Plastic and reconstructive surgery最新文献

Background: Lower-eyelid surgery by means of the transcutaneous approach is challenging because of common complications such as ectropion and scleral show.

Methods: The authors devised a transcutaneous lower-eyelid technique that incorporates 4 modifications that greatly reduce these complications-namely, tension-reducing incision of the capsulopalpebral fascia to prevent ectropion and preserve the pretarsal fullness; selective omission of lateral canthoplasty; universal application of arcuate expansion cuts to prevent lateral compartment bulging; and reattachment of the tear-trough and orbital-retaining ligaments to the orbital septum. A prospective cohort study was conducted on all consecutive patients who underwent the technique in January of 2020 to March of 2023. All complications were reviewed. The 50 most recent patients were assessed objectively by 3 independent plastic surgeons with regard to patient preoperative and 3- and 6-month postoperative tear trough, lid-cheek groove, eye bag, and fine lines. Each variable was scored on a 5-point scale.

Results: In total, 340 patients underwent the procedure. No major complications, including ectropion, were observed. All 4 aesthetic variables improved significantly at 3 and 6 months relative to preoperative baseline.

Conclusions: This new approach significantly mitigates common complications of transcutaneous lower-eyelid operations, including persistent postoperative ectropion. Thus, it may be a promising advance in surgical correction of lower-eyelid aesthetics.

Background: This study evaluated early debulking combined with corrective osteotomy for the treatment of hand macrodactyly in young patients.

Methods: This retrospective study included 31 young patients (mean age, 12.7 years) with severe hand macrodactyly. All the patients underwent microsurgical debulking based on multiple pedicled flaps and osteotomy to reduce soft-tissue volume and correct finger deformity. The mean follow-up period was 3.1 years. Clinical evaluations included ratios of finger length, circumference, and nail dimensions compared with the intact fingers; metacarpophalangeal joint range of motion; and functional scores (Kapandji, Action Research Arm Test, and Barthel) before and after surgery. The Vancouver Scar Scale score, parent satisfaction, and complications were also assessed.

Results: The procedure preserved all the fingers, avoided ablation, and restored near-normal appearance. Preoperatively, affected fingers were 1.3 times longer, with proximal interphalangeal joint and distal interphalangeal joint circumferences 1.5 and 1.7 times larger than those of intact fingers. At the last follow-up, these ratios improved to 1.1, 1.2, and 1.2, respectively. Nail length and width, initially 1.7 and 1.6 times larger, normalized to 1.0 and 1.1 times larger. Metacarpophalangeal joint range of motion improved from 41 degrees to 69 degrees. Functional scores rose significantly: Kapandji from 6 to 9, Action Research Arm Test from 33 to 53, and Barthel from 95 to 98. The average Vancouver Scar Scale score was 2. All parents expressed satisfaction with the results.

Conclusion: Early debulking combined with corrective osteotomy reduces finger volume, preserves digits, improves functional outcomes, and minimizes adverse effects on quality of life, offering a promising option for treatment of severe hand macrodactyly.

Background: Patients undergoing plastic surgery have higher rates of psychiatric disorders, which can influence surgical outcomes and quality of life (QoL).

Methods: A retrospective review was conducted of patients with or without psychiatric comorbidities who underwent reduction mammaplasty or body contouring (panniculectomy or abdominoplasty) from 2016 through 2022. Propensity score matching accounted for age, body mass index (BMI), race and ethnicity, bariatric surgery history, ptosis, and breast tissue mass. Demographics, clinical characteristics, and postoperative outcomes were compared. QoL was assessed using preoperative and postoperative BREAST-Q and BODY-Q scores. A literature review using PubMed, MEDLINE, Embase, Scopus, and Cochrane databases was performed to evaluate surgical outcomes of patients with psychiatric disorders undergoing plastic surgery.

Results: Among 554 patients, 194 underwent body contouring (97 with and 97 without psychiatric diagnoses) and 360 underwent reduction mammoplasty (180 with and 180 without psychiatric diagnoses). Body contouring patients had an average age of 46.7 years and BMI of 31.2. Psychiatric comorbidities were linked to increased surgical site occurrences (adjusted odds ratio [AOR] 3.02) and longer hospital stays (AOR 1.73). Reduction mammaplasty patients had an average age of 36.3 years and BMI of 29.7. Psychiatric comorbidities predicted more readmissions and emergency department visits (AOR 4.86). Both groups showed improved postoperative QoL regardless of psychiatric status. All 7 studies included in the literature review reported higher complication rates in patients with psychiatric diagnoses.

Conclusions: Psychiatric comorbidities are associated with higher complication rates and health care utilization in plastic surgery. Nonetheless, these patients have comparable postoperative QoL improvement, underscoring the benefit of these procedures. Appropriate preoperative or postoperative interventions should be considered to optimize outcomes and satisfaction in this vulnerable patient population.

Background: Lower blepharoplasty has shifted from fat resection to preservation by means of repositioning, yet severe fat herniation still requires selective excision. Traditional resection may compromise transposition. This study introduces deep fat excision to optimize the balance between removal and repositioning, enhancing aesthetic outcomes.

Methods: From 2018 to 2024, 107 patients underwent transcutaneous lower blepharoplasty with deep fat excision. The technique involved incising the orbital septum at the arcus marginalis to selectively resect the deep-layer fat, followed by septum-fat flap transposition to correct tear-trough deformities. Surgical outcomes were assessed using the Hirmand grading system through evaluations by clinicians, 2 publicly available artificial intelligence (AI) platforms, and the FACE-Q survey.

