR). A heat map reveals stable long-standing domains alongside rapidly expanding emerging fields, while the intertopic network highlights semantic links between clinically related areas, including the positioning of gender-affirming surgery adjacent to major reconstructive topics.

Conclusions: The BERTopic model effectively identified core areas of focus, emerging areas of interest, and relationships between research topics. This approach offers a data-driven framework for understanding evolving academic trends and can inform conference programming, funding priorities, and curriculum development as the field continues to advance.

Background: Most breast reconstructions are implant-based (IBR) and performed in two stages using tissue expanders (TE). Despite widespread indication for use, conventional TE can present limitations, especially those that containing metallic or magnetic ports. A new generation of TE incorporating non-metallic radiofrequency identification (RFID-TE) systems has been introduced.

Objectives: To assess outcomes/risk factors for complications following IBR with RFID-TE systems.

Methods: A retrospective cohort of patients who underwent IBR RFID-TE was identified, defining the primary endpoint as occurrence of complications/risk factors. We also evaluated the quality of magnetic resonance images (MRI;T1/T2-weighted sequences) taken for further diagnosis.

Results: 356 patients (mean age:49.9±9.6 years) underwent 471 IBR RFID-TE systems; average follow-up of 29.4±16.6 months; 77 patients (21.6%) experienced complications, most frequently seroma (7.8%). More complications were observed in older patients (p=0.005), smokers (p=0.009), and those who received radiotherapy (p=0.005) and reconstruction using a premuscular pocket (p=0.001). Multivariate regression found that older patients and smokers had odds ratios of 2.12 (p=0.013) and 2.30 (p=0.024), respectively, for developing complications. Radiotherapy (OR:2.29; p=0.024) was also an independent risk factor for overall complications. Use of a submuscular pocket was associated with significantly lower odds of developing seroma (OR:0.21, p=0.08). MRI demonstrated excellent quality, with no artifact-related negative impacts.

Conclusions: Despite extensive research on IBR, previous studies on RFID-TE are limited and did not analyze predictive risk factors. Our findings demonstrate that RFID-TE is a reliable technique, with results similar to those for other series using different devices. The absence of significant imaging artifacts contributes to follow-up and offers benefits over traditional TE.

Background: Breast augmentation remains one of the most commonly performed cosmetic surgical procedures worldwide to achieve a youthful and beautiful breast appearance. We describe a technique that preserves glandular tissue and muscle-glandular junctions of a submuscular pocket through a periareolar approach, providing stable implant coverage.

Methods: Prospective data collection of all patients with mild and moderate breast atrophy who underwent the preservation breast augmentation technique were included, and procedures were performed from February 2019 to August 2021. Demographic characteristics and peri- and postoperative variables were collected.

Results: Sixty-four patients were included in the study. The mean age at the time of the breast augmentation surgery was 26 years. The size of the breast implants used ranged from 275 to 375 cc. At one year postoperative follow-up only one patient required surgical correction for breast asymmetry and another patient experienced a self-resolving subcutaneous hematoma. No infections or wound dehiscence was observed. Sensation in both breasts was normal in all patients at the two-month mark, surgical results were deemed satisfactory according to the BREAST-Q score, and the BAKER score for all patients was one.

Conclusion: Preserving the anatomy and function of the glandular muscle unit leads to the preservation of the breast glands and the creation of more stable sub-muscular mammary pockets. This results in implants with greater muscle-glandular coverage throughout their entire extent and significantly reduces glandular atrophy. These advantages distinguish the technique and make it highly reproducible, with a short learning curve.

Background: Sexual dimorphism in the facial skeleton is fundamental to aesthetics and gender perception. This study employs AI-assisted three-dimensional (3D) imaging to analyze morphological differences between males and females in the upper, mid, and lower facial regions.

Methods: A retrospective analysis was conducted on 280 high-resolution craniofacial CT scans (147 females, 133 males) of adults aged 20 years and older. AI-assisted segmentation and modeling were performed using Materialise Mimics and 3-Matic software. The facial skeleton was divided into upper, mid, and lower regions for detailed morphometric evaluation. Statistical shape modeling (SSM) and heatmaps were used to visualize surface projection differences across age groups. Statistical comparisons were conducted to assess gender-based variation.

Results: Significant sexual dimorphism was observed across all facial regions. In the upper face, males had greater interorbital width, frontotemporal brow width, inter-medial canthi distance, and more prominent frontal bossing. In the midface, males exhibited increased width, depth, and vertical height, with the most pronounced differences occurring in middle age. The lower face showed larger mandibular dimensions in males, including bigonial width, ramus height, and a sharper mental angle, while females had a more rounded chin and smoother mandibular contour. Heatmaps confirmed greater surface projection in male skeletons, particularly in the gonial and midfacial regions, with dimorphism decreasing with age.

Conclusion: This represents the first large-sample CT study utilizing AI to comprehensively quantify facial skeletal dimorphism. Findings support the importance of gender-specific planning in facial reconstructive and aesthetic procedures.