Plastic and reconstructive surgery最新文献

Background: The periorbital area is susceptible to aging and structural changes, resulting in sunken eyelid deformities characterized by a hollow upper eyelid and pronounced orbital bone prominence. Conventional treatments, such as dermal fillers and fat grafting, have limitations in providing consistent and lasting results.This retrospective study introduces the endoscopic Retro-Orbicularis Oculi Fat (ROOF) transposition technique as a novel approach to correct sunken eyelid deformities and enhance lateral orbital convexity.

Methods: Twenty-six patients (25 female, 1 male; mean age: 34, range: 24-44) with noticeable supraorbital rim prominence and no excess upper eyelid tissue underwent endoscopic ROOF transposition between January 2021 and January 2024 were included. The procedure was performed through minimal scalp incisions with endoscopic visualization. Twenty-four patients also had concurrent endoscopic midface and temporal lift procedures, while two underwent forehead lift. Preoperative and postoperative images were evaluated at the 12-month follow-up.

Results: Postoperative assessments demonstrated significant improvements in eyelid contour and lateral orbital fullness, with stable results throughout the follow-up period. Early postoperative edema and bruising resolved within one week. No irregularities or complications were reported, and patient satisfaction ranged from good to excellent.

Conclusion: The endoscopic ROOF transposition technique provides a minimally invasive and effective solution for sunken eyelid deformities, offering lasting results without donor site morbidity. This approach can be combined with other endoscopic facial rejuvenation procedures, though the technique requires expertise and does not fully address medial orbital deformities.

Level of evidence: V.

Background: Insufficient narrowing often occurs after alar base reduction due to inadequate tissue resection. This study quantitatively analyzes the relationship between excised tissue amount and postoperative narrowing in combined sill and alar excision.

Methods: 268 Asian patients met inclusion criteria, including 12 males and 20 with prior alar base reduction. Pre- and postoperative anthropometric measurements were obtained using a vernier caliper. Changes in alar dimensions were compared, and correlations between tissue excision and narrowing were assessed. Outcomes were assessed via FACE-Q scales.

Results: Mean external alar excision was 4.7 mm (0-7 mm) and internal sill excision 6.9 mm (4-9.5 mm). The average external alar flare width decreased significantly from 37.6 mm to 33.0 mm (P < 0.05), with concurrent reductions in internal flare width, alar base width, and nostril width (all P < 0.05). Internal sill excision was the dominant factor in alar base narrowing and strongly correlated with external flare reduction (r = 0.7). On average, 3.2 mm sill excision produced 1.0 mm external flare narrowing, with higher ratios required in smaller excision groups. Patient extreme dissatisfaction with nasal base width decreased from 66.1% to 4.3%, with significant improvement in FACE-Q nostril satisfaction scores (P < 0.05). Overall decision satisfaction was high (73.3 ± 19.7).

Conclusion: Combined sill and alar excision effectively narrows the nasal base in Asians, achieving satisfactory aesthetic outcomes. These findings provide practical guidance for estimating tissue resection and predicting postoperative narrowing.

Level of evidence: 4.

Introduction: Topical nitroglycerin has been shown to enhance wound healing and reduce flap necrosis after oncologic mastectomy.1,2 However, its impact on gender-affirming mastectomy outcomes, particularly in free nipple grafts (FNG), has not been well studied. This study aims to evaluate the effectiveness of topical nitroglycerin in patients undergoing double incision mastectomy with FNG (DIFNG), focusing on graft and wound-related outcomes.

Methods: Adult patients undergoing DIFNG between August 2022 and June 2024 at a tertiary hospital were randomized into control (bacitracin) and treatment (topical nitroglycerin, 15mg per side) groups. All procedures followed a standardized surgical technique and perioperative regimen. Outcomes, including partial and total graft loss and wound complications, were assessed during routine bolster removal and post op visits. Ordinal logistic regression controlled for smoking status.

Results: Of 111 patients (56 control, 55 treatment), there were no significant differences in demographics or preoperative factors. The partial graft loss rate was significantly lower in the treatment group (18.2 % vs. 36.6 %, p = 0.004). Post-operative complications including seroma, hematoma, and wound complicate rates were not significantly different between the two groups. Rates of nipple graft hypopigmentation were significantly higher for African American patients compared to that of the Caucasian patients, but not significantly different between the control and treatment groups.

Conclusions: Topical nitroglycerin application in DIFNG significantly reduces partial nipple graft loss without affecting wound complications.ClinicalTrials.gov Registry: NCT06428669.