Results: Clinically, 91.6% of patients achieved complete elimination of fat bulges and tear-trough deformity, whereas 8.4% exhibited undercorrection in these areas. AI assessments showed 70.9% consistency with clinical evaluations (Cohen kappa, 0.58). Lower eyelid FACE-Q scores improved significantly from 66.7 ± 12.5 preoperatively to 21.9 ± 15.4 postoperatively ( P < 0.001), with high decision satisfaction (71.1 ± 19.9) and a perceived age reduction of 3.3 years (patient-perceived) and 5.8 years (AI-predicted). Minor complications included undercorrection, orbital hematoma, and residual tear-trough deformity.

Conclusions: Deep fat excision achieves the balance between fat excision and repositioning, improving aesthetic outcomes in severe fat herniation cases. In addition, integrating AI-assisted analysis enhances preoperative planning and postoperative evaluation, supporting its potential role in aesthetic surgery.

Background: Facial transplantation offers transformative solutions for patients with severe facial disfigurements. Minimizing ischemia time is critical for preserving tissue viability, and prioritizing facial allograft recovery during multiorgan procurement aims to optimize outcomes. This study evaluates whether prioritizing facial allograft procurement affects the outcomes of non-vascularized composite allotransplantation (VCA) organ transplants.

Methods: This retrospective study analyzed 4 VCA donor recoveries and face transplants at our center. Perioperative data, including operation times, blood pressure, oxygenation, urine output, and blood product administration, were recorded. Donor data were verified using the United Network for Organ Sharing database, institutional records, and data from LiveOnNY and Gift of Life organ procurement organizations to assess recipient and graft survival.

Results: Twenty-one allografts (VCAs and organs) were transplanted into 16 patients. The 1-year patient survival rate was 92% (11 of 12) among non-VCA recipients. One patient died during surgery, and 2 patients died more than 3 years after transplantation from unrelated causes. Three non-VCA graft failures occurred within the first year, resulting in an 87% graft survival rate. The median ischemia time for face transplants was 3 hours 18 minutes. Preoperative planning, including cadaveric rehearsals, computerized surgical plans, and 3-dimensionally printed cutting guides, contributed to stable perioperative parameters and reduced blood loss.

Conclusions: This study suggests that prioritizing facial allograft procurement is feasible and does not appear to compromise non-VCA organ transplant outcomes. Further multicenter studies are needed to validate these findings and further refine protocols.

Background: Poor recovery of active glenohumeral external rotation (aGHER) after brachial plexus birth injury (BPBI) is common. Late spinal accessory nerve-to-infraspinatus motor branch (SAN-IS) transfer has been reported as effective. The authors investigated its efficacy in children older than 4 years with BPBI.

Methods: This case series involved children with no aGHER undergoing SAN-IS transfer. Indications included absent aGHER in shoulder abduction and a positive external rotation drop test. Subscapularis release was done for passive GHER less than 30 degrees in patients without glenohumeral dysplasia, whereas external derotational humeral osteotomy was performed for those with dysplasia and passive GHER less than 0 degrees. Data collected included demographics, Narakas group classification, preoperative and postoperative hand-to-neck Mallet scores, postoperative aGHER, aGHER strength (British Medical Research Council scale), and parental satisfaction.

Results: Twenty-six patients, with a mean age of 9.9 years (range, 4 to 26 years) and mean follow-up of 27.9 months (range, 12 to 74 months), were included. Five patients (19%) had a concurrent upper subscapularis release, and 8 (31%) underwent derotational humeral osteotomy. Infraspinatus was macroscopically normal and contractile in all but 2 cases. Twenty-one patients (80%) achieved a mean aGHER of 71 degrees (range, 60 to 80 degress). Of these, 90% scored M4 on the British Medical Research Council scale, and 85% had a hand-to-neck Mallet score of 4. Shoulder forward flexion improved a mean of 35 degrees (range, 20 to 60 degrees) in 40% of patients. Parents were satisfied in 6 cases and extremely satisfied in 20 cases.

Conclusion: Late SAN-IS transfer is both effective and safe for restoring aGHER in patients older than 4 years with BPBI.

Background: Capsular contracture is a challenging entity to treat with consistent success. Recently, acellular dermal matrix (ADM) has been shown to be a highly effective therapeutic adjunct, particularly for patients at high risk for recurrence.

Methods: A total of 100 consecutive patients with Baker grade III and IV capsular contracture treated with ADM between 2014 and 2024 were included in this retrospective study. ADM was indicated for patients deemed high risk for failure of conventional surgical therapy. Data collected included patient characteristics, primary breast augmentation and revision procedure history, capsular contracture, surgical and nonsurgical treatments, and follow-up findings. Treatment success was defined as Baker grade II or better.

Results: The success rate of capsular contracture treated surgically with ADM was 90%. Among the 10 patients with ADM treatment failure, 8 had silicone implants, of whom 2 had new silicone implant ruptures. Four others had a history of silicone implant rupture before treatment with ADM. Some had additional notable characteristics: 2 resumed smoking, 1 had a hematoma, 1 underwent systemic chemotherapy, and another underwent breast radiation therapy. Salvage of ADM treatment failures with ultrasound was successful in 2 of 5 patients; both patients had saline implants. This increased the overall ADM success rate to 92%.

Conclusions: Adding ADM to conventional surgical techniques has produced the highest success rates in capsular contracture treatment. Given that ADM treatment failure is associated with silicone implant rupture, saline implants are recommended to maximize result longevity. When early ADM treatment failure occurs, ultrasound therapy may salvage those with saline implants.