Plastic and reconstructive surgery最新文献

Background: Patients undergo abdominoplasty/panniculectomy following excessive weight loss and/or to improve abdominal appearance/shape. The authors aim to compare clinical outcomes and quality of life (QoL) following these procedures in patients with and without a history of weight loss surgery (WLS).

Methods: A single-center, single-surgeon, retrospective review from 2015 to 2022 was performed examining patients who underwent abdominal contouring procedures with and without a history of WLS. A propensity-scored match was performed based on age and sex. Surgical outcomes and patient-reported outcomes (BODY-Q) were compared.

Results: Overall, 208 patients (104 per group) were identified (mean follow-up, 15.5 ± 14.2 months). Mean age was 47.4 ± 11.0 years, and the majority were female (86.1%). The WLS group had greater body mass index (35.4 ± 9.3 kg/m 2 versus 29.7 ± 6.9 kg/m 2 ; P < 0.05), had more tissue excised (1680.3 ± 1003.7 cm 2 versus 976.1 ± 630.9 cm 2 ; P < 0.05), and were more likely approved by insurance (85.1% versus 39.8%; P < 0.05). Liposuction was more frequently performed in non-WLS patients (51.9% versus 11.5%; P < 0.05). WLS patients experienced greater rates of delayed wound healing (34.6% versus 16.5%; P < 0.05); there were no predictive factors on multivariate regression. There were no differences in surgical-site infections, hematomas, cellulitis, cosmetic outcomes, readmissions, or revisions ( P > 0.05). WLS patients demonstrated significant improvement in QoL: appraisal, body image, physical function, and sexual function ( P < 0.05).

Conclusions: Patients with a history of WLS undergoing abdominal contouring procedures experience increased wound healing complications compared with non-WLS patients. Major complications requiring reoperation/revision were no different between groups. All patients had significant QoL gains in body and abdominal satisfaction, psychological function, psychosocial function, and appraisal. WLS patients had additional improvements in body image, physical function, and sexual function.

Background: Individuals with neurofibromatosis type 1 (NF1) have a 10% lifetime risk of developing malignant peripheral nerve sheath tumors (MPNSTs). The majority of NF1-associated MPNSTs arise from preexisting plexiform neurofibromas (PNFs). The PNF subtypes susceptible to malignant transformation remain unclear.

Methods: This retrospective study included patients with head and neck PNFs who underwent surgical treatment at Shanghai Ninth People's Hospital from June of 2012 through July of 2023. Logistic regression analyses were conducted to assess risk factors for malignant transformation. Cox proportional hazards regression was used to evaluate the potential effects of variables on time to malignant transformation.

Results: A total of 19 (4%) of the 470 PNFs underwent malignant transformation. Deep or proximal PNFs involving cranial nerve ganglia were significantly associated with an increased risk of malignant transformation (adjusted odds ratio, 3.10 [95% CI, 1.07 to 9.00]); tumor morphology, relationship to adjacent tissues, and demographic factors were not significantly associated with malignant transformation. Ganglion involvement significantly accelerated the time to malignant transformation by 36% (hazard ratio, 7.20 [95% CI, 2.33 to 22.28]).

Conclusions: Involvement of cranial nerve ganglion is an independent risk factor for malignant transformation of head and neck PNFs. Patients with this high-risk profile require closer surveillance for malignancies and proactive management of suspicious lesions.

Background: Pain is a prominent symptom following prosthetic breast augmentation by means of axillary incision, and persists throughout hospitalization. However, routine analgesia is not always effective for all patients. Duration of regional block with ropivacaine is also limited. The objective of this study was to evaluate whether the combination of methylene blue and ropivacaine by means of serratus anterior plane block provides superior long-lasting analgesia compared with ropivacaine alone in prosthetic breast augmentation.

Methods: This double-blind, single-center, randomized controlled trial enrolled 72 female patients, who were randomly and equally assigned to the control group, the ropivacaine group, and the ropivacaine plus methylene blue group during surgery. A standard postoperative analgesic regimen was administered to all patients. The visual analog scale was used to assess pain scores, which were observed and recorded at 6, 24, 48, and 72 hours postoperatively by 2 well-trained, independent investigators.