Background: Botulinum Toxin Type A (BoNT/A) injection for glabellar lines is popular due to its minimally invasive nature, safety, and efficacy. However, injection techniques and factors influencing outcomes need further study. This study compares three-point and five-point injection techniques and constructs a predictive model based on five-point injection results.

Methods: 444 patients were divided into three-point (219) and five-point (225) injection groups. Wrinkle improvement was assessed using the Facial Wrinkle Scale (FWS) and Patient-Rated Facial Wrinkle Severity Scale (PFWS), and complications were recorded. A retrospective analysis of 259 patients (including new patients) receiving five-point injections was conducted. A nomogram prediction model was built using multivariable logistic regression and evaluated using ROC curves, calibration curves, and the Hosmer-Lemeshow test. Decision curve analysis validated its clinical applicability.

Results: The five-point technique had significantly higher long-term efficacy (P=0.041) and similar complication rates to the three-point technique. Age, pretreatment patient self-assessment, physician scores, and procedure time influenced outcomes. Age and moderate-to-severe pretreatment resting physician scores were risk factors for inefficacy, while severe pretreatment patient and physician scores were protective. The nomogram model showed excellent discriminative ability (AUC=0.836) and good consistency.

Conclusion: The five-point BoNT/A injection technique offers superior long-term efficacy and safety. Age and pretreatment scores affect outcomes. The nomogram model effectively evaluates postoperative outcomes, providing a scientific basis for personalized treatment plans and improving patient satisfaction.

Introduction: Greater Occipital Nerve (GON) neurolysis, based on the original description of the procedure, is followed by elevation of a subcutaneous fat flap that is wrapped around the nerve for cushioning. However, this technique places the nerve in a more superficial and exposed position, and may increase the susceptibility to mechanical stimuli and traction, with risk for recurrent pain or injury. More recently, techniques to bury the nerve under the trapezius or semispinalis muscle have been employed to position the nerve beneath protective soft tissues. In this article, both techniques are discussed and postoperative results are compared.

Methods: Patients who underwent primary GON decompression surgery at three centers were included. Pain frequency, intensity and duration was collected preoperatively and postoperatively in a prospective fashion. Manual chart review was performed to collect data regarding type of flap used, complications and reoperations.

Results: 391 patients underwent GON decompression surgery. A fat flap was used in 203 (52%) and a muscle flap in 188 (48%) patients. Postoperative complications were similar between groups (p=0.116). The reoperation rate was significantly higher in the fat flap group as compared to the muscle flap group (n=26 (13%) vs n=9 (4.7%); p=0.007). Postoperative pain characteristics between the fat and the muscle flap group after the last intervention were not significantly different (p>0.05).

Conclusion: In comparing fat versus muscle flap techniques for GON decompression, both methods effectively reduced pain. However, the muscle flap approach resulted in a lower reoperation rate, suggesting this option may provide better long-term pain relief.

Background: The deep inferior epigastric perforator (DIEP) flap is widely used in autologous breast reconstruction, with its success heavily reliant on the vascular anatomy, particularly midline crossing-over vessels that facilitate contralateral flap perfusion. High-frequency ultrasound (HFUS) offers a non-invasive, radiation-free method to visualize small vessels and assess real-time blood flow. This study evaluates the utility of HFUS in detecting midline crossing-over vessels and their correlation with perfusion in DIEP flaps used for unilateral breast reconstruction.

Methods: A prospective study was conducted on 30 women undergoing unilateral DIEP flap breast reconstruction between August 2023 and June 2024. Preoperative HFUS was performed to assess the number, type, and diameter of midline crossing-over vessels. Intraoperative flap perfusion was quantified using indocyanine green (ICG) angiography, measuring the ICG-stained area (%). Spearman's rank correlation and multiple linear regression were used to analyze the relationship between HFUS findings and ICG area.

Results: HFUS identified midline crossing-over vessels in all patients but showed no significant correlation with ICG perfusion area (rho = -0.111, p = 0.5576). Multiple linear regression confirmed that HFUS-derived variables (vessel number, arterial presence, diameter) did not predict ICG area (R² = 0.061, p = 0.6416).

Conclusions: HFUS provides detailed anatomical insights into midline crossing-over vessels but lacks correlation with flap perfusion, limiting its predictive value for DIEP flap outcomes. Further studies are needed to explore its association with perfusion-related complications.

Background: The indications for reconstructing asymptomatic orbital blowout fractures remain controversial. We aimed to evaluate whether these fractures can be managed using a symptom-based protocol, disregarding radiological criteria.

