Plastic and reconstructive surgery最新文献

Background: The 5-item modified frailty index (5-mFI) is used to predict clinical outcomes in breast reconstruction, but its relationship to patient-reported outcomes (PROs) after 2-stage implant-based reconstruction (IBR) is unclear. This study evaluates how frailty is associated with clinical outcomes and PROs using the BREAST-Q. The authors hypothesized that higher 5-mFI scores would correlate with poorer outcomes and PROs.

Methods: Patients aged 18 years or older who underwent immediate 2-stage IBR from January of 2017 to April of 2023 were included. Complications (eg, reconstructive failure, salvage, cellulitis/infection, seroma, mastectomy skin flap necrosis) and BREAST-Q scores for sexual well-being, psychosocial well-being, satisfaction with breasts, and physical well-being of the chest (PWBC) were compared between low-frailty (5-mFI <2) and high-frailty (5-mFI ≥2) groups at baseline and at 6 months, 1 year, and 2 years after exchange.

Results: Of 2697 patients, 2569 (95%) were low frailty. Seroma rates differed significantly between frailty cohorts, but frailty status was not associated with complications on multivariable analysis. High-frailty patients reported significantly lower satisfaction with breasts preoperatively and 2 years after exchange. Low-frailty patients consistently had better PWBC scores than high-frailty patients. Physical well-being and sexual well-being scores were significantly higher in low-frailty patients preoperatively and at 6 months. Multivariable analysis confirmed that increased frailty was associated with lower PWBC scores.

Conclusions: Although the 5-mFI has does not effectively predict outcomes for all aspects of the BREAST-Q, it may be useful for predicting PWBC for patients undergoing 2-stage IBR. Furthermore, it may not be an effective metric to predict IBR postoperative complications.

Background: Periprosthetic infection (PPI) is a complication of alloplastic breast reconstruction that can result in reconstructive failure, delay of adjuvant therapies, and reoperation. Despite multiple observational cohort studies, optimal PPI management remains unclear. The aim of this study was to develop a clinical prediction tool to guide clinical management.

Methods: A multicenter retrospective cohort study was conducted. Consecutive patients with breast cancer who underwent immediate alloplastic breast reconstruction between 2010 and 2020 were included. Collected data included patient, oncologic, and reconstructive factors for patients whose postoperative course was complicated by cellulitic infection or PPI. Two models were created for prediction of progression from cellulitis to PPI and from breast infection to reconstructive failure.

Results: A total of 1438 patients (2165 breasts) were included. The incidence of infection was 7.1% ( n = 145). Implant reconstruction was salvaged in 67.1% ( n = 104) of cases. The first model, predicting progression from cellulitis to PPI, had good predictive accuracy, with an area under the receiver operating characteristic curve of 0.61 (95% CI, 0.53 to 0.70; P < 0.001). The second model, predicting progression to reconstructive failure, also had good predictive accuracy, with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.71 to 0.87; P < 0.001).

Conclusions: This study presents novel clinical prediction tools with good predictive accuracy. Application of these prediction tools can assist the clinician in making evidence-based management decisions for treatment of PPI after alloplastic breast reconstruction. Future research will aim to prospectively validate treatment algorithms and improve reconstructive success.

Learning objectives: After studying this article, the participant should be able to: 1. Understand the embryologic and anatomical basis of the nose in a unilateral cleft lip. 2. Identify key challenges in achieving nasal symmetry and balance in cleft rhinoplasty coinciding with primary lip reconstruction. 3. Evaluate the advantages and limitations of different surgical approaches to the nasal tip, including open, closed, and conservative techniques. 4. Recognize the role of septoplasty, alar base repositioning, and nasal tip manipulation in improving outcomes. 5. Appreciate the importance of postoperative management and the commitment to systematically documenting and analyzing long-term results.

Summary: The nose, associated with a unilateral cleft lip, presents a complex surgical challenge, requiring a precise understanding of nasal anatomy and cleft-related distortions. Primary cleft rhinoplasty aims to restore nasal symmetry by repositioning the alar base, centralizing the columella, improving tip projection, and minimizing tissue trauma and growth impairment. This article reviews the embryologic and anatomical basis of the unilateral cleft lip and nose; highlights key challenges in correction; and examines the impact of different surgical techniques, including open, closed, and conservative approaches. The role of septoplasty, alar base repositioning, and tip manipulation is analyzed, along with the importance of consistent postoperative care and outcome monitoring to achieve long-term symmetry and functional success. This review provides a structured framework to guide surgical decision-making and optimize long-term outcomes in cleft rhinoplasty.