Results: No statistically significant differences were observed in age ( P = 0.200), body mass index ( P = 0.200), prosthesis brand ( P = 0.764), size ( P = 0.580), or type ( P = 0.260) among the 3 groups. The study demonstrated that serratus anterior plane block significantly improved postoperative pain management within 24 hours. Furthermore, the ropivacaine plus methylene blue group showed no advantages over the ropivacaine group at 6 hours postoperatively, whereas it had a better visual analog scale score than the ropivacaine group 24, 48, and 72 hours postoperatively, which were statistically significant differences ( P < 0.05).

Conclusion: The analgesic effect of methylene blue and ropivacaine in serratus anterior plane block has a longer duration than ropivacaine alone in prosthetic breast augmentation.

Background: Fibrous dysplasia of the jaw (FDJ) is a rare fibroosseous skeletal disorder that affects the maxilla and/or mandible, often resulting in significant dental complications. However, its impact on dentition and occlusion remains poorly characterized. This study aims to analyze the dental and orthodontic sequelae of FDJ to enhance clinical management and improve patient care.

Methods: A retrospective cohort study was conducted on patients with FDJ seen at the authors' institution from 2015 to 2023. Medical records and computed tomographic imaging were reviewed to assess disease distribution, dental abnormality, occlusion, and orthodontic treatment outcomes.

Results: Among 39 patients with FDJ, 30 (76.9%) had direct dentoalveolar involvement. Malocclusion was documented in 29 patients (74.4%), with Angle class 1 in 26 (66.7%), Angle class 2 in 10 (25.6%), and Angle class 3 in 3 patients (7.7%). Dental abnormalities included retained primary teeth ( n = 5 [12.8%]), dental caries ( n = 8 [20.5%]), enamel hypoplasia ( n = 1 [2.6%]), and loss of permanent dentition ( n = 3 [7.7%]). Of 15 patients with long-term follow-up after initiation of orthodontics, 12 (80%) experienced long-term stability of occlusion without requiring repeated orthodontic intervention.

Conclusions: FDJ presents significant dental challenges, with high rates of dentoalveolar involvement and malocclusion. Although some patients experienced tooth pain and rapid disease progression resulting in need for surgical intervention, most patients achieved stable occlusion into adulthood, suggesting that orthodontic treatment is generally successful with appropriate follow-up and multidisciplinary management. Despite concerns about disease progression, adult dentition is typically preserved, and early intervention can be effective when closely monitored.

Background: Administering local anesthesia to the zygomaticotemporal nerve (ZTN) involves a deep insertion 1.5 cm lateral to the lateral canthus of the zygomatic bone, which may cause substantial pain. Use of a superficially located ZTN can cause less pain and fewer complications during injection. This study was performed to compare the conventional anesthesia method with the novel injection method by comparing the anesthesia area and degree, pain intensity using the visual analog scale (VAS), and muscle morphologic anatomy through ultrasonography.

Methods: A split-face randomized study was conducted on 24 adult patients with no general medical conditions. The zygomaticotemporal fossa and nerve were marked, and their depths were calculated using ultrasonography. A total of 0.9 mL of the dental ample of 2% lidocaine mixed with epinephrine was injected using the conventional injection technique, and another 0.9 mL was injected using the novel injection technique. VAS scores, skin temperature, anesthesia area, and the efficacy of block anesthesia on the related fibers (cold, pressure, and pain) were assessed.

Results: Nineteen women and 5 men (average age, 29.3 ± 3.7 years) were enrolled in this study. The average VAS scores for the novel injection technique (2.4 ±1.1) were significantly lower than those for the conventional method (3.7 ± 1.1) ( P < 0.01). Touch sensation and skin temperature showed statistically significant differences between the injection groups ( P < 0.05).

Conclusions: The novel technique for superficially located ZTN injection results in a significantly lower pain level during injection and similar effects compared with the conventional technique. This novel technique can be considered for aesthetic procedures requiring anesthesia in the temporal area.