Methods: In this single-center prospective follow-up study, we included adult patients with unilateral, isolated, and dislocated blowout fractures. The recommendation for surgical treatment was based exclusively on clinical symptoms and findings: obvious diplopia, restricted eye movements, or >2 mm of globe malposition (GMP). We assessed clinical outcomes and patient satisfaction over a 9-month follow-up. The reduction in surgical interventions was compared to historical data.

Results: A total of 206 consecutive patients were included. Of these, 35 (57% male, mean age 38 years) underwent early reconstruction, while 171 (53% male, mean age 55 years) were managed non-surgically. At 9 months, >2 mm of GMP was observed in 11% of the follow-up group and in 7.1% of the early reconstruction group. All patients who developed >2 mm GMP during follow-up declined reconstructive surgery. Compared to the surgical group, the follow-up group had lower rates of obvious diplopia (0% vs. 14%), any diplopia (13% vs. 63%), restricted eye movements (0% vs. 7%), and paresthesia (19% vs. 39%). Satisfaction with diplopia (97% vs. 64%) was also higher. Implementation of the new protocol reduced the reconstruction rate from 41.6% to 17.0%.

Conclusions: Development of subjectively disturbing late GMP in asymptomatic orbital blowout fractures is rare. Ocular function tends to recover spontaneously. A symptom-based approach is a safe and effective way to treat orbital blowout fracture patients.

Background: Breast augmentation (BA) is one of the most commonly performed plastic procedures worldwide. The transaxillary approach (TAA) has gained popularity for avoiding visible breast scars. Despite its increasing adoption in the clinical practice and technical refinements, the available evidence on safety and outcomes remains limited and heterogeneous.

Methods: A comprehensive search of MEDLINE, Embase, Scopus, Cochrane, and Web of Science databases was performed up to May 2025. Eligible studies included adult women undergoing primary BA (PBA) with silicone implants via the TAA. Primary outcomes were capsular contracture (CC) and patient-reported satisfaction. Secondary outcomes included infection, reintervention, hematoma, seroma, implant rupture, and other complications.

Results: Twenty-two studies comprising 5,843 patients (11,686 breasts) were included. Patient-reported satisfaction was consistently very high across all studies. Meta-analyses showed no significant differences between TAA and other incisions for CC (RR 0.73; 95% CI 0.29-1.88), reintervention (RR 0.74; 95% CI 0.41-1.34), or infection (RR 1.00; 95% CI 0.14-6.99). Within the TAA cohort, pooled incidences were low for all outcomes: CC 2.3% (95% CI 1.6-3.4), reintervention 3.3% (95% CI 1.7-6.1), and infection 0.7% (95% CI 0.4-1.2). Importantly, secondary endpoints also demonstrated uniformly favorable safety, with hematoma (1.4%), seroma (1.4%), and implant rupture (1%) occurring rarely, and no major adverse events reported.

Conclusions: PBA via TAA is a safe and effective technique, with complication rates comparable to inframammary and periareolar incisions and uniformly high satisfaction.

Background: Electrodiagnostic (EDX) studies are used to confirm the diagnosis of carpal tunnel syndrome (CTS), quantitatively assess disease severity, and distinguish CTS from other conditions. The purpose of this study was to evaluate whether the EDX study findings can predict the success or failure of corticosteroid injection (CI) in patients with CTS.

Methods: A retrospective review was conducted of 79 patients who received first-time CI for CTS without image-guidance between April 2019 and November 2022 and were followed for more than 1 year. Demographic information, disease characteristics, initial physical examination findings, pre-treatment EDX findings and Boston Carpal Tunnel Questionnaire (BCTQ) scores before and after CI were collected.

Results: Of the 79 patients, 41 (51.9%) required no additional procedures (treatment success group), whereas 38 (48.1%) underwent additional CI or surgery within 1 year (treatment failure group). Multivariable logistic regression analysis showed that a positive Phalen test (odds ratio [OR] 7.053; 95% confidence interval, 1.349-36.882, p = 0.021), larger static two-point discrimination (OR 1.491; 95% confidence interval, 1.049-2.118, p = 0.026), and higher initial BCTQ-symptom scores (OR 1.978; 95% confidence interval, 1.027-3.810, p = 0.041) were significant risk factors for treatment failure after CI. Pre-treatment EDX parameters were not significantly associated with predicting CI failure.

Conclusions: Although EDX studies are useful for diagnosing CTS and assessing severity, their value in predicting CI outcomes appears limited. In contrast, provocative tests, sensorimotor assessment of the median nerve, and severe baseline symptoms were significant indicators of CI failure.

Level of evidence: Prognostic, level IV.