Background: Efficient and objective tools for self-assessment of microsurgical skills are needed to ensure high-quality microsurgical training and optimized use of surgeons' time and resources. In addition, the successful clinical integration of microsurgical robots in operating rooms will critically depend on effective training and evaluation strategies for microsurgeons, necessitating the development, usability testing, and validation of such assessment tools for both conventional and robotically assisted microsurgery.

Methods: Two deep convolutional neural network-based computer algorithms were developed to enable automated tracking of conventional and robotic microsurgical instruments. To train these models, supervised and semisupervised learning was applied to 84 microsurgical training videos, and the results were statistically analyzed using t tests, ANOVA, linear regression, and correlation analyses.

Results: Computer algorithms that automatically track conventional and robotic microinstruments in recorded microsurgical training videos were developed. The total trajectory length showed a positive correlation with procedure time and Structured Assessment of Microsurgical Skill scores, reflecting operative efficiency and flow. Both procedure time and total trajectory length of robot-assisted procedures were significantly longer among experienced microsurgeons compared with the conventional approach, but not among microsurgical beginners. The mean deviation intensity, quantifying hand tremor throughout microsurgical performances, was significantly lower with the robot-assisted compared with the conventional microsurgical approach across all experience levels.

Conclusions: The proposed computer algorithms address critical gaps in objective microsurgical skill assessment, enabling accessible, efficient, and quantitative self-evaluation, and allow for direct comparison of robot-assisted and conventional microsurgical performances.

Background: Conventional liposuction techniques involve visible incisions and scars. Newer methods offer less invasive options with improved patient satisfaction and fewer complications. Use of tranexamic acid (TXA) in tumescent solution has shown promise in reducing bleeding and bruising, enhancing postoperative outcomes. The purpose of this study was to describe TXA's effects in edema, ecchymosis, and pain in patients undergoing arm liposuction.

Methods: A comparative contralateral randomized clinical trial was conducted at a single specialized plastic surgery institution in Bogotá, Colombia, from May of 2022 to February of 2024. The study involved adult patients aged 18 to 60 years undergoing arm liposuction, either alone or in combination with other procedures. Patients received TXA in 1 arm, and placebo in the contralateral arm, with random assignment and blinding for both patients and surgeons.

Results: The authors' study included 78 patients, resulting in 156 arms undergoing arm liposuction with either TXA or placebo. Most patients were female (78.2%), with a mean age of 37.6 years and a mean body mass index of 24.7 kg/m². Pain scores and ecchymosis were significantly lower in the TXA arm compared with the placebo arm on the first day after the procedure. No differences in arm circumference measurements were found between groups along the different time points. The overall complication rate was 8.97%. Adding TXA to tumescent solution for arm liposuction significantly reduces pain and bruising, improving patient recovery. Our randomized trial confirms TXA's safety and effectiveness, highlighting its potential as a valuable tool in body contouring procedures and postoperative care.

Background: Unilateral facial paralysis is a condition marked by facial asymmetry. Although reconstructive operations, such as masseteric-to-facial nerve transfer combined with static suspension, significantly improve facial symmetry, patient outcomes can vary considerably. This study aimed to explore cerebral reorganization, focusing on rich-club (RC) organization and structural connectivity (SC)-functional connectivity (FC) coupling as potential biomarkers for facial symmetry recovery.

Methods: The authors enrolled 40 patients with severe oral commissure drooping caused by unilateral facial nerve lesions, who underwent masseteric-to-facial nerve transfer combined with static suspension. Using functional magnetic resonance imaging and diffusion tensor imaging, the authors analyzed RC properties, the macroscale SC, and FC. Based on postoperative symmetry levels, patients were categorized into symmetry and asymmetry groups for comparison.

Results: Patients with better facial symmetry demonstrated stronger SC-FC coupling. In addition, greater strength in non-RC nodes, along with stronger feeder and local edges, played a compensatory role in improving facial symmetry. In contrast, patients with facial asymmetry exhibited increasing FC in RC and non-RC nodes, possibly as a maladaptive compensatory mechanism.

Conclusions: The authors' study highlights RC organization and SC-FC coupling as potential biomarkers for assessing and monitoring facial symmetry recovery in facial paralysis patients after surgery. These findings offer valuable insights into the brain's adaptive responses, serving as sensitive indicators of disease symptoms and functional performance.